Review: Why Catapult Group evaluators would convert to Bisco's DUO-LINK

Is DUO-LINK different enough in the adhesive cement market to convert them to users? The overwhelming response was yes and the key was the handling.

Final cementation of a single or group of indirect restorations is the culmination of hard work in tooth preparation, accurate impression making, provisionalization with tissue management, technical lab work and artistry, and proximal and occlusal contact adjustments.

The grand finale is proper cementation of your adhesive or cohesive restoration(s).

Graham (2012) listed several contemporary considerations:

• Cementation of indirect restorations

• Long-term permanent seal, i.e. long-term stability and minimal degradation

• Inhibit caries and plaque

• No microleakage

• Biocompatible, both internally and externally

• Low solubility

• Strong physical properties such as flexural and compressive strengths

• Thin film thickness

• Universal usage for all ceramic and metal crowns

• Good working and setting times for single and multiple units

• High retention

• Easy cleanup

• Long term studies

Given the crowded market of cement choices and the multitude of restorative options (metal; porcelain fused to metal; all-ceramic zirconia or lithium disilicate), the Catapult Group was asked to review Bisco’s DUO-LINK UNIVERSAL cement, which is its newer and improved version of a composite resin cement that the manufacturer reports offers improved radiopacity; improved film thickness and setting time; and a higher degree of conversion (cure) after 15 minutes of seating and much easier clean-up of excess cement.

The question posed to the Catapult Group is: Is DUO-LINK different enough in the adhesive cement market to convert them to users? The overwhelming response was yes and the key was the handling.

More than 90% of the evaluators would incorporate this DUO-LINK into their practices. This, without question, is an outstanding response to this cement product.

Catapult Group evaluation

What evaluators looked for:

• By far, the most important area to assess for resin cements was the ability to remove excess cement.

• This was closely followed by characteristics such as: physical properties, flowability, working time, seating time, film thickness, and delivery system. All were indicative that usability and predictability were highly important to the clinicians.

• Choices in shades were also of importance to the evaluators.

Features and benefits

• Universally strong for all indications

• Bonds to all substrates with extremely high bond strengths

• Indications include: crowns, bridges (fixed prostheses), onlays, inlays, and posts/dowels, fabricated from metal, composite, porcelain, ceramic, zirconia, alumina, CAD/CAM restorations, etc.

• Extremely easy clean-up because it is precisely formulated to allow for quick and easy removal of excess cement

• It’s highly radiopaque and can be easily identified on radiograph for quick and effective diagnosis

• Easy to use automix, dual-syringe provides a consistent mix for immediate delivery

• New shades for increased universality

• Universal (A2) shade can be used with most restorations and has some translucency at low film thickness

• Milky White shade is more opaque and can be used to mask darker tooth preps

Evaluator findings

1. Removal of excess cement was deemed good to easy by 55% of the evaluators. Using a tacking tip or the flash cure technique (2 seconds from 3 inches) aids in easy removal. Evaluators found this extended gel phase to be better than the previous version of DUO-LINK.

2. Film thickness was seen by 95% of the evaluators as close to ideal. Sounds simple, but all too often easy seating can be prevented by a cement that is too thick and if it’s too thin, then it’s an issue of being too runny and difficult to clean.

3. Flowability impacts the placement of cement into the crowns. More than 86% of the clinicians found this product was “just right.”

4. The working and setting time are also critical issues and these were favorably evaluated with the vast majority of the group, who said it offered plenty of time for up to a few crowns. More than 81% felt the working time was just right for single crowns and 61% for bridges. With almost 70% giving a good to excellent rating for the setting time, positive feedback on these issues make bonding or two to three units at a time much more predictable and stress-free.

5. Finally, the appearance of the shades was again positively seen with both the Milky White and Universal with good to excellent responses for 66% and 86% respectively.

Conclusions

Given the statistics, more than 90% of the evaluators would incorporate this DUO-LINK into their practices. Clearly the focused development and hard work put into this product by Bisco’s developers has resulted in an outstanding product. Two key tips from the manufacturer:

• To avoid incompatibility, it is recommended to avoid using different bonding systems with different resin cements. Therefore, using All Bond Universal (with a film thickness < 10μm) is suggested to optimize results, however DUO-LINK Universal is compatible with most adhesives.

• Bisco research shows that a separate pure silane primer (such as Porcelain Primer or Bis Silane) for porcelain/lithium disilicate and separate metal oxide primer for zirconia (such as Z-Prime) results in better long-term durability of the bond.

• Lastly, based on clinical experience with other products by many Catapult members, careful isolation technique and temperature/moisture control will result in better handling properties and clinical results.