vitality, 54,55 excellent oral hygiene and participation
in a structured recall system for monitoring and
controlling oral hygiene measures is a prerequisite
for successful long term results.
• Indication: large cavities needing cusp replacement.
• Preparation: defect oriented, create enough space
for at least 1.5 mm ceramic thickness; no classical
retention but guidance for insertion.
• Temporization: chairside using an impression taken
before preparation, filling it with a temporary resin-
based composite, placing it onto the prepared teeth
and removing after setting. Temporaries should
be luted with a eugenol-free material although the
influence of eugenol on the final curing of luting
composites is subject to discussion. In any case,
more important is the careful removal of temporary
cementation materials from the cavity prior to luting 56
using e.g. air polishing with glycin; calcium carbonate
air polishing generally caused significantly reduced
dentin bond strengths. 57
• Lab work can be performed in the dental office or
in the dental laboratory
• Try in of the restoration and careful adjustment
of approximal and occlusal surfaces avoiding high
pressure (heat), which may lead to ceramic fractures
or to crack initiation; try in paste can be used to check
for esthetics but must be carefully removed prior to
bonding.
• For certain materials like lithium disilicate ceramic
for CAD/CAM chairside application, further lab
work (final painting, glazing, improving strength) is
necessary.
• Pretreatment of the ceramic: Etching of the ceramic
(silicate glass ceramic), silanization (see Table 4)
• Self-adhesive luting materials: ceramic pretreat-
ment, additional selective enamel etching
• Luting composites with E&R adhesives: Separate
curing of the adhesive improves bond strength. 58
• Luting composites with universal adhesives: E&R
is possible with all products; SE (with and without
selective enamel etching) with certain products (see
manufacturer information)
• light curing: e.g. 40 seconds/800 mW/cm 2 on three
sides; be careful with high power light curing units (>
3000 mW/cm 2 ).
• Rough surfaces are abrasive to opposing enamel
and reveal lower resistance to crack propagation, 18,29
polishing using e.g. silica, silicon carbide or diamond
impregnated rubber polisher. 18
• Ceramics and luting materials differ between
manufacturers: it is essential that the specific
recommendation of each manufacturer provided for
the specific materials are followed meticulously.
Author Contributions
GS has drafted the manuscript. MF has added
relevant information and a number of figures.
Acknowledgments
No conflict of interest exists for any of the authors
of the