Question: What is your favourite protocol/procedure on bonding protocols for lithium disilicate ceramic?
Some members asked me to open a discussion on bonding protocols for lithium disilicate ceramic. What is your favourite protocol/procedure?
Salvatore Sauro: The biaxial bending resistance of new generation lithium disilicate ceramic is affected by the concentration and time of application of hydrofluoric acid. The longer the application and concentration of hydrofluoric acid , the lower the material’s strength . http://www.scielo.cl/scielo.php?script=sci_arttext… (Spanish)
International journal of odontostomatology – Evaluación in Vitro del Efecto de la Concentración…
scielo.cl
Stefano Daniele: Etching with HF 9% according flyer istructions of prodoct- generally 15-30 sec- then silane solution and mild evaporation of sovent. Bonding over conditioned surface before cementation
Guido Picciocchi: Same 20 sec 1 bottle silane
Tito Faus Matoses: 5% Fluorhidric 20 sec
Guido Picciocchi: 20 sec 9%
Salvatore Sauro: for no-prep veneers, do you use dual-cure cements or composite?
Guido Picciocchi: Foto cement
Muthanna Ahmed: Light cured cement has more color stability than chemical cure, especially in thin veneers.
Tito Faus Matoses: photopol resin cements
Salvatore Sauro: Variolink-like cements?
Tito Faus Matoses: Calibra Dentsply or Relyx Veneer 3M
Salvatore Sauro: I see……………..and you have never had problems with such a dual-cure cements; haven’t you?
Tito Faus Matoses: These two are photopol . With Calibra you have the option of transfor it into dual
Salvatore Sauro: Thanks Tito Faus Matoses!!!1
Tito Faus Matoses: Love this group!!
Salvatore Sauro: After HF etching do you place the ceramic in ultrasonic bath for decontamination?
Stefano Daniele: Yes, to remove salt of lithium disicate that is produced during etch HF. Clinically this salt appear milk white
Salvatore Sauro: Stefano Daniele 
Guido Picciocchi: H3PO2 2 min barghi 2007
Tito Faus Matoses: H3PO2 also
Salvatore Sauro: Hypophosphorous acid
Tito Faus Matoses: Phosphoic Acid 37%
Salvatore Sauro: Tito Faus Matoses I see, orthophosphoric acid 37%
Tito Faus Matoses: That ‘s it!! 
Salvatore Sauro:
Jason Smithson: Never
Salvatore Sauro: Jason Smithson what is your protocol? Can you please teach us your method? Many thanks!!
John Comisi: This is the protocol for resin cementation, per Dr. Byung Suh, Bisco Dental Company. This is how he recommends it should be done.
Stefano Daniele: I think that veneers are very very thin….there’s not impedence of light diffusion. I think that there’ not a rationale to use a dual resin composite…. The light pass away very easy
Salvatore Sauro: I like that!!!
Thiago Stape: I am not sure if something new has been published recently regarding this topic, but light cure resin cements should be the first choice. One of the reasons is that the tertiary amine component in dual core cements oxidezes much faster than in ligh…See more
Zvonimir Kunosic: <2-3mm= composite at 55celsius, >2-3mm=DC
Walter Zenobi: Thanks Salvatore Sauro
Walter Zenobi: relyx ultimate 3M?????
Zohaib Akram: Currently working on a systematic review on lithium disilicate restorations Sir Sauro
Salvatore Sauro: Please keep us informed about that. I am sure we will learn all very much from that. Thanks!!!
Zohaib Akram: Sure will do Dr Sauro
Guido Picciocchi: Congratulation for the quality of the post Salvatore Sauro finally not show but something useful
Salvatore Sauro: Guido Picciocchi,I understand that sometimes discussion on pure research can be boring for some clinicians ……………but in this group, we are trying our best to join research data to clinic observations. I hope you are enjoying this group. Just let me say my feeling: the real show off and auto-celebration about personal dentistry skills can be found quite easily anywhere on internet. Hugs Guido.
Salvatore Sauro: Is there anyone here who does perform any etching in such a situation?…………for instance, the veeners come from the lab alredy slightly sand blaseted, and than one just apply silane?
Tito Faus Matoses: I don’t remember the author but in P Magne’s book you can read that you can reach better surface if after laboratory sandblasting you etch them
Zvonimir Kunosic: Actually, according to Magne, sandblasting may weak silicate ceramics.
Tito Faus Matoses: that’s true. He was talking about feldspathic not silicates
Karol Babiński: I always sandblast things myself. They may get contaminated after being sandblasted in the lab. This way it takes only a few seconds longer but I’m sure IT IS sandblasted and clear.
Salvatore Sauro: And do you etch after sandblasting?
Karol Babiński: I treat sandblasting just as a cleaning option. I etch also.
Salvatore Sauro: Karol Babiński thanks a lot. Thanks Tito Faus Matoses I have really learnt a lot today
Zdravko Dimitrov: Why would you sandblast etchable ceramic?
Stefano Daniele: Of course Zdravko Dimitrov. why sandblast etchable vetro ceramic?
Salvatore Sauro: Zdravko Dimitrov, what is your protocol? Can you please teach us your method? Many thanks!!
Zdravko Dimitrov: Mine is quite standart and have been mentioned above.I dont use ultrasonic bath as it takes time,rubbing with H3Po4.2 bottle silane
Zdravko Dimitrov: I never sandblast ceramic except if I need to clean the cement of decemented veneer/crown which has happened occasionally.I sandblast only zirkonia
Paulo Monteiro: Feldspatic and lithium disilicate ceramic should never be sandblasted. This procedure can creat internal cracks in the ceramic (also with small particles like 27 or 30 micros).
Andrea Fabianelli: Sandblasting weaks…
Zdravko Dimitrov: The most interesting strategy for preparation of ceramic veneers Ive seen is by Nasser Barghi.Not because of materials or sequence cause they are the same(HF ,clean residue with H3po3 or ultrasonic bath with distilled water/acetone/alcohol,2 bottle silane) but all this is done before try in.He claims as silane is highly hydrophobic they cannot get contaminated during try in.Sadly or not Ive never tried it.
Salvatore Sauro: Thanks a lot dear Zdravko Dimitrov
Fabian Murillo: HF acid for 20 seconds (5 or 10%), ultrasonic cleaning, silane active application for 1 min, air to evaporate the solvent (just in case), a thin adhesive layer (preferably the “bond” from 3 steps systems), air and proceed with cementation process.
Salvatore Sauro: I like it!!! Zenobi Walter
Salvatore Sauro: Encarna Piquer Mañó esta discusión puede ser importante para tu proyecto de tesis doctoral.
Andrea Fabianelli: Just to add my point of view…sandblasting can be done in lab just to clean the manufact ( low pressure and soft particles. In office I etch with HF acid (5 or 9% seem not relevant) for 20 seconds. I don t use ultrasonic bath or fosforic acid cleaning but rinse for 30 seconds (literature supports me). Air drying, thin layer of 2 botte silane ( more stable silane), hot air drying ( literature supports this) and finally bonding not to be cured till the placement of the manufact. Don t place the silanated manufact on stone model. That s the way I handle the game 
Jason Smithson: me give or take same
Jason Smithson: I do 5-10 a day for 10 years…no debond ever at ceramic interface….2 debonds at dentin
Jason Smithson: I place adhesive component of optibond FL prior to luting cement…usually heated composite
Rodrigo Cavaco: Sandblasting or glass beads?
Salvatore Sauro: Thank you all so much!!!!
Andrea Fabianelli: I prefer very precise manufacts and resin cements…
Umer Daood: Is there a recommendation of placing the restoration in water for ultrasonication after etching of the lithium disilicate ceramic?
Albert Verd Bertran: HF 5% 20 seconds or HF 9,6% 10 seconds, air-water clean, after clean with ortofosforic acid brushing with a pellet and then ultrasonic wash 3-5 minutes with alcohol 96% (I allways do this two cleanings when I treat feldesphatic veneers, in lithium disilicate only with ultrasonic wash is enough). Apply Silane brushing 20 seconds and then 1 minute hot air drying. And the last part is put a thin layer of the bonding inside the restauration at the moment of adhesion.
Salvatore Sauro: Very nice protocol. Thanks!!
Muthanna Ahmed: With out curing the final bond?
Umer Daood: ^ Thank you Albert Verd Bertran
Albert Verd Bertran: I’m not absolutly agree about the use Of sandblasting in ceramics. I’m only use it ig I need to clean the inside of the restauration because of different contaminations
Albert Verd Bertran: Umer Daood I allways look the inside of the restoration to asure that is all clean, if it isn’t I brush with ortophosforic acid too.
Umer Daood: Yes that is imperative to do. The adhesion process with the tooth substrate is impaired in case its not clean as you rightfully pointed out. Well done
Zvonimir Kunosic: Nice way to deal with lab. contaminats.My protocol is: 3x5sec of woooosh :)https://www.amazon.co.uk/Thane-Electric…/dp/B00J08H81M
Thane H2O SteamFX Steam FX Electric Portable Hand Held Kitchen Bathroom…
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Salvatore Sauro: I used to do that many many years ago when I was just a dental technician
Salvatore Sauro: Andrea Fabianelli may you help Domingos Brandão and me about this prolonged etching time in di-silicate ceramics?
Sergio Hernández: You could consider The article by Dellabona about The resistance reduction when extended etching time is performed.
Salvatore Sauro: Thanks a lot Sergio. That is way I said that prolonged period of etching may not be necessary
Sergio Hernández: I can share this later
Salvatore Sauro: please do it when you can. Thanks!!!!
Andrea Fabianelli: Are u sure that you have to etch with HF for 60? Sounds strange. Anyway almost 99% of references suggests 20 seconds for lithium disilicate and Clinic support this. As reported overetch ceramics weaks
Domingos Brandão: You are right! This is an article, about IPS system, and I think there is a mistake (printing error) between DiSi and Leucite. Misplaced numbers.
Andrea Fabianelli: Leucite glass ceramics go for 60 secs…
Domingos Brandão: Thanks!!!
Zvonimir Kunosic: Who knows better than manufacturer himself?
Sergio Hernández: http://www.scielo.br/pdf/bdj/v22n1/v22n01a08.pdfSalvatore Sauro, here you can find some aditional information
Salvatore Sauro: Nice image!!!
Sergio Hernández:
Salvatore Sauro: Sergio Hernández what about this?
Salvatore Sauro: Sergio Hernández what about this ? https://www.researchgate.net/…/264831256_Longevity_of…
Longevity of silicate ceramic restorations
researchgate.net
Salvatore Sauro: Muthanna Ahmed read this post completely
Giacomo Derchi: I like this about this topics: Influence of Etching Protocol and Silane Treatment with a Universal Adhesive on Lithium Disilicate Bond Strength.Kalavacharla VK, Lawson NC, Ramp LC, Burgess JO.Oper Dent. 2015 Jul-Aug;40(4):372-8. doi: 10.2341/14-116-L. Epub 2014 Dec 23.
Alessandro Vichi: We have just performed a test to verify the influence of time and concentration on Lithium Dislicate ( e.max CAD ) and Lithium Silicate Zr reinforced ( VITA Suprinity ) glass ceramics. The paper is now under review, even if it is available as part of a PhD thesis. The test is a microshear with fracture mode analysis and SEM observation. Very shortly, the results are that neither the concentration (5% and 9.6%) nor the timing (20,40,60, 120) have an influence on bond strength. There is a modest but statistically significant difference between the two materials, with Vita Suprinity higher than e.max CAD.
Salvatore Sauro: thanks for sharing Alex…………so, absed on this results, what would you propose us as a clinical/in vitro protocol to test?
Alessandro Vichi: You mean what I propose for clinical protocol or … further studies ?
Salvatore Sauro: what you propose for clinical protocol
Salvatore Sauro: …….but you can also share with us what about further studies. Thank you so much for sharing
Alessandro Vichi: As there is no difference in timing, I think the shortest is better, so 20″. Concentration seems not so important. It seems that there is not a reverse correlation between concentration and timing. Anyway, as the SEM images look different while microsh…See more
Salvatore Sauro: Alessandro Vichi, I personally thank you very much for your contribute. I hope you will keep sharing your great expertise with us. Thanks again!!!
Alessandro Vichi: My pleasure, Salvatore, if I can be of any help. And my compliments for the idea …
Salvatore Sauro:
Giacomo Derchi: I like so much the concept of Alessandro Vichi, the shortest time for lithium disilicate is the best, but at the same time in my opinion is the best lower concentration, I think with lithium dislocate we must be more delicate. Is only my opinion! Love this group! very huge person and very scientific person!
Giacomo Derchi: sorry for my english!
Salvatore Sauro: Thanks Giacomo Derchi for your contribute and for your comments; really useful. 
Alessandro Vichi: Our experimental data does not support the use of lower concentration, but, as I wrote, maybe the viscosity of the cement influenced the results. Anyway, our one is merely one single study … The reason why Companies suggest and sell 5% is probably based on other than better adhesion.
Giacomo Derchi: I know that the companies are be afraid about fracture with long time and hight concentrations , but that is their opinion! in literature you could find the opposite of everything , unfortunately !
Alessandro Vichi: The reason is not worries about fracture, the problem is the hazard category of the product…. For a Company selling wordwide a lower concentration is easier to register …
Salvatore Sauro: Absolutely agree with that. Most of the companies (not All) care about business rather than other issues
Alessandro Vichi: When a business-friend choose does not afftect the results, like in this case, it is not a problem….
Salvatore Sauro: this is also called maximisation of the cost-&-efficency
Andrea Fabianelli: But is the hazard between the two concentration relevant? Probably no. Other misleaded reason…? May be. In any case I don’t think, with the support of several articles, that there is any clinical difference between the 5 and 9 % HF concentrations…not about weakness, not about bond strenght, not hazard diversities..
Giacomo Derchi: Andrea do you think is more important over etching?
Andrea Fabianelli: I red that 20 secs is enough for LIDiSi and that 9 or 5 % doesn’t matter
Alessandro Vichi: The hazard is, in this case, meaningful as we etch out of the oral cavity. But the problem is registration. It’s a legal problem, I mean. If a Company has to register a product A, 10% concentration, hazard level 3, or a product B, 20% concentration, ha…See more