Thank you for reading the magazine so closely!
That actually is not a mistake, although it’s very easy to see why you came to that conclusion. This is one of the more confusing areas of dentistry recently, although I will shoulder the blame for this one.
When I initially began using Ceramir, I noticed that it contains phosphates and assumed that was the mechanism through which it bonded to zirconia oxide. Six months later, the company heard me say that and corrected me. Even though there are phosphates in the cement, they are in such a tiny amount that they have nothing to do with how Ceramir bonds to zirconia oxide.
In short, you do not need to use the Ivoclean prior to using Ceramir. Since the mechanism of bonding between the Ceramir and the zirconia oxide is based on hydrophilicity and nanocrystalline formation (as opposed to phosphate groups), the salivary phosphates that attach to the internal aspect of a zirconia oxide crown do not affect Ceramir. If you were to use Ivoclean prior to Ceramir, it would not help anything, nor would it hurt anything — you would just be wasting a dollar or two. Zirconia primers such as Z-PRIME™ Plus (BISCO; Schaumburg, Ill.), however, will cause a large decrease in bond strength if placed on a zirconia oxide crown prior to Ceramir cementation. Ceramir is unique in its ability to be used without any additional treatment (cleaning or priming) of the zirconia oxide crown, and once you see how easy it is to clean up, there is a good chance it will become your everyday cement, like it has for me. I just cemented a BruxZir crown this morning with Ceramir and even had to remind my assistant that she didn’t need to use the Ivoclean and the Z-PRIME Plus.
Any cement with a resin component, such as an RMGI (RelyX™ Luting Plus [3M™ ESPE™; St. Paul, Minn.] and GC FujiCEM™ [GC America Inc.; Alsip, Ill.]), self-adhesive (RelyX™ Unicem [3M ESPE] and Maxcem Elite™ [Kerr; Orange, Calif.]), self-etch (Multilink® Automix [Ivoclar Vivadent] and Panavia™ [Kuraray Dental; New York, N.Y.]) or etch-andrinse (Nexus® [Kerr] and Variolink® [Ivoclar Vivadent]) needs to be cleaned after try-in with either Ivoclean or sandblasting. The internal portion of the zirconia oxide crown then needs to be treated with a zirconia primer, such as Z-PRIME Plus or Monobond Plus (Ivoclar Vivadent).
Lastly, you can also place Z-PRIME Plus inside the crown prior to try-in, make any adjustments, rinse and dry the crown when finished, and then cement it with any resin-containing cement without adding any more Z-PRIME Plus, or using Ivoclean or sandblasting. The hydrophilic end of the Z-PRIME Plus molecule with the phosphate groups attach to the zirconia oxide crown, and the hydrophobic end of the molecule keeps the saliva from interacting with the inside of the crown. That’s why you can simply rinse it off after try-in and go straight to cementation.
Hope that helps!