Adhesion to Zirconia: A Systematic Review of Surface Pretreatments and Resin Cements

Abstract

This systematic review aims to evaluate the different pretreatments of the zirconia surface and resin cement in order to determine a valid operative protocol for adhesive cementation. Methodologies conducted for this study followed the Prisma (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. An electronic search was performed in four databases. The established focus question was: “What type of surface conditioning method is the one that obtains the best adhesion values to zirconia over time by applying a resin cement?” Forty-five relevant papers were found to qualify for final inclusion. In total, 260 different surface pretreatment methods, mainly combinations of air-abrasion protocols and adhesive promoters, were investigated. Altogether, the use of two artificial aging methods, three types of cement and four testing methods was reported. The results showed that mechanicochemical surface pretreatments offered the best adhesive results. Self-adhesive cement and those containing 10-MDP obtained the best results in adhesion to zirconia. Artificial aging reduced adhesion, so storage in water for 30 days or thermocycling for 5000 cycles is recommended. A standardized adhesive protocol has not been established due to a lack of evidence

A comprehensive in vitro study on the performance of two different strategies to simplify adhesive bonding

“…13,14 Zirconia is air-abraded using alumina followed by application of a primer (10-methacryloyloxydecyl dihydrogen phosphate [MDP]) to generate chemical bonding. [15][16][17][18] Treatment of CAD/CAM polymer materials and composites strongly relies on their specific composition. This treatment usually consists of alumina air abrasion followed by application of methacrylates that can covalently bond to the resin matrix.…”

Effects of Different Airborne Particle Abrasion Protocols on the Surface Roughness and Shear Bonding Strength of High/Ultra-Translucent Zirconia to Resin Cement

“…A study evaluated the effects of different priming agents, including the 10-MDP primer used in this study, on the SBS of a resin cement with translucent zirconia and found that the 10-MDP primer resulted in a higher post-thermocycling bond strength in the case of all the tested resin cements [31]. In addition, a recent review that compared the efficacies of different zirconia surface pre-treatments found that the mechanochemical treatment of zirconia surfaces with a 10-MDP primer and a self-adhesive resin cement resulted in the highest adhesive strength [34]. The use of highly translucent dual-curing resin cements is supported by other studies as they exhibit a greater degree of polymerisation and higher bond strength compared with those of opaque or self-curing resin cements [31,35].…”

Effect of Thermocycling on the Bond Strength of Self-Adhesive Resin Cements Used for Luting CAD/CAM Ceramics to Human Dentin

“…These challenges remain since there is no unified protocol for simulating accelerated aging. The literature describes dynamic simulations [ 23 , 25 , 26 ] or the storage of samples in water baths at constant temperature [ 6 , 14 , 26 ]. Thermocycling is one of the most common methods to age the material; however, its parameters have not yet been unified.…”

“…Thermocycling is one of the most common methods to age the material; however, its parameters have not yet been unified. Comino-Garayoa et al conducted a systematic review analyzing 45 different papers, concluding that artificial aging should be based on 5000 thermal cycles or 30 days of continuous water bath [ 26 ]. Other systematic reviews [ 5 , 9 , 10 , 26 ] comparing parameters of thermocycling enable us to draw the general conclusion that a gradient of temperatures from 5 °C to 55 °C should be applied.…”

“…Comino-Garayoa et al conducted a systematic review analyzing 45 different papers, concluding that artificial aging should be based on 5000 thermal cycles or 30 days of continuous water bath [ 26 ]. Other systematic reviews [ 5 , 9 , 10 , 26 ] comparing parameters of thermocycling enable us to draw the general conclusion that a gradient of temperatures from 5 °C to 55 °C should be applied. These temperatures are also in accordance with the ISO TS 11405 Technical Specification for testing the adhesion to tooth structure.…”