Acid etches bridges and its scope/certified fixed orthodontic courses by Indian dental academy

Seminar on

ACID – ETCHED BRIDGES AND ITS SCOPE

CONTENTS

1. Introduction

2. History

3. Review of literature

4. Design concepts in acid- etched resin bonded bridges.

5. Advantages and disadvantages

6. Indications and contraindications

7. Selection of abutments

8. Preparation of abutment
9.

Anterior teeth
Posterior teeth

Impression procedure

10.

Laboratory procedures

11.

The Enamel Etch and Resin Bond

12.

The Acid for Etching Enamel

13.

Alloy etching and bonding

14.

Etching of Various Alloys

15.

Alloys used for acid etched bridges

16.

Acids used for etching

2

17.

Electrolytic etching

18.

Bonding the restoration
-

Acid etching

-

Resin cements

19.

Longevity and scope

20.

Summary and conclusion

21.

References

3

INTRODUCTION
The development of a technique for the fabrication of fixed partial dentures,
involving little or no preparation of abutment teeth, has been perhaps the most important
single advance in the history of prosthetic dentistry. Although not suitable for many
cases where abutment teeth are badly broken down, the resin-bonded fixed prosthesis
provides a means for tooth replacement that has both short-term and long-term benefits.
The 1970s saw the expansion of the acid etch technique into unexplored areas of
clinical dentistry. The 1980s have seen further developments and improvements in the
technique of bonding fixed partial dentures. The techniques explored in the 1970s by
various investigators, leading up to the present status, where alloy frameworks are
electrolytically etched prior to bonding to etched enamel with unfilled and filled resin.
Undoubtedly, major changes in the present technique will be made in the years to come.
An understanding of all the techniques previously used is important, particularly since
these techniques are still viable alternatives to be considered when planning the
treatment of certain cases requiring temporary care.
Resin –retained FPD have had variable popularity since the technique of
splinting lower anteriors with perforated metal casting was described by Rochette in
1973. His alternative to conventional metal –ceramic FPD’s this kind of prosthesis
gained popularity which required minimal tooth removal of the abutment teeth that are
intact and caries free.
The primary goal of resin – retained FPD is replacement of missing teeth and
maximum conservation of tooth structure.
The development of acid etching of enamel to improve the retention of resin, first
described by Buonocore in 1955, has proven to be a means of attaching fixed partial
dentures to teeth by less destructive means. Ibsen first described the attachment of an
acrylic resin pontic to an unprepared tooth using a composite bonding resin. Others
since that time have utilized the technique, but it is probably best suited for use as a
long-term provisional restoration or intermediate replacement of a missing tooth.
The advent of electrolytic etching of metal to provide micromechanical retention for
metal adhesion to enamel has led to the broad application of such bridges.
HISTORY- DEVELOPMENT OF RBP
Two distinct branches in the development of bonded fixed partial dentures can be
traced. The first method utilizes materials readily available in most dental offices, and no

4

laboratory involvement is required. This is the technique using an acrylic resin denture
tooth, a composite resin crown, or the extracted tooth as a pontic. The second method
utilizes the laboratory manufacture of a cast metal framework with a porcelain or acrylic
resin pontic. Both methods have their own indications and contraindications and both
branches of the technique offer alternatives for dental practitioners willing to venture into
new and fertile areas.
1. Bonded pontics
Earliest resin – retained prosthesis were extracted natural teeth or acrylic teeth
used as pontics bonded to proximal and lingual surfaces of abutment teeth with
composite resins.
The use of an acrylic resin denture tooth as a pontic was first published in 1973,
although Ibsen in 1974 and Buonocore in 1975. Both Ibsen and Buonocore also
described the use of the extracted tooth as a pontic. Buonocore's technique involved
etching the adjacent enamel with 50% phosphoric acid (buffered with 7% zinc oxide) for
60 seconds prior to applying the ultra-violet light-curing unfilled and filled resins. In a
1978 publication,

Jordan described 86 cases of single and multiple-unit fixed partial

dentures followed for up to three years. The only major differences in Jordan's technique
are that autopolymerising resins were used instead of ultra-violet light-curing materials,
and Class III preparations were cut into the pontic crowns, rather than a lingual retentive
groove.
Simonsen in addition to describing cases using denture teeth and natural teeth
as pontics also described the use of composite resin pontics. A thorough description of
the technique with case reports was provided by Simonsen in 1978 and 1980.
In a 1979 clinical trial, Hallonsten reported on 49 cases of up to four years
duration. A success rate of approximately 50% was reported. Simonsen and Davila and
Gwinnett have also described use of the natural tooth as a pontic.
Sweeney and co-workers tested similar single-unit pontic attachments against
hose where a wire was incorporated within the composite resin for, one would expect
increased strength.
Lambert and co-workers showed that when testing acrylic resin maxillary lateral
incisors bonded with a ultra-violet polymerizing resin. The pontics and pontic-to-tooth
bonds withstood a force sufficient to suggest that the application of this technique to the
clinical practice of dentistry is warranted.

5

Disadvantages:


Composite resins were brittle



They required supporting wire or stainless steel mesh framework.



Their use is limited to short anterior spans.



Limited lifetime with debonding of resin and subsequent fracture.

Such restorations were used as short term replacements.
2. Cast perforated resin – retained FPD’s( Mechanical retention)
In 1973 Rochette introduced the concept of bonding metal to teeth using flared
perforations of metal casting to provide mechanical retention. He used this for
periodontal splinting but also included pontics in his design.
Howe and Denehy recognized that metal framework improved retention and
began using FPD’s with cast perforated metal retainers bonded to abutment teeth and
metal – ceramic pontics to replace anterior teeth. Their design included, extending the
metal framework onto the lingual surfaces with little or no tooth reduction. Patient
selection limited its use in mandibular teeth with open occlusal relationship. The
restorations were luted with heavily filled composites.
This concept was expanded to the replacement of posterior teeth by Livaditis.
Perforated retainers were used to increase resistance and retention. The castings were
extended interproximally into the edentulous areas and onto the occlusal surfaces with a
defined occlusogingival path of insertion by tooth modification which involved lowering of
proximal and lingual height of contour of enamel on abutment teeth. Survival rate upon
recall was up to 13 years. However they had following limitations:


Weakening of metal retainer by perforations with subsequent wear of the resin.



Limited adhesion of metal provided by perforations.
3. Etched cast resin – retained FPD’s ( Micromechanical retention MARYLAND
BRIDGE)
Based on the work of Tanaka et al on pitting corrosion for retaining acrylic resin

facings and metal studies of Dunn and Reisbick, Thompson and Livaditis at University of
Maryland developed a technique for electrolytic etching of Ni- Cr and Cr- Co alloys.
Etched cast retainers have definite advantages over cast perforated restorations
Retention is improved because resin to etched metal bond can be substantially
stronger than resin to etched enamel. The retainers can be thinner and still resist flexing.

6

The oral surface of the cast retainers is highly polished and resists plaque
accumulation
Their use led to first generation of resin cements with low film thickness which
permitted micromechanical bonding into the undercuts in metal casting created by
etching while providing adequate strength and allowing complete seating of cast
retainers.
4. Macroscopic Mechanical retention resin – retained FPD’s (VIRGINIA
BRIDGE)
As a result of concerns about etching base metal and desire to use alternative
alloys several methods were developed to provide visible macroscopic mechanical
undercuts on inner surface of FPD retainers. The first was developed at Commonwealth
University School of Dentistry known as Virginia Bridge. It involves the lost salt crystal
technique. On the cast the abutments wee coated with a model spray and lubricant is
then applied. Within outlines of the retainers specially sized crystals (150 – 250 Mm) are
sprinkled over the surface in a uniform monolayer leaving 0.5mm border without crystals
at the periphery of pattern.
Disadvantages


Adequate thickness of casting must be there to allow for undercut thickness.



No long term results reported



Permits use of any metal – ceramic alloy.

Advantages


Good bond strength to enamel.
An alternative technique was use of a cast mesh pattern on internal surface of

retainers given by Taleghani. Mesh made of Nylon was adapted to lingual and proximal
surfaces of abutments. The mesh was then covered with wax or resin done carefully to
prevent occluding mesh or wax or resin. It was invested and casted.
Disadvantage


Technique sensitive



Results in thick lingual casting.
5. Chemical Bonding Resin- Retained FPD’s ( ADHESION BRIDGES)
While etched castings were used for retention of resin – retained FPDs in 1980
and early 1990 are extensive research was underway in Japan to develop adhesive
systems for direct bonding of metal.

7

Maryland Bridge
With etched inner surface
for retention

Rochette Bridge
With metal perforations for
retention

First Date
of Publication

Contribution

Author

1955

Bonding to enamel

Buonocore

1962

Development of composite resin

Bowen

1973

First bonded cast alloy framework

Rochette

1976

Electrolytically etched dental alloy

Dunn and

Reisbick
1981

The etched metal bridge developed

McLaughlin

1982

Advanced etching techniques

McLaughlin

REVIEW OF LITERATURE

Williams V.D, Dremon D.G et al (1982) studied the effect of retainer design on
retention of filled resins to acid - etched FPD’s. They determined which retainer design
had the best retention capacity to enamel.


Rochette used 6 holes with sharp spatula in wax pattern 0.8mm in diameter.



Howe and Denehy used 1-1.5mm, 0.5mm in diameter.



Kuhlke and Drenon used 0.33- 0.5 thickness with holes drilled with

No.1/2

round bur.


Newman bonded orthodontic brackets using fine mesh screen.

They found that all retainer design had enough retention for anterior forces of occlusion.
Most retainer failure occurred at retainer - composite resin interface.

8

Love L.D and Britman J.B. (1985) evaluated a new method for etching base metal
alloys and the bond strength of ARC to etched alloys. Here the castings made of Ni- Cr
alloys were air abraded and then immersed in etchant solution containing 50% nitric
solution, 25% hydrochloric acid, and 25% methanol. The control group was etched with
10% sulphuric acid. However there was no significant difference in bond strength. The
only advantage was the etchant solution was easy to use.
Hill G.L., Zidan O., Gonez M. (1986) evaluated the tensile bond strength of three alloys
Ni-Cr, non Be Ni- Cr, and Co- Cr alloys after etching with a lab etching instrument. They
were divided into two groups i.e. over etched and under etched. It was concluded that
under etching had a negative effect than over etching. Over etching on non Be-Ni-Cr
alloys did not reduce the bond strength.
Livaditis G.J. (1986) described a method to chemically etching non – precious alloys to
create micromechanical retention. ASSURE – Etch a chemically etching solution was
heated to 70ºC and applied to surface of metal disc for different periods of time (30, 45,
60, 75 and90 mins). It was observed under SEM. This method used was simple to use
and inexpensive. It gave suitable bond strength when etched for 60 minutes.

Tanaka T. et al (1986) studied the effect of oxidation of alloys on the bond strength of
resin cements. Here two types of alloys Ni- Cr and Co – Cr alloys were used. Two
samples were air brushed with 50μm alumina powder whereas others oxidized with an
oxidizing agent. A solution of 0.3% sulfuric acid and 1% potassium per manganate forms
an oxide layer thus increasing the adherence of resin cements. It was shown that Ni- Cr
alloys developed superior bond strength after sandblasting and oxidation but an
equivalent strength was obtained with Co –Cr alloys by merely sandblasting and
ultrasonic washing.

Teleghani Leinfelder K.T. (1987) compared the use of mesh pattern and conventional
etching technique on the bond strength. Duralingual mesh pattern were attached to one
side of the disc. They were divided into three groups:


Chemically etching with cast screen mesh on surface.



Etching without cast screen mesh an surface



Cast screen mesh on un-etched alloys.

9

Ag- Pd alloys were etched with NaF and sodium nitrate
Base metal alloys were etched with 10% sulfuric acid.
It was concluded that cast mesh surface serve as an alternative to chemical or
electrolytic etching. The bond strength of base metal alloys with mesh screen was
42.4lbs, etching alone was 34.2lbs, etching with mesh 37lbs. this procedure was
advantageous for gold and palladium alloys which have no etchants available.
Layer B. Nicholls J.I. and Townsend (1988) used a mixture of 10% sulfuric acid and
methanol followed by 18% HCl cleaning.

Re G.J. et al (1988) compared three methods of etching metals for resin bonded
bridges. Ni- Cr alloys were air abraded with 50μm alumina MET- ETCH Gel, Electrolytic
etching with 10% sulfuric acid for 10 mins at 300mA and Silicoating were evaluated as
surface treatments. It was observed that silicoating with electrolytic etching gave
superior results. MET- Etch Gel produced lowest shear strength.
Kern M, Thompson V.P (1995) studied bonding to glass infiltrated alumina ceramicadhesive methods and their durability.
Inceram glass infiltrated alumina ceramic has 3-4 times greater flexural strength than
other ceramic or glass materials. Therefore can be used as a core material for RBFPD’s.
Etching silica based feldspatic or glass ceramics with hydrofluoric acid or ammonium
bifluoride creates sufficient resin bond – enhanced with a silane coating of etched
ceramics. Inceram can be etched with boiling sulfuric acid. Long term durable bond to
Inceram was achieved with combination of tribochemical silica coating and conventional
BIS- GMA composite resin or combination of sandblasting and composite resin modified
with phosphate monomer.

Shakal M.H, Pfeiffer P et al (1997) studied the effect of tooth preparation design on
bond strength of resin – bonded prosthesis. A pilot study
Here molar teeth were prepared in conventional form or with occlusal coverage and
opposing grooves and retainers were silicoated and bonded to etched enamel by bisglycerol methacrylate adhesive. Bond strength was determined after water storage and
thermocycling. They concluded that:

10



Metal surface area and design of tooth preparation had a substantial effect on
strength and durability of adhesive bonding joint.



Occlusal coverage improved resistance and retention form of adhesive FPD’s



Placement grooves or increasing bonding surface area improved both strength
and durability of bonding joints.



Combination of 180deg opposing grooves, channels with lingual wraparound and
occlusal coverage remarkably improved the strength and durability of bonding
joints.

DESIGN CONCEPTS
The guidelines for optimum design of resin-retained FPD’s have been empirically
derived. The underlying principle for these restorations has always been that it is
necessary to cover as much enamel surface as possible, as long as occlusion, esthetics,
or periodontal health are not compromised
General Principles of Design
The ideal design for an etched cast resin-bonded restoration involves creation of
a distinct path of insertion for the restoration by a sequence of modifications to the
enamel contours of the abutment teeth. When seated, the restoration should not be
displaced or rocked in any direction by occlusal forces. Displacement is prevented by
alloy engaging tooth structure. Stated in other terms, the framework mechanically
engages each of the abutment teeth. The bonding of the alloy to the tooth structure
allows the casting to be supported by the tooth structure. Bonding also prevents
displacement back along the path of insertion. Because displacement of the casting in all
directions other than back along the path of insertion is prevented by alloy engaging
tooth structure, the framework design limits the stresses placed on the luting agent and
the bond. Consequently, a well-designed framework and the resin bond between the
etched alloy and tooth structure are synergistic. We shall see that this is even carried to
the point that the occlusal rest in the posterior and the cingulum notch, sometimes used
in the anterior, are designed to allow the casting to mechanically engage the tooth and
prevent displacement of the framework in all directions other than incisally or occlusally.
Posterior design principles
Framework design and the necessary modifications to abutment teeth are most
easily described for posterior restorations. An idealized diagram for a three-unit, fixed
partial prosthesis and the modifications of the abutment teeth are shown below.

11

The following design elements should be included in any etched cast retainer:
1.

A distinct path of insertion must be created in an occlusogingival direction. This is

accomplished by parallel modification of first proximal, and then lingual, surfaces of the
abutment teeth. The height of contour is lowered to approximately 1 mm from the
gingival margin where possible, provided that such modification will not penetrate the
enamel. Thus, in some proximal areas the height of contour may only be lowered
sufficiently to provide occlusogingival width for the connector - generally a minimum of 2
mm as a result of the concave area from the coronal narrowing in a gingival direction.
2.

Proximal resistance form must be created. The alloy framework must extend

buccally beyond the distobuccal and mesiobuccal line angles of the respective
abutments. Thus, the framework cannot be displaced from the buccal toward the lingual.
This is another key element in creating a distinct path of insertion. If aesthetics are
compromised by the buccal extent of the alloy, then Judicious modification of

the

buccal enamel allows the buccoproximal line angle to be moved lingually. The alloy
only needs to extend just buccal to this line angle to establish the resistance form and it
is easily hidden with proper contour of the buccal porcelain. This proximal enamel
modification is distinctly different from that used for a removable partial denture where
guiding planes are the norm. Bonded retainers require the modified enamel to retain the
approximate original buccal to lingual curve of the proximal surface when viewed from
the occlusal. This proximal resistance form can also be created by the use of proximal
grooves or boxes when the buccal extent of the preparation might compromise
aesthetics by narrowing excessively the mesiodistal width of the tooth (e.g., mesial of
maxillary first premolar, where the tooth, when viewed from the buccal, narrows
dramatically). Proximal grooves must be prepared judiciously to avoid penetration of
enamel.
3.

Proximal

"wrap-around"

should

be obtained. The alloy framework should

be extended to engage the tooth structure at 180° or more of its circumference when
viewed from the occlusal. The framework should not extend to the point where it can
compromise the occlusal embrasure form between the abutment and an adjacent tooth.
The proximal wrap-around allows the casting to mechanically engage the abutment
tooth. This is ideal but is not always clinically possible. Correct design of the occlusal
rest can reduce the need for 180° wrap-around.
4.

Maximum bonding area is utilized on a given abutment without compromising

gingival health or aesthetics. This is obtained with the proximal and lingual modifications,

12

which lower the height of contour. The bonding area can be increased by extending the
framework toward the occlusal above the modified enamel, providing it does not interfere
with the occlusion.
The better the mechanical retention of the framework, the less critical is the
necessity to maximize the bonding area. Indeed, in anterior restorations with good
proximal wrap-around, the restoration is routinely kept 1.5-2.0 mm short of the incisal
edge to prevent graying of the translucent incisal edge.
5.

Some form of occlusal rest is required on each abutment of a posterior resin-

bonded restoration. The rest should be small but well defined and not a broad spoon
shape similar to classic removable partial denture occlusal rests. Usually a number 5 or
6 round bur is employed and the rest created is 1.5-2.0 mm in buccolingual direction,
1.5-2.0 mm in the mesio-distal direction, and 1 mm deep.
It is important that the occlusal rest follow the contour of the tooth structure going from
the marginal ridge toward the fossa. Thus, relative to the occlusal plane, the rest should
become deeper as it approaches the central fossa of the abutment tooth. Utilizing this
rest design, removal of the casting from the tooth requires that it be lifted. Alternatively, if
the tooth is to migrate out of the framework (due to lack of 180° proximal wrap-around) it
must first be displaced gingivally relative to the casting. Thus, the occlusal rest design
mechanically retains the tooth in the casting by functioning as a shallow pin.
The location of the rest is not critical and it can be placed anywhere along the marginal
ridge to remove it from an area of occlusal contact. When a distinct cusp of Carabelli is
present, the cusp can be modified to function as a rest. Note, however, that the alloy
framework is carried up to, and just over, the height of contour of the marginal ridge and
thus functions as a broad additional occlusal rest.
6.

Create knife-edge gingival margins on posterior abutment teeth. Enamel is

removed only to the extent that a knife-edge supragingival margin results. Thus, the
gingival contour of the restoration should

duplicate the enamel removed during

preparation. These fine margins are aided by the 0.3 mm minimum thickness commonly
employed for the lingual portion of the retainer. There is no attempt made to create a
chamfer margin at the gingival; this only removes enamel unnecessarily.

13

A definite path of insertion and 180º wrap-around design

Note the minimal preparation of molar and mesial rest added to
incorporate the mesial occlusal amalgam filling

Anterior Design Principles
The anterior design depends upon the same general principles for retention as
does the posterior retainer. The modifications made to the enamel of abutment teeth are
much more subtle than those used in the posterior region. Only minor recontouring of
enamel is necessary.
The retention is attained by preparing a distinct path of insertion. This path of
insertion is the result of three factors.
First the surfaces of abutment teeth are modified proximal to the edentulous space so
that the casting can be fabricated with proximal wrap-around. This is accomplished in
conjunction with lowering the height of contour on the abutment teeth to provide
sufficient depth (1.5-2.0 mm) for the connector. When viewed from an inciso-gingival
direction, the modification is small but distinct. The wrap-around is facilitated by the
divergent orientation of the proximal surfaces of anterior teeth caused by the curvature
of the dental arch. Modification interproximally has as its objective recontouring to move
the proximo-labial line angle toward the lingual. Alternatively, the proximolingual line
angle can be sharpened and, as a result of the divergence in the labial direction
between the proximal surfaces, a distinct path of insertion is created. The actual
preparation involves the intersection of two gently curving preparations. The
intersection line is the path of insertion. The cast framework need only extend labially a

14

minimal amount past this line of intersection. Consequently, when the casting is seated
along this incisogingival direction it cannot be displaced toward the lingual. The
relationship of the wrap-around of the framework to the porcelain can be seen in figure
below. The alloy is not visible because the wrap-around does not extend too far toward
the labial. The porcelain has some depth, and the composite resin used for bonding fills
in the interproximal, masking the presence of the alloy.
The subtlety of the tooth modification is difficult to illustrate. On many teeth,
simply by lowering the height of contour and retaining the original proximal contour (as
seen inciso-gingivally), this wrap- around can be achieved. The proximal wrap-around
allows the abutments to reciprocate one with the other for retention of the restoration.
Another retentive factor involves extension of the framework over the marginal
ridge not involved with the edentulous space as well as over the marginal ridge lingual to
the connector. This extension further defines the path of insertion and allows the
framework to mechanically engage the abutments.
The third and final factor in anterior framework design is the modification of each
abutment to create a distinct cingulum notch. This can be considered as a cingulum rest
specifically prepared so that the rest becomes deeper gingivally as the preparation
extends towards the labial (in cross section, a V shape). This notch functions in a role
similar to that of the occlusal rest design suggested previously. The cingulum notch
mechanically retains the tooth into the framework and reciprocates with the proximal
wrap-around to prevent the tooth from moving out of the framework.
The point might be well taken that any one of the above factors might by itself be
sufficient to protect the bonding. We try; however, to routinely use all of these retentive
components even though clinical experience may, in the future, allow us to eliminate one
or more of the factors.

15

ADVANTAGES
1. Minimal Tooth Preparation: Little tooth structure has to be removed for this
technique, making it more conservative and less likely to create problems in
unblemished abutment teeth.
2. Minimal potential for pulpal trauma: Conservativeness of tooth preparation.
3. No Anesthetic Needed. An anesthetic is not required because most of the
preparation will be done in enamel.
4. Supragingival Margins. Although supragingival margins can be used with
conventional retainers, they are mandatory for the resin-bonded fixed partial
denture. Only when the retainer gingival margins were less then 0.5 mm from the
gingival crest was there correlation with gingival response.
5. Easy impression making: due to supragingival margins
6. Provisional not usually required: However judicious placement of composite
resin is important to maintain occlusal clearances after final impression and until
final restoration is bonded.
7. Reduced chair time: due to conservativeness of tooth preparation
8. Unaltered casts without removable dies
9. Reduced Cost. This is probably not as significant as was first thought when little
or no preparation was involved with the technique. However, with the increased
use of preparation features, more of the dentist's time and skill are required, and
the cost differential between a conventional prosthesis and a resin-bonded fixed
partial denture has become less.
10. Rebonding Possible. Resin-bonded fixed partial dentures can be rebonded if
the "wings" or axial extensions are not sprung or bent when the restoration
debonds. Commonly, one retainer does become

loose before the other. If this

goes undetected for any significant period of time, caries can develop on the
abutment under the retainer and a new conventional fixed partial denture may
have to be constructed. However, if the debonding is detected early enough, the
retainer that remained attached must be removed without damage to the tooth or
to the restoration. This can be quite difficult if the tooth has been well-prepared.
Removal of resin-bonded restorations by the use of specially designed ultrasonic
scaler tips has been described. The KJS, a straight chisel, is used to develop a
fracture in resin along the incisal edge, and the KJC, a curved chisel, is used at
the gingival margin.

16

DISADVANTAGES
1. Irreversible. The resin-bonded fixed partial denture, as it is frequently used
today, requires the removal of enough tooth structure that it should be
considered irreversible. Whether this is really a disadvantage or not is debatable,
but the point is raised simply to remind the reader that it is necessary to do some
preparation of the tooth.
2. Uncertain Longevity. The resin-bonded fixed partial denture is not new and
totally untested, but there is still some concern about the longevity of this type of
prosthesis. The results of 27 studies on resin-bonded FPD longevity by Marinello
et al, the success rate dropped from 95% after 3 months to 91 % at 6 months,
81.5% at 1 year, and 73% at 18 months.
3. Enamel modification is required: Extensive enamel modifications are required
with retentive design to the proximal and lingual surfaces of the abutment teeth. If
the restoration is removed, composite resin bonding could restore the enamel
contours, but transition to a more traditional prosthesis is likely. Enamel is limited
in thickness, which requires precision in design and preparation with attention to
detail. Enamel lingual surfaces of anterior teeth are almost always thinner than
0.9mm.
4. No Space Correction. Although some porcelain can be added to the metal
retainer on the adjacent abutment teeth, there are definite limitations on what can
be done if the edentulous space is significantly wider than the mesiodistal width
of the tooth that would normally occupy the space.
5. Good Alignment of abutment is required: It is impossible to correct alignment
problems with this restoration, inasmuch as nothing is done to the facial,
proximal, and incisal areas of the abutment teeth. Good alignment of abutment
teeth is required because the prosthesis' path of insertion is limited by potential
penetration of the enamel thickness. However, some posterior teeth, which are
mesially or mesiolingually tilted, can be onlayed with a bonded retainer. Thus
patient selection in limited.
6. Plaque accumulation can occur: as designs are outside the dimensions of the
tooth and bulky contours may be intolerable to some patients.
7. Difficult Temporization. A provisional fixed partial denture cannot be fabricated
with this type of restoration. If a missing tooth is to be replaced while the fixed

17

partial denture is being made, it must be accomplished with a muco-adhesion
temporary removable partial denture.
8. Esthetics is compromised on posterior teeth: Posterior resin-retained FFD
design requires the extension or the metal framework onto the occlusal surface
of posterior teeth. These occlusal rests and occasional onlaying of cusps are
visible, which might be objectionable to some patients.
9. Graying out of teeth: that are thin labio-lingually due to alloy visibility
10. Dependence on laboratory: for competent treatment of cast metals and selective
waxing to avert over-contouring and equipment requirement.
11. Patients expectation of esthetics is high: but routine results are fair to good not
outstanding.
INDICATIONS
In the treatment plan for any fixed prosthesis, the patient's individual needs must
be properly identified. The presence of any existing disease, its etiology, and how it
relates to the treatment prognosis must be assessed. Periodontal and general denial
health must be reestablished, and the proposed abutment teeth should not exhibit
mobility; however, periodontal splinting of teeth with a resin-retained FPD has been
successful with strict provision of mechanical retention of each tooth within the alloy
framework.
1. Replacement of missing anterior teeth in children and adolescents:
Conventional fixed prosthodontic techniques are generally contraindicated in
young patients because of management problems, inadequate plaque control,
the large size of the pulps, and the fact that children, routinely participate in
sports. Anteriorly, one or two teeth with mesial and distal abutments can
generally

be

replaced

with

a

resin-bonded

FPD.

Depending

on

the

circumstances, a greater number of teeth can be involved.
2. Caries-free Abutment Teeth/ Unrestored abutments: If the edentulous span is
not too long, the resin-bonded fixed partial denture allows tooth replacement with
minimal destruction of tooth structure on undamaged abutment teeth. Sound
teeth or those with minimal restorations are suitable as an abutment with a resinbonded retainer. When bonding to anterior teeth, the presence of Class III
restorations is not a contraindication to a bonded retainer. However, large

18

multiple restorations or a Class IV restoration would limit the bonding and the
abutment's mechanical integrity. In the posterior region, existing Class II lesions
proximal to the edentulous space can be incorporated in retainer design.
3. Mandibular Incisor Replacements. The acid-etched resin-bonded fixed partial
denture is the restoration of choice for replacing one or two missing mandibular
incisors when the abutment teeth are unblemished.
4. Maxillary Incisor Replacements. Maxillary incisors can be replaced if they are
in an open-bite, end-to-end, or moderate overbite situation.
5. Periodontal Splints. The splinting of periodontally involved teeth comprised the
first published report of the use of a resin-bonded prosthesis by Rochette, and
other authors described the use of resin-bonded, perforated and etched-metal
splints for long-term usage. However, abutment mobility has been cited as one of
the causes of failure by Barrack, and the study by Marinello et al indicated that
the failure rate for splints was 13% greater than that for fixed partial dentures' If a
resin-bonded prosthesis is to be used as a splint, careful attention must be paid
to resistance features on the abutment preparations. In the previously cited study
by Marinello et al, the use of grooves on abutments for splints improved the
chances for success by nearly 15%.
6. Stabilizing dentition after orthodontics
7. Prolonged placement of interim prosthesis: to augment surgical procedures
i.e. cranio-facial anomalies.
8. Single Posterior Tooth Replacements. While replacement of multiple teeth can
be done with this type of prosthesis, it becomes a higher-risk procedure. Resinbonded fixed partial dentures of more than three units have a 10% higher failure
rate than those that are only three units in length Resin-bonded FPDs of greater
than three-unit length should be used only if there is some mitigating treatmentplanning consideration, such as opposing a removable partial denture, which
would result in less occlusal stress. Fixed partial dentures with more than two
retainers have a failure rate 2.5 times that of resin-bonded FPDs with only two
retainers.
9. Significant clinical crown length: should be present maximize retention and
resistance.

19

10. Innovative applications: New and innovative applications include

bonding an

attachment for RPD to an abutment tooth. The other use maybe bonding the
laminate veneer alloy- ceramic facing over prepared tetracycline stained tooth
CONTRAINDICATIONS
Because of the apparent advantages of resin-retained restorations, they have
often been used in inappropriate circumstances, leading to failures that reduced patient
(and dentist) confidence in the technique. Fortunately, these failures were usually
correctable by more conventional methods. If any of the following contraindications exist
in a particular clinical situation, an alternative approach to treatment should be selected.
1. Parafunctional

habits:

Patients

with

parafunctional

habits

should

be

approached cautiously when the use of resin-retained FPD’s is considered,
because the resistance, to displacement of these retainers is lower than in
conventional FPD’s. They should be used judiciously where above-average
lateral forces are likely to be applied (e.g., in a patient with parafunctional habits
or in a patient who requires an anterior tooth replacement in the presence of an
unstable or nonexistent posterior occlusion). In these instances, all means of
mechanical retention of the framework (grooves, occlusal rests, interproximal
extension of metal should be used. The patient should be informed about the
possibility of debonding. Periodontal splints can also be fabricated, but they
require strict attention to mechanical retention.
2. Long edentulous span: should be avoided because they place excessive force
on the metal retention mechanism; with repeated loading, fatigue of the bonding
interfaces or even the metal is possible.
3. Extensive Caries. Because the resin-bonded fixed partial denture covers
relatively little surface area and relies on bonding to enamel for its retention, the
presence of caries of any size will require the use of a more conventional
prosthesis. Surgical crown lengthening may therefore be necessary as a way to
increase the bondable surface area and because subgingival margins must be
avoided.
4. Restored or damaged abutments: Extensively restored or damaged teeth are
unsuitable as abutments. One sound abutment and one extensively restored
abutment can be incorporated into a combination FPD.

20

5. Compromised enamel: on abutment teeth as a result of hypoplasias,
demineralization, or congenital, problems (e.g. amelogenesis

imperfecta or

dentinogenesis imperfecta) will adversely affect resin bond strength.
6. Significant pontic width discrepancy: The labiolingual thickness of anterior
abutment teeth and translucency of the enamel should be assessed to
determine whether the shade of the abutment teeth will be changed (a
consequence of reduction of tooth translucency by the metal retainer. Graying of
the abutments can be eliminated with opaque resins and by limiting the incisal
extent of the metal on the lingual surface. Translucent resins cause optical
coupling of the metal to the tooth; appreciable graying of the enamel will result. A
trial insertion of the metal with water between the metal and tooth provides a
preview of the possible graying. Similarly, when custom-staining the pontic of
resin-retained FPD, a trial resin (which will not polymerize) should be used to
visualize the final shade of the abutment teeth with the metal backing.
7. Nickel Sensitivity. Since most resin-bonded fixed partial dentures are etched
nickel-chromium restorations, nickel sensitivity in a patient requires that another
alloy be used or that another type of prosthesis be employed. Tin-plating and
laboratory-applied bonding systems allow the use of noble alloys. However with
the reduced elastic modulus of most noble alloys, the metal thickness should be
increased approximately 30% to 50% to make the stiffness of noble metal
framework equal to that of base metal. This is an important factor in treatment
planning and can influence the amount of occlusal clearance required for the
metal (which is critical in patients with deep vertical overlap.
8. Deep Vertical Overbite. So much enamel must be removed from the lingual
surface of a maxillary incisor in this occlusal relationship that retention would be
drastically reduced because of the poor bonding strength afforded by the
exposed dentin.
9.

Incisors with thin faciolingual dimension.

Lingual Enamel Thickness of Maxillary Anterior Teeth (m millimeters)
Millimeters from cementoenamel junction
Central incisor 0.3

0.5

0.6

0.7

0.7

0.7

Lateral incisor

0.4

0.5

0.5

0.6

0.7

0.7

Canine

0.2

0.4

0.6

0.7

0.9

0.9

21

SELECTION OF ABUTMENT
The dentist should determine the restoration design before beginning tooth
preparation. This may include surveying the abutment teeth and making trial
modifications on the cast.
Abutment teeth that are caries free and periodontally sound with adequate thickness
of enamel forms ideal abutment. eg. missing upper lateral incisor with central incisor and
canine as abutments
When designing the anterior prosthesis, use largest possible surface area of enamel
that will not compromise the esthetics of the abutment teeth. The retentive retainers
(wings) should extend one tooth (mesial and distal if a single tooth is replaced. If two
teeth are replaced, double abutment on either side can be considered, but only if
periodontal support of the abutments is compromised. With proper mechanically
retentive designs, two maxillary incisors pontics can be retained by two lateral incisors,
unless the laterals have short clinical crowns or a deep vertical overlap is present. If a
combination of tooth replacement and splinting is
cover

more

used,

the

framework

may

teeth.

Cantilevering pontics with resin-retained FPD’s is also possible. Replacement of
lateral incisors where cantilevers from either the central incisor or canine are possible.
The retainer design is critical and requires adequate mechanical engagement of the
abutment tooth.

RBFPD with missing upper left central incisor

ABUTMENT PREPARATION
The early use of acid-etched resin-bonded fixed partial dentures was accomplished
with no preparation of the abutment teeth. Although some authors advocate little or no
tooth preparation for this type of prosthesis, emphasizing its, reversibility preparation
features are used by many to enhance the resistance of resin-bonded fixed partial
dentures

22

Whether anterior or posterior teeth are prepared, common principles dictate tooth
preparation design.


Nearly parallel walls i.e. 6 degree taper



A specific path of insertion



Sufficient occlusal clearance



Maximum coverage of virginal enamel



Vertical stops
A distinct path of insertion must exist, proximal undercuts must be removed to

provide "planes of metal" on the lingual and proximal surfaces, with a slight extension
onto the facial surface to achieve a faciolingual lock. The preparation should
encompass at least 180 degrees of the tooth to enhance the resistance of the retainer.
Occlusal rest seats and proximal groove/slots must provide resistance form, and a
definite and distinct margin gingival margin should be established wherever possible
about 1mm supragingivally.
Occlusal clearance is needed on very few teeth that are prepared as abutments
for acid-etched resin-bonded fixed partial dentures. Specifically, 0.5 mm is needed on
maxillary incisors, where preparation is done on the lingual surface of the teeth. .
Because of the limited thickness of enamel near the cemento-enamel junction, this type
of restoration cannot be used on patients with a severe Class II vertical overlap.
Vertical stops are placed on all the preparations. This will consist of two or three
flat countersinks on the lingual surface of an incisor, a cingulum rest on a canine or an
occlusal rest seat on a premolar or molar. Wilkes found rests to be the dominant feature
in a preparation, contributing to both resistance and rigidity. The occlusal rest directs the
applied force from the pontic to the abutments
On anterior teeth, the procedure is similar in many ways to the lingual reduction
needed for a pinledge, preparation, but the amount of reduction is less because the
enamel must not be penetrated, if necessary, the opposing teeth can be recontoured to
increase interocclusal clearance. There must be sufficient, enamel area for successful
bonding, and the metal retainers must encompass enough tooth structure and have
sufficient resistance form to prevent the individual abutment tooth from being displaced
in any direction out of the framework.
Bur selection depends on operator preference. Gingival margins and
circumferential preparation are easily accomplished with a chamfer or round tipped
diamond. Occlusal rest seats and cingulum notches can be prepared with a diamond or

23

carbide inverted cone bur. The other critical retentive features (e.g., slots, grooves) can
be made with tapered fissure bur.
Anterior tooth preparation and framework design
Steps involved are:


Clearing the occlusion



Creating a path of insertion



Cingulum notch or rest
The occlusion is assessed to ensure at least 0.5 mm of interocclusal clearance

for the metal retainer in the intercuspal position and throughout the lateral and protrusive
excursive pathways. If inadequate clearance exists, selective enameloplasty is
performed. Occasionally, additional clearance can be obtained by reducing the opposing
teeth. However, this is contraindicated if there is wear or attrition on the incisal edges.
Modification of the proximal surfaces is necessary to create a parallel path of
insertion. This also depends on the presence or absence of proximal restoration.
Another modification is a slight alteration of the marginal ridge to allow the casting to
wrap over the marginal ridges of each abutment tooth. This modification results in a
slight chamfer which acts as a guide to locate the gingival margin and at the same time
creates a smooth transition from the casting to enamel. The gingival margin should be
designed so that slight supragingival chamfer exists that delineates the gingival
extension of the preparation. Any undercut enamel is removed at this time. The chamfer
finish line should extend incisally through the distal marginal ridge area so that mesial,
lingual, and distal “planes" are created. Abutments should have parallel proximal
surfaces whenever possible.
The finish line on the proximal surface, adjacent to the edentulous space, should
be placed as far facially as practical. A 0.5-mm-deep slot, prepared with a tapered
carbide bur, should be placed slightly lingual to labial termination of the proximal
reduction. Great care paralleling the proximal grooves is required. A paralleling
instrument is very helpful during this procedure and has demonstrated its importance in
highly successful clinical studies. This device is also helpful when many teeth are to be
incorporated in the framework (e.g., an extensive periodontal splint).
The restoration must extend labially past the proximal contact point. To optimize
esthetics, the proximal wrap in the anterior region may be achieved in part with the
porcelain pontic.

24

A V- shaped notch can be prepared with an inverted cone bur in lingual
approach. The preparation must be small but distinct. Judicious preparation is necessary
and penetration into enamel in avoided.
Preparation of mandibular anterior teeth is similar to that for the maxillary
incisors. Lingual enamel thickness is 11% to 50%less than for maxillary teeth and tooth
preparation must therefore be more conservative. Combinations of periodontal splinting
and tooth replacement are commonly used in mandibular anterior region. This presents
a challenge for providing mechanical retention for the abutment and splinted teeth.

Posterior tooth preparation and framework design
The basic framework for the posterior resin-retained FPD consists of
three major components:


the occlusal rest (for resistance to gingival displacement),



the retentive surface (for resistance to occlusal displacement), and



the proximal wrap and proximal slots (for resistance to torqumg forces)
A spoon-shaped occlusal rest seat, similar to that described for a removable

partial denture (RPD) is placed in the proximal marginal ridge area of the abutments
adjacent to the edentulous space. An additional rest seat may be placed on the opposite
side of the tooth. The rest is an important retention feature for resistance to both occlusal
and lateral forces and should be designed to function as a shallow "pin."
To resist occlusal displacement, the restoration is designed to maximize the
bonding area without unnecessarily compromising periodontal health or esthetics.
Proximal and lingual axial surfaces are reduced to lower their height of contour to
approximately I mm from the crest of the free gingiva. The proximal surfaces are
prepared so that parallelism results without undercuts. In the interproximal area, no
gingival chamfer is necessary to prevent penetration of the enamel, resulting in a knifeedge margin. Occlusally, the framework should be extended high on the cuspal slope,
well beyond the actual area of enamel recontouring (provided it does not interfere with
the occlusion).
Resistance to lingual displacement is more easily managed in the posterior
region of the mouth. A single path of insertion should exist. The alloy framework should
be designed to engage at least 180 degrees of tooth structure when viewed from the
occlusal. This proximal wrap enables the restoration to resist lateral loading by engaging
the underlying tooth structure and is assisted in this regard by grooves in the proximal

25

just lingual, to the buccal line angle. Distal to the edentulous space, the retainer
resistance is augmented by a groove at the lingual proximal line angle. Moving a
properly designed resin-bonded FPD in any direction except parallel to its path of
insertion should not be possible, nor should it be possible to displace any tooth to the
buccal from the framework.
In general, preparation differs between maxillary and mandibular molar teeth only
on the lingual surfaces. The lingual wall of the mandibular tooth maybe prepared in a
single plane. The lingual surface of the maxillary molars requires a two-plane reduction
due to occlusal function and the taper of these functional cusps in the occlusal two
thirds. However, the mandibular lingual retainer may be carried over the lingual cusps to
augment resistance and retention form on short clinical crowns of mesially and lingually
inclined molars (this may require a two- plane modification).
A wide range of extensions of the casting onto the occlusal surfaces of posterior
teeth is possible. They include shoeing of cusps, encircling, of cusps, and extensions of
metal through the central fossa from mesial to distal with the lingual cusps exposed. The
clinician is limited only by imagination, available enamel, occlusion, and the display of
metal tolerated by the patient.
Occasionally, a combination restoration can be used. This type of FPD includes a
resin-bonded retainer on one of the abutment teeth and a conventional cast restoration
on the other. As previously noted, this type of FPD has been very successful in clinical
studies. Periodontal splinting is the most demanding of the restoration designs; splints
and splint-FPD combinations require care in designing adequate mechanical retention.

IMPRESSION PROCEDURE
An accurate impression is necessary as marginal fit is as critical for a resin-retained
restoration as for a conventional FPD. Bond strengths are reduced with thick resin
layers. A custom tray can be fabricated to minimize the distortion of using stock trays.
Elastomeric impressions are superior and reversible hydrocolloid is less desirable for
final replica.
Provide temporary occlusal stops. Significant supraocclusion of the abutment teeth
can occur rapidly, particularly in younger patient or patients with reduced periodontal
support. This can be avoided on anterior teeth by placing a small amount of composite
resin on the opposing lower teeth. This is rarely needed for posterior teeth unless
significant onlaying of the abutment is planned (in which case small composite resin

26

stops can be bonded to the enamel). The resin is removed just before placement of the
resin-retained FPD.
LABORATORY PROCEDURES
Framework Fabrication
Framework design for the resin-bonded fixed partial denture is important. It cannot
be divorced from the preparation since the extensions for the retainers will be
determined by the preparation. There must be an adequate thickness of the metal in the
finished restoration so that it will be immune to distortion and/or dislodgment.
Caputo et al found through the use of photoelastic stress analysis that stresses could
be lowered significantly by thickening the wraparound arms of the retainer to 0.6mm and
including proximal extensions." Failure to reduce stress in the arms of the retainer will be
translated into fatigue failure of the underlying resin bonding material.
Framework can be fabricated using resin copings or pattern waxes.


Wax the framework. The approximate thickness of the wax pattern should be no
less than 0.4mm and preferably closure to 0.6mm. Carve and flush the wax on
the lingual surface. There should be no voids. Use a spoon excavator or a
discoid carver to cut 1mm deep grooves in the facial, lingual and gingival
surfaces of the pontic. The grooves on the incisal edge should be 1.5mm deep.
These grooves will ensure adequate thickness of porcelain when added to the
metal framework.



Cast in nickel- chromium alloy or any other metal ceramic alloy



Different alloys require different surface preparation or tin-plating; the dentist
should use an alloy that has been well tested with the adhesive composite resin
of choice (see below).



Build up the pontic in porcelain, fire it, and contour it.

27



Evaluate the restoration clinically; when the fit is satisfactory, characterize and
glaze it. Opaque resins are necessary to prevent metal from graying the
abutment teeth. Depending on the opacity of the resin and the teeth, the value of
the abutment may be increased.



Try-in for anterior teeth should involve a try-in paste for proper characterization
of the pontic. Any remaining try-in paste will be burned out during the glaze firing.



After this is completed, the restoration can be polished. Regular finishing
compound is suitable.



Clean the fitting surface with a particle abrasion unit, using aluminum oxide
(50Mm at a minimum of 40 psi [0.3 MPa] pressure); rinse thoroughly with water
and dry. If the restoration is tried-in again, particle abrasion should be repeated
just before bonding.

THE ENAMEL ETCH AND RESIN BOND
The development of the acid etch technique has had a profound effect on many
phases of clinical dentistry. The expanded adaptation of the acid etch technique into the
bonding of etched alloy frameworks to etched enamel has significantly and irrevocably
changed the treatment choices available to practitioners in the area of fixed partial
dentures. The late Michael Buonocore's pioneering work in the field started in 1955 with
the publication of his paper entitled “A Simple Method of Increasing the Adhesion of
Acrylic Filling Materials to Enamel Surfaces.'" Recognizing that one of the major
shortcomings of the resin filling materials was their lack of adhesion to dentin and
enamel, Buonocore

embarked on the development of "bonding", as the acid etch

technique is popularly referred to Buonocore's choice of the use of phosphoric acid to
etch enamel was not an accident. For years, this acid had been used in industry to
obtain better adhesion of paint and resin to metal. The strength of acid used in industry
(85%) was also used by Buonocore in his initial work. Buonocore showed that acrylic
resin can be attached to human enamel in vivo simply by etching the enamel surface for
30 seconds with 85% phosphoric acid. The increased bond strength of acrylic resin to
etched enamel compared to unetched enamel was attributed by Buonocore to several
factors:
1. A large increase in surface area of enamel available for interaction

with resin as a

result of the etching process.

28

2. The exposure of the organic framework of enamel, which then serves as a framework
for adhesion.
3. The removal of inert enamel surface structure, exposing a fresh reactive surface
4. The presence on the enamel of a strongly absorbed layer of highly polar phosphate
groups derived from the acid

THE ACID FOR ETCHING ENAMEL
Several investigators have conducted in vitro studies into various acids and their
effect on both bovine and human enamel. Brauer and Termini, Laswell and co-workers
Lee and co-workers, and Silverstone have all contributed to the scientific literature in this
field. Silverstone's 1974 data were critical in the choice, by several manufacturers, of the
acid and the strength of acid to recommend with composite resin systems. Silverstone
tested 20%, 30%, 40%, 50%, 60%, and 70% phosphoric acid, 50% phosphoric acid
buffered with 7% zinc oxide by weight, 5% and 50% citric acid, 10% polyacrylic acid, and
5% and 50% neutral and acid solutions of EDTA for exposure times varying from one to
five minutes. Silverstone observed two types of attack of the enamel by phosphoric acid.
The first was a loss of surface contour, and the second was the creation of a porous
subsurface region. It is this porous subsurface region that is the key to the retention of
resins.
Silverstone found the greatest retention of resin with phosphoric acid in the range
of 20-50%. By further selecting the acid that combined the least amount of surface
contour loss with the greatest depth of subsurface porous region, Silverstone concluded
that a 30% solution of phosphoric acid was the most effective etching agent. This most
significant study resulted in the majority of the resin manufacturers choosing to supply
phosphoric acid in the strength range of 30-40% for the acid etching of enamel. This
does not mean that 50% phosphoric acid will not give a clinically acceptable etch.
Silverstone's work, however, shows that the degree of surface etching decreases with
increasing concentration of acid. Only about 5 microns of surface enamel are lost with a
three-minute etch of 60% phosphoric acid, whereas a three-minute etch with 20%
phosphoric acid produces a 40 micron loss of surface enamel. The same effects are
seen with the subsurface histologic changes in tissue – the weaker the acid, the deeper
the changes. However, weak acids do not produce such a consistent etching pattern and
it is not desirable to lose large amounts of surface enamel each time etching takes
place. A 30% phosphoric acid solution produces a 10 micron loss of surface contour and

29

a 20 micron depth of histologic change. The reason for a weaker acid affecting the
surface enamel more than a stronger acid may be related to the degree of ionization of
the acid. The weaker the acid, the greater is the degree of ionization leading to greater
diffusion into the tissue. Silverstone has also suggested that the formation of soluble or
insoluble precipitates with the various strengths of acids can affect the dissolution rate of
enamel.
In a 1975 report, Silverstone and co- workers defined three basic etching
patterns of human enamel produced after exposure to phosphoric acid. In the type1
etching pattern, the enamel prism cores are preferentially removed, leaving the prism
peripheries standing. The enamel surface thus appears cratered under the scanning
electron microscope (SEM). The type 2 etching pattern is the reverse of type 1. The
prism cores are left relatively intact and the peripheries removed. The SEM allows us to
view such a surface, which appears much like a tightly packed forest of trees as viewed
from above.
The Type 3 etching pattern was defined as one where small areas of types 1 and
2 could be seen intermixed with areas that could not be related to prism morphology.
Any one or all three of these patterns can be seen on a single sample of etched enamel.
Clinically, etched enamel takes on a frosty white appearance. If this is not seen after
etching for 60 seconds, an extended etch time may be required. In general, if teeth are
carefully cleaned prior to etching, and the phosphoric acid is continually and carefully
reapplied during the course of the etch time, it is seldom necessary to increase the etch
time.

Type 1 etching pattern



Resin tags

30

ALLOY ETCHING AND BONDING
The electrolytic etching of non-precious casting alloys in order to create a microretentive surface for resin bonding (Figure Ill-1) was a natural progression from earlier
work on perforated retainers at the University of Maryland. Based upon the work of
Rochette in France and Howe and Denehy of the University of Iowa, the perforated
retainer was introduced at the University of Maryland by Kuhlke. Impressed with the
possibilities of the technique, Livaditis in consultation with others instituted a study to
evaluate the perforated retainer for replacement of missing posterior teeth with the
restoration in normal occlusion. Indeed, these posterior restorations, although of limited
number, are continuing to function without failure for up to four years. Denehy has
recently reported on 250 anterior restorations of up to seven years duration with
excellent results. The following limitations of the perforated retainer were noted:
1.

The resin retention into the perforations is the limiting factor in strength of the

system. That is, failure can occur through the resin projections into the perforations
leaving the resin retained on the abutment teeth. This has been observed in several
anterior failures and confirmed in in-vitro tests by Eshleman and others:
2. The composite resin used for bonding is exposed at the perforations and can wear,
causing loss of mechanical retention. This is of particular concern with the low film
thickness composite resin developed for this technique (Comspan, L. D. Caulk
Company, Milford, Delaware), which has a filler loading of only 65% as compared to
75-85% for conventional composite resins.
3. The perforations weaken the alloy framework. This necessitates making the lingual
arms thicker in cross section for stiffness and fatigue resistance. In two earlier anterior
cases lacking some of the later design criteria, fatigue fractures of the alloy propagating
through the perforations were observed. (This problem is somewhat eliminated with
proper design employing a distinct path of insertion with the casting engaging tooth
structure in all displacement directions

Initial alloy etching
The appearance in September of 1979 of an elegant article by Tanaka and
others, utilizing pitting corrosion of a nonprecious alloy for mechanically retaining
acrylic facings, caused us to immediately attempt to apply these techniques to nonprecious

alloys,

with

the above- mentioned limitations in mind. Pitting corrosion

proved to be difficult and highly variable for the nonprecious (Ni-Cr) alloy selected

31

(Biobond C&B, Dentsply International Inc., York, Pennsylvania). Review of the literature
established that Dunn and Reisbick had previously used electrolytic techniques to etch a
cobalt- chromium implant alloy (Surgical Vitalhum, Howmedica Inc., Chicago, Illinois) to
provide mechanical retention for a ceramic coating. Following their example, work was
initiated in the winter of 1979-1980 at the University of Maryland to determine the etching
conditions for the above Ni-Cr alloy. The test configuration was that employed by
Tanaka and involved a low voltage DC power supply connected to a stainless steel
cathode (—) and a disc of the alloy mounted on a conductive anode (+). All areas of the
anode except the face of the test disk were masked with sticky wax. Both electrodes
were immersed in a stirred bath of acid, and current was passed through the bath for a
specific period of time.

Following etching, a debris layer was present on the alloy

and this was removed by immersion in 18% hydrochloric acid in an ultrasonic bath for
10-15 minutes. The details of the testing procedures are covered elsewhere.
Nitric acid was selected for the etchant as a result of the similarity between the
composition and microstructure of the Ni-Cr alloy investigated by Dunn and Reisbick and
this Ni-Cr alloy. This choice was fortuitous and results were almost immediate, but trial
and error involving acid concentration, etching current, and etching time were necessary
to refine the process. Nitric acid at a concentration of 0.5 N and a current density (mill
amperes per square centimeter of it
resulted in surfaces exhibiting a great

area to be etched) of 250 ma/cm2 for five minutes
deal

of three-dimensional relief. This is most

easily seen in the scanning electron microscope (SEM).
Immediately

after

successfully

etching this alloy, clinical evaluations of

etched casting resin-bonded restorations were begun with the first fixed prosthesis
placed in March 1980. Investigations of the etching conditions for other alloys were
begun in the spring of 1980, and a great deal of effort was expanded in trying to etch a
representative alloy (Rexillium III, Jeneric Industries, Wallingford, Connecticut) of the
Ni-Cr- Be class to obtain sufficient three-dimensional relief. The 10% sulfuric acid
etching of Ni-Cr-Be alloys was finalized in December of 1980. Here the slight flecking of
the surface due to relief of individual grains is apparent. This is characteristic of Ni-Cr-Be
alloys for porcelain bonding. Rexillium III alloy has been the alloy with which the authors
have the most experience, but it should be pointed out that other alloys have since been
shown to etch equally as well and have excellent resin-to-alloy bond strengths. The
Rexillium III alloy can be thought of as representative of the class of Ni-Cr-Be alloys for
porcelain bonding. The choice of alloy for this technique should also be concerned with

32

other characteristics of the alloy such as corrosion resistance, yield strength, and case of
casting or polishing. The electrolytic etching is most conveniently evaluated using a light
microscope at 40-80 magnifications to inspect for surface relief and etching patterns. (It
is helpful to use lighting incident at a shallow angle to the alloy surface to highlight the
surface relief.) The etching pattern is most easily observed with a stereomicroscope and
a characteristic pattern showing the junction of an unetched control area with 10%
sulfuric acid etched area is seen In Figure Ill-5. Higher magnification photomicrographs
lose quality due to prolonged exposure times. Viewed with the SEM, the junction
between the unetched and etched areas becomes more apparent. Here it can be
appreciated that the amount of surface relief created depends upon selective removal of
one or more of the phases present. Consequently, this technique is limited to alloys that
solidify with a multiphasic structure - that is, nonprecious alloys. There are at this time no
known precious or semi-precious alloys suitable for this technique.
Particular efforts have been made to grain-refine the high noble metal content
alloys for porcelain bonding in order to prevent sag at porcelain firing temperatures,
which precludes a retentive surface being formed during etching. The selective removal
of the alloy phases present between the dendritic arms in the Ni-Cr-Be alloy can be
evaluated.
The phases removed are the lamellar interdentritic eutectic high in Beryllium
according to Baran. Even the intra-dentritic gamma prime phase ascribed to be NI; AI in
composition is attacked to some degree by sulfuric acid. Any factor which changes the
solidification structure of the alloy will affect the etching process. This can be seen in
recast Ni-Cr-Be alloy where the interlamellar eutectic phase is hardly present due likely
to loss of some constituents during the reheating of alloy.
ETCHING OF VARIOUS ALLOYS
Subsequent studies in our laboratories have established etching conditions to a
number of alloys. These alloys can be generally classified as Ni-Cr-Be, Ni-Cr and Co-Or
although within any one class there are wide variations of other metallic constituents
within the alloys.

33

Conclusions
1.

Ni-Cr-Be alloys as a class yield micromechanically retentive surfaces when

electrolytically etched in sulfuric acid at a concentration of 10%. There are, however,
individual variations.
2. Micromechanical retention in Ni-Cr- Be alloys is achieved by massive removal of the
lamellar interdendritic phases and to a lesser degree by removal of the intradendritic
gamma- prime phase.
3. Ni-Cr and Co-Or alloys generally etch in nitric acid. Porcelain firing causes oxide layer
formation that binds nitric acid etching.
4. The Ni-Cr and Co-Cr alloys have microstructures in which the secondary phases are
less broadly distributed than those for Ni-Cr-Be alloys and etching conditions must be
tailored to each alloy composition.
5. The presence of a retentive surface on a candidate alloy should be confirmed with the
scanning electron microscope and bond studies conducted to determine the efficacy of
the etching conditions.
In order to investigate the clinical situation, lingual retainer castings have been
fabricated in a Ni-Cr-Be alloy, electrolytically etched and bonded to phosphoric acid
etched tooth structure with a low film thickness composite resin. Such a casting was
embedded in methyl methacrylate. When this cross-section is examined under the SEM
an appreciation is gained of the relative size difference between the degree of relief on
the alloy surface as compared to the etched enamel. The small particle size in the
composite resin is easily appreciated to be

less

than

5

microns

(the

interspace between the tops of the alloy and the etched enamel is 8-12 microns in this
selected area).

34

ALLOYS USED FOR ACID ETCHED BRIDGES
Ni-Cr-Be Alloys
 RexiBium III
 Pacific 5B
 Vera Bond
 Litecast B
 Bak-On N.P.
 Unitbond
 Ticonium 100
Ni-Cr Alloys
 Biobond C&B
 NP2 (Howmedica, Chicago. IL.)
Co-Cr Alloys
 Neobond II Special (Neolloy Posen, IL.)
 Vitallium (Howmedica, Chicago. IL.)
Silver-Palladium
 Albabond (Heraeus, Queen Village,NY.)
High Palladium
 Spirit (Jensen Industries, New Haven, CT.)
ACIDS USED FOR ETCHING
SULFURIC ACID
Sulfuric acid is easily obtainable in a 98% concentration. It is available in both
reagent grade and technical grade. Some researchers have found that use of the
technical grades of sulfuric acid has resulted in a poorly etched surface with red and
brown discolorations. For this reason reagent grade sulfuric acid should always be used.
To achieve an approximately 10°/o solution from a 98% solution of sulfuric acid it
is only necessary to dilute the reagent grade sulfuric acid 9:1 by volume with water. In
order to do this properly it is important that you be aware of one detail. Concentrated
sulfuric acid is a very strong dessicant. In the presence of compounds containing water it
has the ability to withdraw water from the compound very rapidly. When mixed with
actual water, this reaction takes place so rapidly that much heat is given off. If water is
added to concentrated sulfuric acid, the reaction takes place so rapidly that it causes
boiling. Therefore, the correct technique for diluting sulfuric acid is to add the sulfuric
acid to cold water, rather than to add the water to the acid.
To create a 10% solution of sulfuric acid follow these steps.
1. Fill a 1-liter polypropylene bottle about two thirds full of cold water.

36

2. Measure out 102 m of 98% reagent grade sulfuric acid and slowly add this to the cold
water. Remember, it is important that the acid be added to the water rather than the
other way around.
3. Fill the bottle with additional cold water until the total contents equal 1 liter.
This will result in an approximately 10% solution of sulfuric acid.

NITRIC ACID
Nitric acid is available in reagent grade at a 70% concentration. The steps for
diluting this to 0.5 N solution are as follows;
1. Fill a polypropylene bottle with I liter of cold water.
2. To this, add 30 ml of 70% nitric acid.
The resultant solution is 0.5 N nitric acid.
To mix the 10% solution of nitric acid that is used for the cleaning phase of some
high palladium alloys, the directions would be as follows:
1. Into an unbreakable bottle pour 85.7 ml cold water
2. Add to this 14.3 ml of 70% nitric acid.
The resultant solution is 10% nitric acid.

HYDROCHLORIC ACID
Hydrochloric acid is a solution of hydrogen chloride gas dissolved in water. It is
available in various grades, and readily available solutions range in concentration from
32% to 36%. One important thing to realize about hydrochloric acid is that the hydrogen
chloride gas is constantly being released from the solution. Therefore, it is important that
when the solution is not actually being used, it should always be in a closed container.
The final concentration of the hydrochloric acid in the cleaning phase of the twostep technique is not critical. Success can be expected when using solutions in the
range of 16% to 18%. Thus, it is easiest simply to take the concentrated hydrochloric
acid and dilute it 1:1 with cold water.
As with all gases in solution, the gas is more soluble in a cold liquid then in a hot
liquid. Therefore, when mixing and handling the hydrochloric acid, it is usually best to
use cold solutions.

37

MIXTURES OF ELECTROLYTES
With the introduction of the one-step etching technique, it has become
increasingly common to use more exotic and sophisticated electrolytes than those used
in the single component system. By combining various electrolytes, we have been able
to increase the efficiency of the entire etching process. The first such combination to be
put to use in dentistry was the combination used in the one-step etch.
ONE-STEP SOLUTION
This patented solution is a mixture with a resultant concentration of 10% sulfuric
acid and 18% hydrochloric acid. It is mixed in the following manner:
1. Make a 20% solution of sulfuric acid. This is accomplished by adding
98% reagent grade sulfuric acid to chilled water in a 2:8 ratio. Refrigerate the resulting
mixture.
2. In a 1-liter polypropylene bottle pour 500 ml of 36% hydrochloric acid. Refrigerate this
liquid.
3. When both liquids have chilled sufficiently, slowly add the 20% sulfuric acid solution
to the 36% hydrochloric acid solution.
The resulting solution is a 10% sulfuric acid and 18% hydrochloric acid mixture.
When mixing the one-step solution, exercise great care. Because hydrogen
chloride gas, which is extremely caustic, is liberated from the hydrochloric acid in great
quantities when the solution becomes warm and because the dilution of sulfuric acid by
water solutions results in the liberation of heat, this procedure should take place only
under a vent. Even with a vent, it is best to chill the solutions adequately before mixing,
in order to ensure that the final concentrations will be that which is anticipated. That
having been said, the process is quite simple.
The solution that has been developed for etching, Spirit alloy," requires a solution
of 33.25% methanol and 23.4% hydrochloric acid. This solution is mixed as follows:
1. Into an unbreakable bottle pour 35 ml of anhydrous methanol.
2. Add 65 ml of cold 36% hydrochloric acid.
It is important to observe carefully the following order when mixing these
chemicals. If the methanol were to be added to the concentrated hydrochloric acid, it
could react in various ways to produce aldehydes, fatty acids, explosive nitrogen
compounds. Once the hydrochloric acid concentration has been reduced below 35%

38

however, this danger does not exist. It is therefore the mixing and not the using that is
particularly tricky.
METHANOL-SULFURIC ACID SOLUTION
The addition of a small percentage of alcohol to most etching solutions seems to
facilitate the etching procedure. Although this is a well-known fact in industry, it is still
poorly understood. It has been hypothesized that the alcohol facilitates the etching
process at the surface, perhaps by lowering the viscosity in the debris layer in the
immediate areas of the etching.
One such mixture commonly used in dentistry for etching dental alloys is a
mixture that is approximately 9% sulfuric acid and 10% methanol. This solution should
be mixed in the following manner:
1. Fill a 1-liter polypropylene bottle about two thirds full with cold water.
2. Measure out 92 ml of 98% reagent grade sulfuric acid and slowly add this to the cold
water (Note: it is important that the acid be added to the water rather than the other way
around).
3. Add 100 ml methanol to this solution.
4. Fill the bottle with additional cold water until it equals 1liter in volume.
Alternatively, a 10% sulfuric acid can be made, and this then diluted with a 9:1
mixture of sulfuric acid and methanol.
HYDROCHLORIC ACID- METHANOL- SULFURIC ACID SOLUTION
In order to create a retentive etch on one silver palladium alloy, Albabond- 60, it
was necessary to resort to an extremely corrosive solution. After extensive testing, the
specific solution that proved to combine the greatest effectiveness with the highest
degree of safety was a solution of 16.2% hydrochloric acid, 10% anhydrous methanol,
and 9% sulfuric acid by volume.
The simplest way to mix this etchant is first to prepare a batch of one- step
etchant. Then dilute it by adding a 9:1 mixture of one-step etchant and methanol. As with
all the previous recipes, the order of mixing is of extreme importance.
As already mentioned, hydrochloric acid is nothing more than hydrogen chloride
gas dissolved in water. For this reason it is advisable to refrigerate the acid before
diluting it, because gasses are more soluble in cold liquids.

39

When concentrated sulfuric acid is diluted, a great deal of heat is liberated. This,
then, is both the reason for mixing small quantities at a time, and for adding the sulfuric
acid to the water, instead of the reverse. If the water were to be added to 98% sulfuric
acid, the solution would probably begin to boil and splatter.
Even after diluting the sulfuric acid, it is best to refrigerate the liquid before going
on to the next step. If the solutions are not quite cool when they are combined,
voluminous amounts of extremely caustic HCI gas can be released. Once the solution
has cooled down again, this problem is diminished.
It is also important to delay adding methanol until the final step, because the
combination of methanol with concentrated sulfuric acid may form dimethylene sulfate,
an odorless, tasteless compound that may be fatal if absorbed in sufficient quantities into
the skin or respiratory tract. Even gas masks do not offer adequate protection.
If methanol were to be added to concentrated hydrochloric acid, it could react in
various ways to produce aldehydes, fatty acids, or explosive nitrogen compounds. Once
the hydrochloric acid content has been reduced below 35%, however, this danger does
not exist. It is therefore the mixing and not the using of this electrolyte that is particularly
tricky.

ELECTROLYTIC ETCHING TECHNIQUE
It must be borne in mind that electrolytic etching of alloys in order to create threedimensional relief for micromechanical bonding of resins represents an entirely new
technology. There has never been any basic research published in this area. Tanaka
and his co-workers' pointed the way with their pitting corrosion studies and based part of
their concept on the previous work of Dunn and Reisbick. The metallurgical literature
has been concerned with slight amounts of etching relief on polished surfaces in order
to visualize metal and alloy microstructure. At the other extreme, there has been
extensive research on electro-polishing, which occurs at higher current densities, and
this is well covered in the classic text of Teggart.
In the early investigation of electrolytic etching for resin bonding, it was assumed
that factors critical in electropolishing were also critical in this technique. As we shall
see later in this chapter, this is not the case, and we are learning daily about this new
technology. There are a number of research projects being conducted at the University
of Maryland and at other universities to better understand the etching process.

40

Consequently, there are likely to be changes in the following technique as the dental
profession gains experience in this new area.
Laboratory procedures in etching
1. Complete the restoration
The restoration is completed prior to etching. All adjustments, characterization
and staining, glazing, and final polishing should have been finished. Adjustments and
polishing following etching can lead to contamination of the etched surface. Cleaning in
an ultrasonic bath with a soap solution and then thorough rinsing could remove this
contamination. However, the etched surface is quite friable and easily scratched with a
sharp instrument. Repeated try-ins with the inner surface of the casting etched are
definitely not recommended. The best procedure is to have all aspects of the restoration
completed prior to etching.

2. Mounting the restoration
The restoration is initially tacked to an electrode with a brittle sticky wax. Holding the
restoration and electrode in contact while tacking them with sticky wax is difficult. It is
best accomplished with the use of a "soldering assistant" for splints or for restorations
with pontics by placing the buccal or facial surface of the pontic into a mound of
modeling clay on the bench top, being careful not to allow the clay to contact the "wings"
of the retainer. This frees a hand for the mounting procedure.
The electrode can be any conductive metal. This is awkward since making metalto-metal contact at more than two points on the restoration is difficult due to the stiffness
of the rod. It is recommended that a less stiff electrode material such as no. 12 or no.
14-gauge copper wire be used. This is easily adjusted to make contact at two points on
a three-unit bridge and multiple contacts on more extensive cases. Multiple contacts on
extensive cases do not appear to be critical in the procedure, but they are routine. The
electrode to which the restoration is attached (the positive electrode) is to be masked
with a sticky wax or insulation and should never be in contact with the etching solution.
Thus it can be any conductive metal. One manufacturer of etching equipment (Time
Dental Laboratories, Baltimore, Maryland) routinely uses 0.036 inch diameter stainless
steel orthodontic wire as the electrode material. If any

portion of the electrode other

than the restoration is in contact with the etching solution, it will give false current

41

reading. The mounting electrode is also bent to allow the maximum surface area for
etching to be at right angles to the long axis of the electrode.
3. Assuring electrical contact
A conductive paint (Silversol, Hanau Teledyne Inc., Buffalo, New York) is then
applied with a brush at the contact points between the mounting electrode and the
restoration. This assures a broad electrical contact between these curved surfaces. It
also prevents the shrinkage of the sticky wax from opening the point contact. Any
conductive paint may be used. Do not allow the conductive paint to extend to a margin
or it will become the main current path and inhibit etching.
4. Masking the restoration
All areas of the restoration not to be etched are then masked with sticky wax, taking
special care that the wax is brought just to the margins. Any sharp margins that are
exposed will be preferentially etched due to the higher local current density. This results
in ragged margins. Remember that thorough masking of all areas (even porcelain)
is necessary in order to prevent loss of polish. (Note that the electrode must be
completely insulated also.)
This is a time-consuming procedure, and several alternative masking paints are
being evaluated which are essentially rubberized paints (e.g. Plating Mask, Yarter-Tech
Inc., Denver, Colorado). These masks are applied with a brush. After etching, they can
be peeled off the restoration or dissolved solvent.

Attaching to electrode

Metal immersed in electrolyte
solution

5. Cleaning areas to be etched
The surfaces of the restoration to be etched are routinely cleaned by air abrading
with 50 micron alumina, and rinsed with tap water. The margins are checked and sticky
wax reapplied to areas inadvertently exposed.

42

6. Determining the etching current
The total area on the restoration to be etched is estimated by comparing it to a
one square centimeter standard. An oblong piece of paper 5 mm x 20 mm is very
convenient. It is necessary to estimate the area to be etched in order to determine the
total amount of current to be passed through the etching solution. For instance, if the
current density called for in the etching formula is 300 ma/cm2 and the area to be
etched is estimated as 0.75 cm", then the current through the etching bath should be
0.75 x 300 = 225 milliamperes. It is better to underestimate the area to be etched (lower
current) than to overestimate (higher current) and perhaps get into the electropolishing
domain of the potentiostatic anode current density curve (Figure Vll-10). This will be
covered later. The suggested etching current densities have been selected to allow
some latitude in area estimation and still be assured of an adequate etch.
7. Electrode arrangement
Attach the electrode with the mounted restoration to the positive (anode) lead of
a low voltage DC power supply.
The remaining electrode (cathode) is then attached to the negative (-) lead of the
power supply. The cathode must be stainless steel. The cathode is bent at right angles
at the end of the shaft to allow a 1.5-2.0 cm length of the cathode to point toward the
anode. The spatial relationship of the anode to the cathode has not been found to
influence the etching process to any extent. This is quite the opposite of what is found in
pitting corrosion' and electropolishing. The electrode "clamp assembly" is manipulated to
position the cathode so that the end of the cathode is directed at the maximum surface
area of the restoration.
Inter-electrode distance is usually 1.5-2.0 cm. Since the resistance of the etching
solution changes with the length of the current path through the solution, increasing the
inter-electrode distance increases the voltage drop across the electrodes. Alternatively,
if a constant voltage is maintained, the current through the solution will decrease as the
inter-electrode distance is increased.
8. The etching process
Submerge the electrodes in the etching solution. Solutions are covered in the
next section. Following the manufacturer’s instructions for the utilization of the power
supply:

43

a) Turn the power on and adjust the current (milliamperes) to the level calculated based
on the current density necessary for the particular alloy. Begin to time the etching
process.
b) Check that the current level is maintained (it may fluctuate initially). The current need
only be maintained to within ± 20 ma for the average three- unit retainer and it is less
critical for larger cases.
c) The restoration should begin to turn dark and go to a black color within the first 30
seconds. Bubbles should form on the cathode and a yellow colored solution should form
around the restoration. If a large number of bubbles form on the restoration and it does
not turn black, the electrodes are reversed. Occasionally, a few bubbles may form on the
restoration, these can usually be displaced by tapping on the clamp assembly and they
should not reform.
d) At the end of the required etching time, turn the unit off and remove the electrode on
which the restoration is mounted, using caution to avoid skin contact with the acid. Rinse
with tap water and then observe the uniform black debris layer present on the etched
surface. Note that stirring of the etching bath is not mentioned. Del Castillo and
Thompson have recently investigated this and determined that there is no significant
difference in resin-to-alloy bond strength with stirring, with no stirring, or with ultrasonic
agitation of the solution during etching,
9. Cleaning the restoration
The restoration, still attached to the electrode, is placed in a closed container
with an 18% hydrochloric acid solution. Approximately 150 ml of fresh solution is
necessary for a three-unit retainer. The acid should not contact the exposed upper
portion of the electrode where it connected to the electrode clamp assembly. Place the
closed container in an ultrasonic cleaner for 10 minutes. When the ultrasonic cleaner is
first turned on, the debris layer will fall away from the etched surface as if black ink were
being released from the surface.
The cleaning is continued for approximately 10-15 minutes or until a uniform gray
surface appears. The electrode is removed carefully from the acid, rinsed, and
inspected. Ideally, the surface should appear a uniform gray. This can vary widely. In
general, Ni-Cr alloys give brighter, more uniformly metallic surfaces. On the other hand,
Ni-Cr-Be alloys tend to be a darker gray, which is due likely in part to optical effects
created by the much finer etched structure. In addition, Ni-Cr-Be alloys have been found

44

to have areas of brown or gray-black those are not cleaned away in the 18% HCl
solution. These discolored areas appear to be properly etched when viewed with the
SEM, and no debris layer remains. They may be due to chemical contaminants in the
etching solution. Bond strengths appear to be unaffected by this discoloration. The use
of 18% HCI solution can be questioned, as this is not substantiated in the literature.
Whether this is the optimal concentration for cleaning these various alloys has not been
determined. There is much research to be done in this area.
10. Checking the etch
It is necessary to check the alloy surface for characteristic etching patterns prior
to its separation from the electrode. Without a great deal of experience with a given
alloy, it will be impossible to determine the presence of a properly etched alloy surface
with the naked eye. It is strongly suggested that the etch be verified by observation of
the alloy surface at a minimum magnification of 60x. This is most conveniently and
accurately done with a stereomicroscope. A compound microscope can be used, but the
depth of field is so limited that verification of the etching pattern on the curved surfaces
of the retainers is difficult. To aid in visualization of the three- dimensional relief on the
surface, it is recommended that the light source be directed at a very shallow angle to
the surface to be observed. There are a number of stereomicroscopes on the market,
and it is felt that this is a wise purchase for a dental laboratory, as the microscope has
many other uses. If the etching pattern of the given alloy cannot be observed or is
limited to a few areas, the retainer should be returned to the etching solution for an
additional 60-90 seconds of etching and then cleaned again in HCI solution.
Once the etching pattern can be observed over approximately 90% or more of
the surface, etching should be stopped. The majority of cases will routinely etch
completely unless there is a gross underestimation of surface area with, therefore, a
very low current density.
Contaminants in the etching solution or on the alloy surface can also cause
problems. Any additional etching does not create more three-dimensional relief of the
surface but instead strips alloy from the surface. If this is continued, the etching can, in
time, perforate the retainer in thin areas.

45

11. Separating restoration and electrode
Removal of the restoration from the electrode is best achieved by chilling the
sticky wax in cold water and then breaking the restoration away from the electrode
under water. The sticky wax can be chipped away under water. This allows the wax to
float away and prevents it from becoming embedded in the etched alloy surface. If this is
not done, wax invariably gets into the etched surface and can only conveniently be
removed by steam cleaning. Once all the wax is removed and the restoration is dried, it
should be handled carefully in order to avoid contamination.
The etched casting should not be placed back on the master cast. Rather, the
restoration should be placed in a hard paper or plastic envelope. Packing directly in
cotton or soft fibrous materials is to be avoided as fibers become entangled in the
etched surface and nearly impossible to remove. The restoration is now ready for
bonding.

Etching in process

Etched metal

Etching apparatus
A variety of products have been manufactured to be self-contained power
supplies and timers for electrolytic etching of castings. It is helpful to bear .in mind that
the etching can be satisfactorily completed using a six-volt storage battery, a rheostat,
and a current meter. The next step up would be to purchase a low voltage DC power
supply with continuously variable current control between 100 mA to 1.5 mA and an
accurate current meter. Beyond this there are package systems with integral timers,
stirrers, and even integrated circuit controls with preprogrammed functions. Some
systems monitor only current, while some display both current and voltage. Others
monitor one or the other. Monitoring of voltage is not critical to the procedure, but it does
help to confirm that estimated area has not been grossly (two or three times)
overestimated. The following is helpful to remember: when in doubt monitor current, not
voltage. The reason for this will be covered in the section on factors in the etching
process.

46

Etching Solutions
The various etching solutions and conditions for selected alloys are given in
Tables below. The depth of etching pattern has been verified in the scanning electron
microscope. In making the etching solutions it is important that reagent grade acids be
used. It has been found, particularly for sulfuric acid etching, that the several varieties
of technical grade acid give very poorly etched surfaces with brown and red-brown
discolorations- The restorations and test disks,

when subsequently etched in

reagent grade acid solutions, gave excellent results.
The hydrochloric acid cleaning solution, which is consumed in considerable
quantity, can be made with technical grade acid.
Handling and storage of these solutions require some care. Contact with skin
and clothing is to be avoided, and closed unbreakable containers should be used as
much as possible. Observe good technique when diluting concentrated acid and always
add acid to water, rather than water to acid.

Factors in the etching process
In order to further investigate this previously described method of creating a
micromechanically retentive surface by electrolytic etching of non-precious alloys,
studies were initiated to elucidate the laboratory variables that influence the etching
process.
In order to better understand this process and compare it to the well-known
phenomenon of electropolishing, curves of current density vs. voltage were determined
for one representative alloy (Rexillium III, Jeneric Industries, Wallingford, Connecticut).
Below 2.7 volts and current densities less than approximately 600 ma/cm", etching
occurs.
As the voltage is increased, the current density falls and electropolishing is
observed at the edge of the sample. At higher voltages, the current rises again and
uniform electropolishing occurs. Note that over a narrow range of voltage (2.1-2.7 volts)
the current density changes from 50 ma/cm" to over 550 ma/cm. Based on this curve,
the etching current density of 300 ma/cm" was selected for this alloy. This allows for a
fair variation in the estimation of area to be etched while the current density is still within
the etching region. If only voltage is monitored, then as little as 0.2v change can alter the
current density by a factor of two, and either greatly prolong the etching time or, at
higher current densities, strip excessive amounts of alloy from the framework for a given

47

three-minute etching time. This also explains why the current drops substantially when
voltage is kept constant and inter-electrode distance is increased (increasing the
resistance).
A definite relationship between current density and etching time over the etching
portion of this curve has been verified by Del Castillo and Thompson. This is shown In
Table below, where the control etching conditions of 300 ma/cm2 for three minutes,
etching at 150 ma/cm

2

for six minutes and 600 ma/cm2 for one and one-half minutes

give equivalent bond strength values. At this higher current density, if area is misjudged
and over-estimated, it is easy to begin to electropolish the restoration.

Should the

concentration of the sulfuric acid solution be low, then the current density vs. voltage
curve is shifted to higher voltages. The resulting surface etched at 300 mA/cm2 for three
minutes has very poor surface relief and cannot be expected to give good bond strength
values.
1. Not stirring the etching bath gives higher bond strength values (not significant)
than control etching with stirring or ultrasonic agitation. Thus, ultrasonic agitation does
not increase bond strength.
2. Recast alloy gives significantly lower bond strength values and has a highly changed
etched morphology.
3. Orientation of the test disks relative to the cathode had little effect on bond strength
values, whether facing the cathode or facing in an opposite direction.
Ultrasonic agitation of the etching solution results in over etched dendritic arms of
the specimens. The significance of this is not clearly understood.

48

BONDING THE RESTORATION
Resin Cements
The first resin-bonded restorations described by Rochette, which were splints, were
held in place by a unfilled resin, poly(methyl methacrylate)(Sevriton), attached to
etched enamel, based on the work of Laswell et al. While a whole generation of resinbonded fixed partial dentures would bear the title of Rochette Bridge, they made use
only of the perforated retainers described by Rochette, ignoring the silane coupling with
which he augmented resin attachment to the metal framework.
Unfilled/filled composite resins

(Adaptic/Adaptic Bonding Agent, J&J Dental

Products Co, East Windsor, NJ, and Concise Composite and Enamel Bond System, 3M
Co, St Paul, MN'447) were used with perforated retainers. Then a modified unfilled/filled
composite resin with a thin film thickness specifically intended for luting resin-bonded
fixed partial dentures was released, closely following the development of electrolytic
etching.
The next step was "chemically active (adhesive) resin cements:
4META, or 4-methacryloxyethyl trimellitate anhydride (C&B Metabond, Parkeli Corp,
Farmingdale, NY) .It was developed with a unique tri-n-butylborane catalyst system that
is added to the liquid before combining with the powder. On base metal alloys Super
bond has the highest initial bond strengths of any adhesive resin system. Unfortunately
there is some concern about the hydrolytic stability of these bonds over time which
depends on the alloy‘s Ni-Cr ratio. Its advantages include:


Lower elastic modulus



Higher fracture toughness when compared to BIS-GMA based resin cements
which could result in less brittleness and better clinical results with less well
adapted castings.
This system has shown poor clinical results with bonding high gold alloy retainers

to abutment teeth. However alloy primers are being developed to provide more stable
bond to noble alloy surfaces.
Super Bond was followed by introduction of BIS-GMA based composite resin
luting cement that is modified with adhesion promoter MDP, or 10-methacryloytoxydecyl
dihydrogen phosphate (Panavia EX, Kuraray Co, Osaka, Japan). These cements rely on
adhesion to the metal and not on microretention in the surface of the metal for bond
strength. Etching was no longer necessary.
Panavia has excellent bonds to air abraded Ni-Cr and Co- Cr alloys.

50

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Acid etches bridges and its scope/certified fixed orthodontic courses by Indian dental academy