d e n t a l m a t e r i a l s 2 6 ( 2 0 1 0 ) 426432

available at www.sciencedirect.com

journal homepage: www.intl.elsevierhealth.com/journals/dema

Effect of primer treatment on bonding of resin cements to

zirconia ceramic
Shuzo Kitayama a,b, , Toru Nikaido a , Rena Takahashi a , Lei Zhu a , Masaomi Ikeda c ,
Richard M. Foxton d , Alireza Sadr b , Junji Tagami a,b
a

Cariology and Operative Dentistry, Department of Restorative Science, Graduate School, Tokyo Medical and Dental University, 1-5-45
Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
b Global Center of Excellence (GCOE) Program, International Research Center for Molecular Science in Tooth and Bone Diseases at Tokyo
Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
c Faculty of Dentistry, School for Dental Technology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549,
Japan
d Department of Conservative Dentistry, Floor 25, Kings College London Dental Institute at Guys, Kings and St. Thomas Hospitals,
Kings College London, London Bridge, London SE1-9RT, UK

a r t i c l e

i n f o

a b s t r a c t

Article history:

Objectives. To evaluate and compare bond strengths of different primers and resin cements

Received 4 March 2008

to silica-based and zirconia ceramics.

Received in revised form 8 July 2009

Methods. Silica-based and zirconia ceramic specimens were ground at with #600-grit SiC

Accepted 5 November 2009

paper. The ceramic surfaces were airborne-particle abraded and then divided into 11 groups
of seven each: untreated (control); and conditioned with one of the six primers in combination with a resin cement from the same manufacturer as follows: Bistite II/Tokuso Ceramic

Keywords:

Primer, Linkmax/GC Ceramic Primer, RelyX ARC/RelyX Ceramic Primer, Panavia F 2.0/Clearl

Zirconia ceramic

Ceramic Primer, and Resicem/Shofu Porcelain Primer and Resicem/AZ Primer. Stainless steel

Silica-based ceramic

rods were bonded to the ceramic surfaces using one of the ve resin cements. After 24-h

Resin cement

water storage, the tensile bond strengths were tested using a universal testing machine and

Primer

failure modes were examined.

Acidic monomer

Results. Conditioning with primers containing a silane coupling agent (all the primers except

Silane coupling agent

AZ Primer) signicantly enhanced bond strengths of resin cements to silica-based ceramic.

Tensile bond strength

For zirconia ceramic, Resicem/AZ Primer exhibited signicantly higher bond strength than

Failure mode

the other groups except Panavia F 2.0/Clearl Ceramic Primer. The predominant failure mode
of the groups conditioned with primers containing a phosphonic acid monomer (AZ Primer)
or a phosphate ester monomer (Clearl Ceramic Primer and Tokuso Ceramic Primer) was
cohesive failure in cements whereas that with the other primers was adhesive failure at the
zirconia surfaces.
Signicance. The use of primers containing a silane coupling agent improved resin bonding
to silica-based ceramic. On the other hand, the use of primers containing a phosphonic acid
monomer or a phosphate ester monomer improved resin bonding to zirconia ceramic.
2010 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Corresponding author at: Cariology and Operative Dentistry, Department of Restorative Science, Graduate School, Tokyo Medical and
Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan. Tel.: +81 3 5803 5483; fax: +81 3 5803 0195.
E-mail address: nuevo centro@yahoo.co.jp (S. Kitayama).
0109-5641/$ see front matter 2010 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.dental.2009.11.159

d e n t a l m a t e r i a l s 2 6 ( 2 0 1 0 ) 426432

1.

Introduction

The popularity of all-ceramic restorations has increased

in recent years due to superior esthetic appearance and
metal-free substructure of these materials [1]. All-ceramic
restorations can be fabricated in many systems using
different ceramic materials [1]. Computer-aided design
and manufacturing (CAD/CAM) has become an increasingly interesting alternative to the conventional casting
or pressing techniques. The clinical success of CAD/CAMfabricated densely sintered high-purity alumina ceramic
[2,3] relies on its high exural strength and fracture resistance compared with other ceramics, such as feldspathic,
leucite-reinforced, and glass-inltrated alumina ceramics
[24].
Yttria partially stabilized tetragonal zirconia polycrystalline (Y-TZP) ceramic, which is used as an orthopedic
material [5], exhibits high exural strength (>1000 MPa) [6]
and fracture toughness (>910 MPam1/2 ) [7]. Y-TZP ceramic has
been recently introduced to restorative dentistry, based on
these improved physical properties compared with aluminabased ceramics. CAD/CAM technologies have contributed
to the ease of working with this high crystalline material, allowing the fabrication of frameworks for complete
coverage all-ceramic crowns and xed partial dentures
[8,9].
Similar to any restorative material, successful cementation of Y-TZP ceramic is important for the clinical success of
the restoration [10,11]. Zirconia crowns and xed partial dentures have high fracture resistance and can be cemented using
conventional methods recommended by the manufacturers
[12]. However, resin bonding between a dental substrate and
a restoration is advocated for improved retention, marginal
adaptation, and inhibition of secondary caries [10,11].
Obtaining adhesion between resin cement and ceramic
surface requires surface pretreatment [13,14]. The use of a
silane coupling agent is recommended for glasses and porcelains in order to form a siloxane network with the silica in
the ceramic surface and improve the bond strength between
the resin cement and the ceramic [1]. However, this technique
may not improve the bond strength of zirconia and alumina
ceramics because such a chemical reaction is not possible
with those substrates [14,15]. Micromechanical interlocking
of the cement and the ceramic surface may be improved
on roughened restoration surfaces. High crystalline content
makes zirconia and alumina ceramics resistant to roughening by hydrouoric acid etching [1,16,17]. Therefore, in order
to increase the micromechanical interlocking, surface roughening by airborne-particle abrasion has been introduced as an
alternative method for these high-strength ceramics [1,18,19].
Blatz et al. [18] compared the bond strengths of different combinations of bonding/silane coupling agents and resin
cements to zirconia ceramic. The authors concluded that conditioning with a bonding/silane agent, containing a phosphate
ester monomer, MDP (10-methacryloyloxydecyl dihydrogen
phosphate), yielded superior resin bonds to zirconia surface
airborne-particle abraded with Al2 O3 particles.
A new primer (AZ Primer, Shofu, Kyoto, Japan)
containing a phosphonic acid monomer, 6-MHPA (6-

427

methacryloxyhexylphosphonoacetate), has been marketed

for bonding to alumina and zirconia ceramics; however, no
information has been reported in the literature regarding the
adhesiveness of this primer to zirconia.
In vitro investigations are indispensable to indentify superior materials before their clinical evaluation, especially for
comparative studies of primer/cement combinations. The
purpose of this study was to examine the effect of primer
treatment on tensile bond strengths of ve resin cements to
silica-based and zirconia ceramics. The null hypotheses proposed were: (i) the use of a primer did not improve the resin
cement bond to silica-based ceramic, and (ii) the use of a
primer did not improve the cement bond to zirconia ceramic.

2.

Materials and methods

2.1.

Materials used in the study

The ceramic materials used in the present study are shown

in Table 1. Seventy-seven silica-based ceramic specimens
(GN-1 Ceramic Block; GC, Tokyo, Japan) were obtained from
the manufacturer. The dimensions of these specimens were
13 mm 17 mm 21 mm. Also, 77 pre-sintered Y-TZP ceramic
specimens were milled from ingots (Cercon Base; Degudent,
Hanau, Germany) and sintered according to the instructions
in the relevant equipment of the supplier (Cercon Heat; Degudent). The cylindrical specimens were approximately 15 mm
in diameter and 2 mm in thickness.
The ve resin cements and the six primers used for bonding ceramics are listed in Table 2. Each resin cement was
used in conjunction with the primer from the same manufacturer; Bistite II/Tokuso Ceramic Primer (BII/TCP) (Tokuyama
Dental, Tokyo, Japan), Linkmax/GC Ceramic Primer (LM/GCP)
(GC), RelyX ARC/RelyX Ceramic Primer (RX/RCP) (3M ESPE, St.
Paul, MN, USA), Panavia F 2.0/Clearl Ceramic Primer (PF/CCP)
(Kuraray Medical, Tokyo, Japan), and Resicem/Shofu Porcelain
Primer (RS/SPP) or AZ Primer (RS/AZP) (Shofu).
All the above mentioned primers are aimed for the use in
conditioning ceramics before bonding. Except for AZ Primer,
which contains the phosphonic acid monomer 6-MHPA, the
primers listed contain a silane coupling agent. Clearl Ceramic
Primer contains the phosphate ester monomer MDP and
Tokuso Ceramic Primer also contains a phosphate ester
monomer.

2.2.

Specimen preparation and tensile bond test

The ceramic surfaces were ground at up to #600-grit silicon

carbide paper in a polishing machine (Ecomet 4; Buehler, Lake
Bluff, IL, USA) at 200 rpm, until the surface nish appeared
consistent under a light microscope (Olympus OCS 912042;
Olympus, Tokyo, Japan) at 10 magnication. The uniform
surface was then airborne-particle abraded with 70 m Al2 O3
particles (Hi Aluminas; Shofu) at 0.5 MPa for 5 s at a distance
of 10 mm. Thereafter, all the specimens were ultrasonically
cleaned in distilled water [20,21] for 10 min and air-dried. A
piece of polyethylene tape with a circular hole 4.0 mm in
diameter was positioned on the surface of the specimen to
demarcate the area of bonding. Subsequently, the silica-based

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d e n t a l m a t e r i a l s 2 6 ( 2 0 1 0 ) 426432

Table 1 Ceramic materials used in this study.

Trade name

Batch no.

GN-1 Ceramic Block

Cercon Base

0507121
18001459

Composition
Leucite glass-ceramics
Zirconium dioxide: 92 wt%
Yttrium trioxide: 5.0 wt%
Hafnium dioxide: <2.0 wt%

and zirconia ceramic specimens were divided into 11 groups

of seven each, ve groups were left untreated as the control
(NO) and the others were each conditioned with one of the six
primers.
Stainless steel rods were then bonded to the specimens
in each group with the corresponding resin cement, and any
excess was carefully removed with a bristle brush applicator (Microbrush International, Grafton, WI, USA). The bonded
specimens were left at room temperature for 30 min [21]
and stored in water at 37 C for 24 h. Then the tensile bond
strengths were measured using a universal testing machine
(Autograph AGS-J; Shimadzu, Kyoto, Japan) at a crosshead
speed of 1 mm/min.
After debonding, the fractured interfaces of the specimens
were examined with a light microscope (Olympus OCS 912042)
at 40 magnication to determine the area percentage of each
debonding mode; adhesive failure at the ceramic surface or
cohesive failure in resin cement.

2.3.

Manufacturer
GC, Tokyo, Japan
Degudent, Hanau, Germany

Statistical analysis

The tensile bond strengths were analyzed by one-way analysis

of variance (ANOVA) to assess the effect of the combination of resin cement and primer. Tukeys HSD test was used
for multiple comparisons of the tensile bond strengths to
Cercon Base. Since Levenes test indicated signicant nonhomogeneity among the variances of tensile bond strengths
to GN-1 Ceramic Block, Dunnetts T3 test was used as post hoc
for this substrate. Statistical signicance for the above tests
was predetermined at a 95% condence level.

3.

Results

3.1.

Tensile bond strengths

The tensile bond results of cements to GN-1 Ceramic Block

and Cercon Base are summarized in Table 3. The statistical

Table 2 Resin cements and primers used in this study.

Material

Code

Batch no.

Bistite II

BII

001037

Tokuso Ceramic Primer

TCP

003037

Linkmax

LM

A-Paste: 0612052

A-Paste (catalyst): 0612052

GC Ceramic Primer

GCP

RelyX ARC

RX

A-Primer: 0608072
B-Primer: 0608072
FLGE

RelyX Ceramic Primer

Panavia F 2.0

RCP
PF

6XK
A-Paste: 0255AB
B-Paste: 0133AA

Clearl Ceramic Primer

CCP

0001BA

Resicem

RS

010701

Shofu Porcelain Primer

AZ Primer

SPP
AZP

010701
010701

Composition
Dimethacrylate, MAC-10,
silica-zirconia, initiator
Silane coupling agent, phosphate
ester monomer, alcohol
UDMA, methacrylated phosphoric
acid esters, silica ller,
uoro-almino-silicate glass,
initiators, pigment
UDMA, methacrylated phosphoric
acid esters, silica ller,
uoro-almino-silicate glass,
initiators, pigment
Silane coupling agent, ethanol
UDMA, MMA, organic acid, ethanol
Bis-GMA, TEGDMA, functionalized
DMA, silane-treated ceramic and
silica llers
A silane, ethanol, water
Methacrylate, MDP, quartz-glass,
microller, photoinitiator
Methacrylate, barium glass,
sodium uoride, chemical initiator
3-Trimethoxysilylpropyl
methacrylate, MDP, ethanol
UDMA, TEGDMA, HEMA, 4-AET,
uoroaluminosilicateglass,
initiator, others
-MPS, ethanol, others
6-MHPA, acetone, others

Manufacturer
Tokuyama Dental, Tokyo, Japan

GC, Tokyo, Japan

3M ESPE, St. Paul, MN, USA

Kuraray Medical, Tokyo, Japan

Shofu, Kyoto, Japan

MAC-10, 10-methacryloyloxydecamethylene malonic acid; UDMA, urethane dimethacrylate; MMA, methyl methacrylate; Bis-GMA,
bisphenol A diglycidyl ether dimethacrylate; TEGDMA, triethyleneglycol dimethacrylate; DMA, aliphatic dimethacrylate; MDP, 10methacryloyloxydecyl dihydrogen phosphate; HEMA, 2-hydroxyethyl methacrylate; 4-AET, 4-acryloxyethyltrimellitic acid; -MPS, methacryloxypropyltrimethoxysilane; 6-MHPA, 6-methacryloxyhexylphosphonoacetate.

429

d e n t a l m a t e r i a l s 2 6 ( 2 0 1 0 ) 426432

Table 3 Tensile bond strengths to GN-1 Ceramic Block and Cercon Base (MPa).
Resin cement

Treatment

GN-1 Ceramic Block

Cercon Base

Bistite II

NO
Tokuso Ceramic Primer

7.7 (1.1)
19.5 (3.8)

9.9 (2.0)
14.8 (2.1)

Linkmax

NO
GC Ceramic Primer

15.9 (2.8)
23.2 (2.4)

9.5 (1.4)
15.1 (3.0)

RelyX ARC

NO
RelyX Ceramic Primer

7.8 (1.1)
13.7 (2.4)

7.1 (2.2)
14.0 (1.6)

Panavia F 2.0

NO
Clearl Ceramic Primer

11.5 (2.3)
19.5 (4.0)

10.9 (2.5)
19.1 (2.9)

Resicem

NO
Shofu Porcelain Primer
AZ Primer

7.9 (2.2)
21.1 (2.9)
9.1 (1.8)

9.8 (1.4)
15.6 (2.7)
22.3 (4.6)

n = 7, all values are mean (SD).

Table 4 Summary of the statistical analysis of the bond strengths to GN-1 Ceramic Block using ANOVA supplemented
with Dunnetts T3 test.
Cement

Treatment

Cement
Bistite II
NO

TCP

Linkmax
NO

GCP

RelyX ARC
NO

RCP

Panavia F 2.0
NO

CCP

Resicem
NO

Bistite II

NO
TCP
NO
GCP

Linkmax

NO
RCP

n.s.

RelyX ARC

n.s.

n.s.

Panavia F
2.0

NO
CCP

n.s.

n.s.

n.s.
n.s.

n.s.

NO
SPP
AZP

n.s.

n.s.

n.s.

Resicem

n.s.

n.s.

n.s.

n.s.

n.s.

n.s.

n.s.

n.s.

n.s.

SPP

AZP

n.s.
n.s.

n.s.
n.s.

n.s.: no signicant differences.

p < 0.05.

Table 5 Summary of the statistical analysis of the bond strengths to Cercon Base using ANOVA supplemented with
Tukeys HSD test.
Cement

Treatment

Cement
Bistite II
NO

TCP

Linkmax
NO

GCP

Bistite II

NO
TCP
NO
GCP

n.s.

Linkmax

n.s.

NO
RCP

n.s.
n.s.

n.s.
n.s.

RelyX ARC
Panavia F
2.0

NO
CCP

n.s.

n.s.
n.s.

n.s.

n.s.
n.s.

Resicem

NO
SPP
AZP

n.s.: no signicant differences.

p < 0.05.

RelyX ARC
NO

RCP

Panavia F 2.0
NO

CCP

Resicem
NO

SPP

n.s.

n.s.

n.s.

n.s.

n.s.

n.s.
n.s.

n.s.

n.s.

n.s.

n.s.

n.s.

n.s.
n.s.

*
*

AZP

430

d e n t a l m a t e r i a l s 2 6 ( 2 0 1 0 ) 426432

Table 6 Fracture mode of GN-1 Ceramic Block and Cercon Base (%). Showing the percentage distributions of adhesive
failures (A) and cohesive failures in cements (C-C).
Resin cement

Treatment

GN-1 Ceramic Block

Cercon Base

C-C

C-C

Bistite II

NO
Tokuso Ceramic Primer

100
0

0
100

81.42
4.28

18.58
95.72

Linkmax

NO
GC Ceramic Primer

100
0

0
100

100
94.28

0
5.72

RelyX ARC

NO
RelyX Ceramic Primer

100
95.7

100
100

0
0

Panavia F 2.0

NO
Clearl Ceramic Primer

100
0

Resicem

NO
Shofu Porcelain Primer
AZ Primer

100
22.86
91.43

signicance of difference in bond strengths between different

cements to each of the substrate, GN-1 Ceramic Block and Cercon Base, are shown in Tables 4 and 5, respectively. One-way
ANOVA revealed that the combination of resin cement and
primer had signicant effect on the tensile bond strengths
to both GN-1 Ceramic Block and Cercon Base (p < 0.001 for
both).
For GN-1 Ceramic Block, conditioning with each primer
signicantly enhanced the bond strength compared to the
control groups, except AZ Primer. LM/GCP provided the highest
bond strength; however, there were no signicant differences
between LM/GCP and RS/SPP, LM/GCP and PF/CCP, and LM/GCP
and BII/TCP. There was no signicant difference between
RS/NO and RS/AZP, therefore effectiveness of AZ Primer in
bonding to silica-based ceramic could not be conrmed.
For Cercon Base, there were no signicant differences in
tensile bond strengths among the control groups. Conditioning with each primer signicantly enhanced the bond
strengths compared to the control groups. RS/AZP showed the
highest and signicantly higher bond strength than the other
groups, except PF/CCP. There was no signicant difference in
the bond strengths between RS/AZP and PF/CCP.

3.2.

Fracture mode

Table 6 shows the fracture mode results for GN-1 Ceramic

Block and Cercon Base. Fracture occurred either at the interface between the ceramic surface and the cements (adhesive
failure) or within the cements (cohesive failure in cement) for
both the silica-based and zirconia ceramics.
For GN-1 Ceramic Block, the control groups showed only
adhesive failure. On the other hand, BII/TCP, LM/GCP, PF/CCP
and RS/SPP showed completely or mostly cohesive failures in
cements, whereas RX/RCP and RS/AZP showed mostly adhesive failures.
For Cercon Base, the control groups showed completely or
mostly adhesive failures except PF/NO, which showed mostly
cohesive failure in cement. Moreover, BII/TCP, PF/CCP and
RS/AZP showed mostly cohesive failures in cement, whereas
LM/GCP, RX/RCP and RS/SPP showed completely or mostly
adhesive failures.

0
4.3
0
100

4.

0
77.14
8.57

5.71
2.85

94.29
97.15

100
85.71
2.85

0
14.29
97.15

Discussion

The ceramic surfaces were airborne-particle abraded in the

present study. Airborne-particle abrasion with Al2 O3 has been
suggested as the preferred surface treatment method for
high-strength ceramic materials such as alumina and zirconia ceramics [18,19,22]. Airborne-particle abrasion produces a
roughening and forms irregularities on the substrate surface
[17], which will promote the micromechanical interlocking of
resin. This surface treatment may increase the surface area
for bonding, surface energy and wettability [18], thus allowing
the polymer (resin composite) to ow into the surface [23].
The bond between silica-based ceramics and resin cements
can be established with application of a silane coupling
agent [1,24]. Silane molecules react with water to form
three hydroxy-silyl groups (SiOH) from the corresponding
methoxy-silyl groups (SiOCH3 ) [24]. The silanol groups then
react further to form a siloxane (SiOSiO) network with
the silica deposited on the silica-based ceramics [24]. The
methacryloyl groups of the silane molecules react with the
methacryloyl groups of adhesive resins in a free radical polymerization process [24]. In summary, a chemical bond is
formed between the silane coupling agent and silica layer on
the ceramic surface or the resin cement.
The present study demonstrated that conditioning with
primers containing a silane coupling agent signicantly
enhanced the bond strengths of resin cements to silicabased ceramic, which was in accordance with previous
studies [20,25]. Failure mode analysis revealed that the
groups conditioned with primers containing a silane coupling
agent showed completely or dominantly cohesive failures
in cements, except for RelyX ARC/RelyX Ceramic Primer.
Interestingly RX/RCP also showed the lowest nominal bond
strength results among the silane-treated silica-based groups.
On the other hand, there was no signicant difference in
bond strength between Resicem/No-primer and Resicem/AZ
Primer, meaning that AZ Primer failed to improve the bond
strength of resin to a silica-based ceramic. In this regard, the
failure mode of Resicem/AZ Primer was also mostly adhesive
failure. These results could be justied by the absence of a
silane coupling agent in AZ Primer.

d e n t a l m a t e r i a l s 2 6 ( 2 0 1 0 ) 426432

Regarding the bond strengths to zirconia ceramic in the

control groups, no signicant differences were found among
the resin cements tested. Failure mode analysis, however,
revealed that the control groups showed mostly adhesive failures except for Panavia F 2.0, which showed mostly cohesive
failures in the cement. Since Panavia F 2.0 itself contains the
phosphate ester monomer MDP, some reactions may have
occurred between the adhesive monomer and zirconium oxide
layer coated on the zirconia surface [15,19,21], similar to the
chemical effects reported on the bond of MDP to metal oxides,
such as chromium, nickel and aluminum [26,27]. It should
be noted that the predominant failure mode of Bistite II and
Resicem, which contain the carboxylic acid monomers, MAC10 and 4-AET, respectively, was adhesive failure at the zirconia
surface. These carboxylic acid monomers may not be effective
in creating a chemical bond with zirconia ceramic. Similarly,
Yoshida et al. reported that MDP may be more suitable for
reacting chemically with chromium than MAC-10 and 4-AET
[26].
When the surfaces of the zirconia ceramic were conditioned with each of the primers, the tensile bond strengths
signicantly improved compared to the control groups. This
may be due to a rewetting effect on airborne-particle abraded
surface [28]. Resicem/AZ Primer showed the highest bond
strength followed by Panavia F 2.0/Clearl Ceramic Primer.
Additionally, the groups conditioned with primers containing a phosphonic acid monomer (AZ Primer) or a phosphate
ester monomer (Clearl Ceramic Primer and Tokuso Ceramic
Primer) showed mostly cohesive failures in cements, whereas
the groups conditioned with the other primers, not containing these monomers, showed completely adhesive failures.
AZ Primer and Clearl Ceramic Primer contain 6-MHPA and
MDP, respectively. The phosphonic acid monomer, 6-MHPA,
has demonstrated good bonding performance to metal oxide
on the metal surface such as NiCr alloy [29]. Previous studies have shown that the application of an MDP-containing
bonding/silane coupling agent mixture to zirconia ceramic
yielded superior shear bond strength [18,30]. 6-MHPA is also an
adhesive monomer with some structural similarities in acidic
hydrophilic moieties to MDP [21,29]. It is assumed that this
monomer would also show some form of chemical bonding to
zirconium oxide layer coated on the zirconia surface.
In the present study, the bond strengths were measured
after 24 h-water storage. It has been reported that conventional bonding agents and resin cements with silane coupling
agents without acidic monomers could not provide durable
bonds to zirconia ceramic [14,18,19]. Moreover, there is no data
available regarding the effect of 6-MHPA on the resin bond to
zirconia ceramic after severe aging conditions. Therefore, further studies need to be conducted to evaluate the durability
of the bond to the airborne-particle abraded zirconia surface
using the materials tested in the present study. Furthermore,
randomized clinical trials are needed to provide reliable recommendations for dental practitioners.

5.

Conclusions

Within the limitations of this study, the following conclusions

were drawn:

431

(1) The primers containing a silane coupling agent were

effective in improving the bonding of resin cements to
silica-based ceramic.
(2) The primers containing a phosphonic acid monomer or
a phosphate ester monomer, including 6-MHPA and MDP,
were effective in improving the bonding of resin cements
to zirconia ceramic. Without a primer, the resin cement
containing MDP was effective in bonding to zirconia
ceramic.

Acknowledgements
This work was supported by a grant for the Global Center of
Excellence (GCOE) Program, International Research Center for
Molecular Science in Tooth and Bone Diseases at Tokyo Medical and Dental University. The authors would like to thank
all named companies for providing the materials used in this
study.

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