Journal of Prosthetic Dentistry
Systematic Review| Volume 125, ISSUE 1, P56-64, January 2021

Does the application of an adhesive layer improve the bond strength of etched and silanized glass-ceramics to resin-based materials? A systematic review and meta-analysis

Published:February 19, 2020DOI:


      Statement of problem

      A consensus on whether to use an adhesive layer on glass-ceramics after etching with hydrofluoric acid and applying a silane-coupling agent is lacking.


      The purpose of this systematic review and meta-analysis was to determine whether adhesive layer application after etching and silanization influences the bond strength values of glass-ceramics to resin-based materials.

      Material and methods

      PubMed, ISI Web of Science, and Scopus electronic databases were searched to select in vitro studies comparing bond strength values of etched and silanized glass-ceramics bonded with or without an adhesive layer. No publication year or language restriction was applied. Data sets were extracted, and the mean differences were applied by using the Rev Man 5.3 program. The association between bond strength (shear/microshear or tensile/microtensile) and an adhesive layer application on nonaged and aged specimens was analyzed.


      Of 4727 potentially eligible studies, 54 were selected for full-text analysis, and 15 were included for qualitative synthesis; of these, 14 were used in the meta-analysis. A total of 2 meta-analyses were performed with heterogeneity varying from high to moderate among study specimens. For shear/microshear studies, both nonaged (MD, 1.36 [95% CI: -0.18, 2.90], P=.080, I2=79%) and aged (MD, 0.89 [95% CI: -1.04, 2.82], P=.370, I2=80%) specimens presented no statistically significant difference between groups bonded with or without an adhesive layer application. For microtensile studies, both nonaged (MD, -1.49 [95% CI: -2.48, -0.50], P=.003, I2=88%) and aged (MD, -3.87 [95% CI: -5.63, -2.11], P<.001, I2=97%) specimens exhibited higher values without an adhesive application.


      Regardless of the bond strength test used, an adhesive layer application did not improve the bond strength of etched and silanized glass-ceramics to resin-based materials. The influence of this adhesive layer application should be evaluated under clinical conditions.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Prosthetic Dentistry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sundfeld Neto D.
        • Naves L.Z.
        • Costa A.R.
        • Correr A.B.
        • Consani S.
        • Borges G.A.
        • et al.
        The effect of hydrofluoric acid concentration on the bond strength and morphology of the surface and interface of glass ceramics to a resin cement.
        Oper Dent. 2015; 40: 470-479
        • Cardenas A.M.
        • Siqueira F.
        • Hass V.
        • Malaquias P.
        • Gutierrez M.F.
        • Reis A.
        • et al.
        Effect of MDP-containing silane and adhesive used alone or in combination on the long-term bond strength and chemical interaction with lithium disilicate ceramics.
        J Adhes Dent. 2017; 19: 203-212
        • El Zohairy A.A.
        • De Gee A.J.
        • Mohsen M.M.
        • Feilzer A.J.
        Microtensile bond strength testing of luting cements to prefabricated CAD/CAM ceramic and composite blocks.
        Dent Mater. 2003; 19: 575-583
        • Reich S.M.
        • Wichmann M.
        • Frankenberger R.
        • Zajc D.
        Effect of surface treatment on the shear bond strength of three resin cements to a machinable feldspatic ceramic.
        J Biomed Mater Res B Appl Biomater. 2005; 74: 740-746
        • Lührs A.K.
        • De Munck J.
        • Geurtsen W.
        • Van Meerbeek B.
        Composite cements benefit from light-curing.
        Dent Mater. 2014; 30: 292-301
        • El-Damanhoury H.M.
        • Gaintantzopoulou M.D.
        Self-etching ceramic primer versus hydrofluoric acid etching: etching efficacy and bonding performance.
        J Prosthodont Res. 2018; 62: 75-83
        • Stewart G.P.
        • Jain P.
        • Hodges J.
        Shear bond strength of resin cements to both ceramic and dentin.
        J Prosthet Dent. 2002; 88: 277-284
        • Peumans M.
        • Hikita K.
        • De Munck J.
        • Van Landuyt K.
        • Poitevin A.
        • Lambrechts P.
        Effects of ceramic surface treatments on the bond strength of an adhesive luting agent to CAD-CAM ceramic.
        J Dent. 2007; 35: 282-288
        • Passos S.P.
        • Valandro L.F.
        • Amaral R.
        • Özcan M.
        • Bottino M.A.
        • Kimpara E.T.
        Does adhesive resin application contribute to resin bond durability on etched and silanized feldspathic ceramic?.
        J Adhes Dent. 2008; 10: 455-460
        • Lise D.P.
        • Perdigão J.
        • Van Ende A.
        • Zidan O.
        • Lopes G.C.
        Microshear bond strength of resin cements to lithium disilicate substrates as a function of surface preparation.
        Oper Dent. 2015; 40: 524-532
        • Elsayed A.
        • Younes F.
        • Lehmann F.
        • Kern M.
        Tensile bond strength of so-called universal primers and universal multimode adhesives to zirconia and lithium disilicate ceramics.
        J Adhes Dent. 2017; 19: 221-228
        • Murillo-Gómez F.
        • Rueggeberg F.A.
        • De Goes M.F.
        Short- and long-term bond strength between resin cement and glass-ceramic using a silane containing universal adhesive.
        Oper Dent. 2017; 42: 514-525
        • Naves L.Z.
        • Soares C.J.
        • Moraes R.R.
        • Gonçalves L.S.
        • Sinhoreti M.A.C.
        • Correr-Sobrinho L.
        Surface/interface morphology and bond strength to glass ceramic etched for different periods.
        Oper Dent. 2010; 35: 420-427
        • El Zohairy A.A.
        • De Gee A.J.
        • Hassan F.M.
        • Feilzer A.J.
        The effect of adhesives with various degrees of hydrophilicity on resin ceramic bond durability.
        Dent Mater. 2004; 20: 778-787
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Int J Surg. 2010; 8: 336-341
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • Mulrow C.
        • Gøtzsche P.C.
        • Ioannidis J.P.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.
        J Clin Epidemiol. 2009; 62: e1-e34
        • Rosa W.L.
        • Piva E.
        • Silva A.F.
        Bond strength of universal adhesives: a systematic review and meta-analysis.
        J Dent. 2015; 43: 765-776
        • Sarkis-Onofre R.
        • Skupien J.A.
        • Cenci M.S.
        • Moraes R.R.
        • Pereira-Cenci T.
        The role of resin cement on bond strength of glass-fiber posts luted into root canals: a systematic review and meta-analysis of in vitro studies.
        Oper Dent. 2013; 39: 31-44
        • Magno M.B.
        • Neves A.B.
        • Ferreira D.M.
        • Pithon M.M.
        • Maia L.C.
        The relationship of previous dental trauma with new cases of dental trauma. A systematic review and meta-analysis.
        Dent Traumatol. 2019; 35: 3-14
        • Fernandes L.M.
        • Neto J.C.L.
        • Lima T.F.R.
        • Magno M.B.
        • Santiago B.M.
        • Cavalcanti Y.W.
        • et al.
        The use of mouthguards and prevalence of dento-alveolar trauma among athletes: a systematic review and meta-analysis.
        Dent Traumatol. 2019; 35: 54-72
        • Ferreira R.O.
        • Corrêa M.G.
        • Magno M.B.
        • Almeida APCPSC
        • Fagundes N.C.F.
        • Rosing C.K.
        • et al.
        Physical activity reduces the prevalence of periodontal disease: systematic review and meta-analysis.
        Front Physiol. 2019; 10: 234
      1. Higgins J.P.T. Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011 (Available at:) (Accessed October 1, 2018)
        • Borenstein M.
        • Hedges L.V.
        • Higgins J.P.T.
        • Rothstein H.R.
        Introduction to meta-analysis.
        John Wiley & Sons, Ltd, Chichester2009: 311-319
        • Higgins J.P.T.
        • Thompson S.G.
        Quantifying heterogeneity in a metaanalysis.
        Stat Med. 2002; 21: 1539-1558
        • Stangel I.
        • Nathanson D.
        • Hsu C.S.
        Shear strength of the composite bond to etched porcelain.
        J Dent Res. 1987; 66: 1460-1465
        • Romanini-Junior J.C.
        • Kumagai R.Y.
        • Ortega L.F.
        • Rodrigues J.A.
        • Cassoni A.
        • Hirata R.
        • et al.
        Adhesive/silane application effects on bond strength durability to a lithium disilicate ceramic.
        J Esthet Restor Dent. 2018; 30: 346-351
        • Sebben J.
        • Canevese V.A.
        • Alessandretti
        • Pereira G.K.R.
        • Sarkis-Onofre R.
        • Bacchi A.
        • et al.
        Effect of surface coating on bond strength between etched feldspar ceramic and resin-based luting agents.
        Biomed Res Int. 2018; 2018: 3039251
        • Al-Thagafi R.
        • Al-Zordk W.
        • Saker S.
        Influence of surface conditioning protocols on reparability of CAD/CAM zirconia-reinforced lithium silicate ceramic.
        J Adhes Dent. 2016; 18: 135-141
        • Estafan D.
        • Dussetschleger F.
        • Estafan A.
        • Jia W.
        Effect of prebonding procedures on shear bond strength of resin composite to pressable ceramic.
        Gen Dent. 2000; 48: 412-416
        • Inokoshi M.
        • De Munck J.
        • Minakuchi S.
        • Van Meerbeek B.
        Meta-analysis of bonding effectiveness to zirconia ceramics.
        J Dent Res. 2014; 93: 329-334
        • Kalavacharla V.K.
        • Lawson N.C.
        • Ramp L.C.
        • Burgess J.O.
        Influence of etching protocol and silane treatment with a universal adhesive on lithium disilicate bond strength.
        Oper Dent. 2015; 40: 372-378
        • Walker E.
        • Hernandez A.V.
        • Kattan M.W.
        Meta-analysis: its strengths and limitations.
        Cleve Clin J Med. 2008; 75: 431-439
        • Melsen W.G.
        • Bootsma M.C.J.
        • Rovers M.M.
        • Bonten M.J.M.
        The effects of clinical and statistical heterogeneity on the predictive values of results from meta-analyses.
        Clin Microbiol Infect. 2014; 20: 123-129