If your all-ceramic restoration has a glassy matrix (e.g. lithium disilicate), than you’re in luck! Forget about traditional cement and welcome to the world of resin cement. You have the ability to bond for added retention. For a full discussion of the kinds of ceramics, check out this post.
I like self-etch cements for this kind of work because they offer more strength than self-adhesive cements but less post-operative sensitivity than total-etch cements. For a full discussion of the kinds of resin cements out there, check out this post.
So here’s a case where #29 had a large amalgam with recurrent decay. I excavated the caries, took an impression, and placed Fermit as a temporary restoration. When the patient returned for the insert, I removed the Fermit and took this picture:
Note that the preparation would be too large for a composite restoration.
(1) I try in the e.max inlay and ensure proper marginal fit. You’ll need to decontaminate the restoration before bonding, so use some etch again. If the lab already used hydrofluoric acid, you can just re-etch with regular phosphoric acid. If the lab has not used hydrofluoric acid yet, then now is the time!
(2) Okay, time to get down to business. We need to make our inlay sticky. That job belongs to a silane coupling agent. I use Monobond Plus (Ivoclar). If you get the Multilink Automix kit, the Monobond Plus will be included. Paint on some Monobond Plus and allow to air dry. No curing needed.
A dab will do ya.
(3) Now let’s make our tooth sticky. This is the self-etch part of the show. Mix primers A and B and apply to the tooth. Again, no curing needed.
Multilink Primer A and Primer B mixed and painted. Use rubber dam if unable to isolate adequately.
(4) Almost done! Now apply the Multilink Automix resin cement to the restoration. This is a dual-cure cement, meaning it will cure on its own but it can be accelerated with a curing light.
(5) Once seated intra-orally, I first floss to remove any interproximal cement. Next I do a quick cure ( about 2 seconds) of the excess to make picking it off easier.
Only about 2 seconds from each side!
(6) Polish up and call it a day.