The complex process of seating and cementing a restoration can be broken down into one simplified, easy-to-follow decision tree. Optimal clinical outcomes are a result of careful planning and foolproof systems that simultaneously rely on the highest quality materials.

It truly is a form of ‘navigation’ to make decisions when bonding glass ceramic and lithium disilicate. Our choices rely on a familiarity with the six main variables of a cementation and bonding decision tree:

  1. Prep Design
  2. Type of Restoration
  3. Partial or Full Coverage
  4. Restorative Material
  5. Amount of Mechanical Retention
  6. Esthetic Properties of Desired Cement

Each cumulative part of the decision tree directs the clinician toward ideal materials and techniques. The ultimate goal, of course, is improved success rates and patient satisfaction. In this blog, I’ll focus on the main variables, which forms the foundation for a reliable decision making procedure.

Preparation Design, Type of Restoration, and Coverage

The first phase in a decision tree is preparation design. For example, if we are dealing with veneers or inlays and onlays, we should recognize that these will have less mechanical retention. Because of this, we need to take steps to bond appropriately.

Adhesive bonding is used with veneers to create a secure bond between the restoration and the tooth. We also must take into account esthetics and color stability of the resin we decide on. A great option would be to use a light-cure resin bonding system like Variolink Esthetic LC.

If the posterior restoration case in question involves inlays, onlays, and crowns, we must assess what dual-cure material would be best for adhesive bonding. There are two key qualities that will largely influence material selection: handling properties and need for long-term color stability.

A product that combines both easy cleanup and stablecolor, such as Variolink Esthetic DC is a great choice. If color stability is less critical than initial bond strength, a material like Multilink Automix might be preferred.

Hybrid Techniques & Restorative Materials

When trying in the ceramic after pre-treatment, the restoration has to be cleaned using a product like Ivoclean and then conditioned properly. The restoration is now ready to be primed.  Monobond Plus is a great restorative primer and can be used on all types of restorative materials.  Only at this point is the restoration ready. We can now shift our focus to dealing with the tooth.

As is shown in this blog, each new consideration brings up questions about how to proceed and what materials to utilize. This way, the steps are less overwhelming and present a more methodical, streamlined approach. 

For more information on restoration decision trees, read Dr. Brady’s article ‘Navigating bonding decisions for glass ceramics and lithium disilicate’ in the November 2017 issue of Dental Economics.

Watch 5 Minutes to a Cure: Learn the different types of cementation and when to use which one.