Bonding Strength of Various Luting Agents between Zirconium Dioxide Crowns and Titanium Bonding Bases after Long-Term Artificial Chewing

The use of hybrid abutment crowns bonded extraorally to a titanium bonding base has aesthetic and biological benefits for the prosthetic rehabilitation of oral implants. The objective of this study was to evaluate the effects of luting agents between a zirconium dioxide crown and the titanium bonding base on crown/abutment retention and the subsequent durability of the prosthetic superstructure. Fifty-six implant abutment samples, all restored with a lower first premolar zirconium dioxide crown, were used and divided into seven groups (n = 8/group) according to the type of luting agent used: group 1, SpeedCEM Plus; group 2, Panavia SA Cement Universal; group 3, Panavia V5; group 4, RelyX Unicem 2 Automix; group 5, VITA ADIVA IA-Cem; group 6, Ketac CEM; and group 7, Hoffmann's Phosphate Cement. All specimens were subjected to thermomechanical loading (load of 49 N, 5 million chewing cycles and 54.825 thermocycles in water with temperatures of 5 degrees C and 55 degrees C). The surviving samples were exposed to a pull-off force until crown debonding from the bonding base. Overall, 55 samples survived the thermomechanical load. Group 2 showed the highest mean pull-off force value (762 N), whereas group 6 showed the lowest mean value (55 N). The differences between the seven groups were statistically significant (ANOVA, p < 0.001). The debonding failure pattern was mainly adhesive and was noticed predominantly at the zirconium dioxide-luting agent interface. Within the scope of the present investigation, it was shown that most of the luting agents are suitable for "cementation" of a zirconium dioxide crown onto a titanium base since the debonding forces are above a recommended value (159 N).