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29 INNOSC Theranostics and Pharmacological Sciences, 2023, Vol. 6, No. 1 Sinha
applied adhesive cements have higher bond strength use certain precise methods for achieving proper
and low solubility compared to non-adhesive adaptation, as the adhesive cement use might not
cements [7,8]. However, sustaining scrupulous compensate for its poor fit.
isolation becomes crucial for the success of
restoration in the case of adhesive cements. 3. Surface treatment for the etchable ceramic
It is important for dental surgeons to understand restorations
these factors to decide on the appropriate Pretreatment of the ceramic interface improves
cementation process for ceramic restorations. This adhesion of cement and the restoration. This
review will focus on the adhesive cementation is achieved by techniques such as air abrasion,
process for ceramic restorations, its interaction
with different ceramic compositions, and sand blasting with aluminum oxide particles, or
appropriate recommendations for routine dental application of etchant. Studies have proven that
practice. among all the techniques, acid etching has yielded
maximum bond strength and ceramic composition
2. Cementation procedure has played not much significant role in it [8].
Etching results in formation of microporosities
The choice of cement depends on various factors that increase the surface area of the interface,
such as resistance form, ceramic composition, enhancing wettability of the cement. This aids
cavity preparation, and isolation technique used in micromechanical interlocking of cement at
during the cementation process [9,10]. Adhesive the ceramic interface and thus is a crucial step
cement forms a hybrid layer between the ceramic in the process of cementation. Different etch
and tooth interface. It binds micromechanically and patterns are formed in successful adhesion process
chemically with ceramic and the tooth structure [6]. depending on the adequate cleaning of internal
At the tooth interface, etching followed by surfaces of the ceramic restorations. The resultant
priming and bonding is done. Resin cement binds hexafluorosilicate formed after etching is rinsed off
with etched enamel and dentin, forming a hybrid with water spray [11]. This etched surface is then
layer resulting in resin tags. It was found that bond salinized. The bifunctional molecule of silanes
strength of ceramic-cement-tooth complex was chemically bonds with inorganic part of ceramic
higher than that of the individual bond strength and copolymerizes with the cement resin through
of cement and tooth or cement and ceramic organofunctional radical [12-15]. Efficacious action
interface [7]. Short and tapered preparations benefit of the silane depends mainly on the hydrolysis
from the cementation process using the adhesive by a weaker acid. The single-bottle system of the
techniques. This is due to the hybrid layer formed silane was pre-hydrolyzed and was found to have a
that helps in improving the mechanical retention of shorter shelf-life with reduced effectiveness over a
restoration [8]. period of time. Hence, the double-bottle forms are
Based on their ability to etch, these cements can mostly preferred [16].
be total etch/etch and wash type where etchant is
applied and rinsed off, or self-etch that does not 4. Composition of ceramic and its bond strength
require washing as the cement is incorporated at cement interface
with monomer and adhesive. However, self-
etch cements were found to have a weaker bond The durability and strength of the bond at cement and
strength to the enamel than that of the total etching ceramic interface depends on the mode of treatment
system [2,9]. Hence, total etching 3-step adhesive selected. This in turn is governed by microstructure
system has been considered the gold standard of the ceramic composition. Conventional ceramic
process. The bonded layer should be prevented has silica and potash feldspar and/or soda feldspar
from contamination as it jeopardizes the cement as their basic components. They are also rich in
adhesion to tooth structure. This requires good glass phase and have been found to have higher
isolation which sometimes becomes a challenge in strength of bonding to resin cement [11-13].
a normal dental setup [1]. In addition, the clinicians When the surface treatments commonly used
and dental surgeons must ensure that the technicians for the feldspathic ceramics are applied to the

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