PANAVIA SA CEMENT and CLEARFIL CERAMIC PRIMER (1 yr)

Consultants’ Comments

• “There was little sensitivity experienced by my patients.”
• “This cement was easy to dispense and required no anesthetic at placement. It is a perfect system to have in my office.”
• “I have seen no marginal staining at one year on any of the restorations I cemented. That gives me confidence in the bond strength.”
• “Applying the ceramic primer was easy and it may ensure a better bond over the lifetime of the crown.”

Description

PANAVIA SA CEMENT is a self-etching, self-adhesive, dual-cured resin cement with fluoride release. It is based on the Panavia and CLEARFIL SE BOND adhesive technology and has a reported film thickness of approximately 20 microns. It is indicated for cementation of crowns and bridges made of metal or ceramic as well as inlays/onlays and metal and fiber posts. It is packaged in 4.6-ml syringes in Universal (A2) and White shades and is dispensed directly from an automix syringe or using a specially designed dispenser.

CLEARFIL CERAMIC PRIMER is a single-bottle silane/acidic adhesive monomer (MDP)-based coupling agent for use with indirect porcelain, ceramic, hybrid ceramic and composite restorations. It may also be used for intraoral porcelain or composite repairs. CLEARFIL CERAMIC PRIMER is reported to bond to any kind of dental ceramic, including feldspathic porcelain, zirconia, alumina, lithium disilicate and leucite-reinforced ceramics. Etching ceramics with hydrofluoric acid is not  necessary before using this product. A phosphoric acid etchant may be used to treat the intaglio surface of any restoration other than zirconia or alumina. Instructions recommend a single coat followed by air-drying. CLEARFIL CERAMIC PRIMER contains an ethanol-based solvent and requires refrigeration but should be brought to room temperature before use. This product combination received a 98% clinical rating.

The purpose of this study was to determine the long-term clinical performance of a self-adhesive resin cement when used with a ceramic primer for cementation of all-ceramic restorations. THE DENTAL ADVISOR evaluated performance at placement, six-months and one-year.

Clinical Evaluation Protocol

• A total of 272 restorations (approximately 50% zirconia and 50% lithium disilicate) were cemented with PANAVIA SA CEMENT and CLEARFIL CERAMIC PRIMER. Restorations included: 136 zirconia-based restorations, 128 lithium disilicate restorations, 6 leucite-reinforced restorations, and 2 ceramic-metal restorations.
• Restorations were placed on 237 posterior and 35 anterior teeth (Figure 1).
• One hundred ninety-six all-ceramic restorations, cemented with PANAVIA SA CEMENT and CLEARFIL CERAMIC PRIMER, were recalled at six-months and one-year.

Clinical Observations

Results at Placement

Handling of cement and ease of clean up of excess

PANAVIA SA CEMENT received an excellent rating for ease of removal of excess after placement (Figure 2).

Fit of restoration

All restorations cemented with PANAVIA SA CEMENT and CLEARFIL CERAMIC PRIMER had excellent marginal fit. The contacts and occlusion were ideal before cementation.

Shade match/esthetics

The optimal esthetics of the restorations was maintained after cementing the restorations with PANAVIA SA CEMENT.

Marginal integrity

The viscosity of the cement allowed passive cementation of the restorations resulting in preservation of the ideal marginal fit of the restorations.

Initial sensitivity

The majority of the teeth exhibited no sensitivity after cementation of the restorations.

Notes on CLEARFIL CERAMIC PRIMER
• CLEARFIL CERAMIC PRIMER was applied to the internal surface of the lithium disilicate and leucite-reinforced restorations.
• Metal primers were applied to the internal surface of ceramic-metal restorations.
• Zirconia restorations were not primed.
• CLEARFIL CERAMIC PRIMER was easy to apply.
• CLEARFIL CERAMIC PRIMER thoroughly wet the internal surface of restorations.

Results at Six Months

Bonding

One of the restorations debonded at six months.
 

Lack of sensitivity

Few patients reported any sensitivity.
 

Resistance to marginal staining

No marginal staining was reported at six months.
 

Resistance to fracture/chipping

No fracture or chipping was noted.

Esthetics

The shade of PANAVIA SA CEMENT blended well with the restoration at placement. No shade shift was noted at six months (Figure 3).

Results at One Year
 

Bonding

Four restorations debonded at one year and required recementation.

Lack of sensitivity

Very few patients reported sensitivity. A small number of patients experienced mild sensitivity lasting 2-4 weeks. Two crowns had to be removed as a result of prolonged significant sensitivity.

Resistance to marginal staining

No marginal staining was observed at 1 year. One restoration had to be remade due to poor marginal fit.

Resistance to fracture/chipping

One restoration fractured at one year and had to be removed and remade.

Esthetics

The shade of PANAVIA SA CEMENT blended well with the restoration at placement. No shade shift was noted at one year (Figure 3).

Summary

One hundred ninety-six all-ceramic restorations, cemented with PANAVIA SA CEMENT and CLEARFIL CERAMIC PRIMER, were recalled at six-months and one-year. All received excellent ratings for esthetics, resistance to marginal staining, lack of sensitivity, and resistance to fracture/chipping at both six months and one year.