Impact of surface pre-treatment on bond strength between cement and zirconia: A systematic review and network meta-analysis

Abstract

Statement of problem: The optimal zirconia pretreatment, contingent upon the type of cement used, warrants further research.

Purpose: The purpose of this investigation was to evaluate the influence of various surface pretreatments on the bonding efficacy of cement to zirconia.

Material and methods: A comprehensive search was conducted across the PubMed, Embase, Scopus, and Web of Science databases for in vitro studies related to bonding with zirconia up to April 2024, supplemented by a manual search. A network meta-analysis was executed to compare different types of cement.

Results: Of the 6118 articles screened, 21 were selected for inclusion in this review. These studies examined various surface pretreatment techniques, primers, resin cements, aging protocols, and bond strength testing methods. The highest bond strengths were observed with 10-methacryloyloxydecyl dihydrogen phosphate (MDP)-based cements. The network meta-analysis indicated that mechanical and mechano-chemical pretreatments yielded superior results across all cement types.

Conclusions: The existing evidence indicates that both surface pretreatments and the specific type of cement should be considered when interpreting the findings of in vitro studies for their application in clinical practice.