Journal of Prosthetic Dentistry

Which surface treatment promotes higher bond strength for the repair of resin nanoceramics and polymer-infiltrated ceramics? A systematic review and meta-analysis

Published:February 09, 2021DOI:


      Statement of problem

      Which surface treatment provides the optimal bond strength (BS) for the repair of resin nanoceramics (RNCs) and polymer-infiltrated ceramics (PICs) is unclear.


      The purpose of this systematic review and meta-analysis of in vitro studies was to determine the best surface treatment protocols for the repair of PICs and RNCs.

      Material and methods

      The PubMed, Scopus, and Web of Science electronic databases were searched to select in vitro studies in English up to March 2020. Studies with fewer than 5 specimens, those that did not evaluate the BS of PICs or RNCs, and those with aging for fewer than 30 days and 5000 cycles were excluded. Data sets were extracted, and the mean differences were analyzed by using a systematic review software program.


      Among 284 potentially eligible studies, 21 were selected for full-text analysis, and 9 were included in the systematic review, of which 6 were used in the meta-analysis. The meta-analyses were performed for each treatment surface versus their respective control group and their combinations according to material: RNCs and PICs. For RNCs, airborne-particle abrasion with aluminum oxide (Al2O3) treatment was statistically higher than tribochemical silica airborne-particle abrasion (CoJet) (P=.02, I2=90%) and that in the hydrofluoric acid (HF) (P<.001, I2=0%) groups and was statistically similar to diamond rotary instrument grinding (P=.40, I2=54%). For PICs, the treatment with hydrofluoric acid (HF) was statistically significantly higher than with CoJet (P=.03, I2=62%) and airborne-particle abrasion with Al2O3 (P<.001, I2=98%).


      The best surface treatment protocol for repair varied according to the restorative material. HF followed by silanization is suggested for PICs, and airborne-particle abrasion with Al2O3 or preparation with a diamond rotary instrument for RNCs.
      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


        • Giordano R.
        Materials for chairside CAD/CAM produced restorations.
        J Am Dent Assoc. 2006; 137: 14S-21S
        • Roggendorf M.J.
        • Kunzi B.
        • Ebert J.
        • Roggendorf H.C.
        • Frankenberger R.
        • Reich S.M.
        Seven-year clinical performance of CEREC-2 all-ceramic CAD/CAM restorations placed within deeply destroyed teeth.
        Clin Oral Investig. 2012; 16: 1413-1424
        • Stawarczyk B.
        • Liebermann A.
        • Eichberger M.
        • Güth J.F.
        Evaluation of mechanical and optical behavior of current esthetic dental restorative CAD/CAM composites.
        J Mech Behav Biomed Mater. 2015; 55: 1-11
        • Coldea A.
        • Swain M.V.
        • Thiel N.
        Mechanical properties of polymer-infiltrated-ceramic-network materials.
        Dent Mater. 2013; 29: 419-426
        • Secilmis A.
        • Ustun O.
        • Buyukhatipoglu I.K.
        Evaluation of the shear bond strength of two resin cements on different CAD/CAM materials.
        J Adhes Sci Technol. 2016; 30: 83-93
        • Sonmez N.
        • Gultekin P.
        • Turp V.
        • Akgungor G.
        • Sen F.
        • Mijiritsky E.
        Evaluation of five CAD/CAM materials by microstructural characterization and mechanical tests: a comparative in vitro study.
        BMC Oral Health. 2018; 18: 1-5
        • Veríssimo A.H.
        • Moura D.M.D.
        • Dal Piva A.M.O.
        • Bottino M.A.
        • Campos M.F.A.
        • Carreiro A.F.P.
        • et al.
        Effect of different repair methods on the bond strength of resin composite to CAD/CAM materials and microorganisms adhesion: an in situ study.
        J Dent. 2020; 93: 103-166
        • Belli R.M.
        • Wendler M.R.D.
        • de Ligny D.
        • Cicconi M.R.
        • Petschelt A.
        • Peterlik H.
        • et al.
        Chairside CAD/CAM materials. Part 1: measurement of elastic constants and microstructural characterization.
        Dent Mater. 2017; 33: 84-98
        • Tunac A.T.
        • Celik E.U.
        • Yasa B.
        Two-year performance of CAD/CAM fabricated resin composite inlay restorations: a randomized controlled clinical trial.
        J Esthet Restor Dent. 2019; 31: 627-638
        • Lu T.
        • Peng L.
        • Xiong F.
        • Lin X.Y.
        • Zhang P.
        • Lin Z.T.
        • et al.
        A 3-year clinical evaluation of endodontically treated posterior teeth restored with two different materials using the CEREC AC chair-side system.
        J Prosthet Dent. 2018; 119: 363-368
        • Rodrigues Jr., S.A.
        • Ferracane J.L.
        • Della Bona A.
        Influence of surface treatments on the bond strength of repaired resin composite restorative materials.
        Dent Mater. 2009; 25: 442-451
        • Batista G.R.
        • Kamozaki M.B.
        • Gutierrez N.C.
        • Caneppele T.M.
        • Torres C.R.
        Effects of different surface treatments on composite repairs.
        J Adhes Dent. 2015; 17: 421-426
        • Stawarczyk B.
        • Basler T.
        • Ender A.
        • Roos M.
        • Ozcan M.
        • Hämmerle C.
        Effect of surface conditioning with airborne-particle abrasion on the tensile strength of polymeric CAD/CAM crowns luted with self-adhesive and conventional resin cements.
        J Prosthet Dent. 2012; 107: 94-101
        • Schwenter J.
        • Schmidli F.
        • Weiger R.
        • Fischer J.
        Adhesive bonding to polymer infiltrated ceramic.
        Dent Mater J. 2016; 35: 796-802
        • Güngör M.B.
        • Nemli S.K.
        • Bal B.T.
        • Ünver S.
        • Doğan A.
        Effect of surface treatments on shear bond strength of resin composite bonded to CAD/CAM resin-ceramic hybrid materials.
        J Adv Prosthodont. 2016; 8: 259-266
        • Elsaka S.E.
        Repair bond strength of resin composite to a novel CAD/CAM hybrid ceramic using different repair systems.
        Dent Mater J. 2015; 34: 161-167
        • Bonfante E.A.
        • Suzuki M.
        • Hirata R.
        • Bonfante G.
        • Fardin V.P.
        • Coelho P.G.
        Resin composite repair for implant-supported crowns.
        J Biomed Mater Res B Appl Biomater. 2017; 105: 1481-1489
        • Üstün Ö.
        • Büyükhatipoğlu I.K.
        • Seçilmiş A.
        Shear bond strength of repair systems to new CAD/CAM restorative materials.
        J Prosthodont. 2018; 27: 748-754
        • Duzyol M.
        • Sagsoz O.
        • Polat Sagsoz N.
        • Akgul N.
        • Yildiz M.
        The effect of surface treatments on the bond strength between CAD/CAM blocks and composite resin.
        J Prosthodont. 2016; 25: 466-471
        • Nogueira I.O.
        • Oliveira P.F.G.
        • Magno M.B.
        • Ferreira D.M.T.P.
        • Maia L.C.
        • Rabello T.B.
        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.
        J Prosthet Dent. 2020; 125: 56-64
        • Moher D.
        • Shamseer L.
        • Clarke M.
        • Ghersi D.
        • Liberati A.
        • Petticrew M.
        • et al.
        Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.
        Syst Rev. 2015; 4: 1
        • 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. 2014; 39: 31-44
        • Pereira G.K.R.
        • Fraga S.
        • Montagner A.F.
        • Soares F.Z.M.
        • Kleverlaan C.J.
        • Valandro L.F.
        The effect of grinding on the mechanical behavior of Y-TZP ceramics: a systematic review and meta-analyses.
        J Mech Behav Biomed Mater. 2016; 63: 417-442
        • Özcan M.
        • Volpato C.Â.
        Surface conditioning and bonding protocol for nanocomposite indirect restorations: how and why?.
        J Adhes Dent. 2016; 18: 82
        • Bona A.D.
        Important aspects of bonding resin to dental ceramics.
        J Adhes Sci Technol. 2009; 23: 7-8
        • Baur V.
        • Ilie N.
        Repair of dental resin-based composites.
        Clin Oral Investig. 2013; 17: 601-608
        • Campos F.
        • Almeida C.S.
        • Rippe M.P.
        • de Melo R.M.
        • Valandro L.F.
        • Bottino M.A.
        Resin bonding to a hybrid ceramic: effects of surface treatments and aging.
        Oper Dent. 2016; 41: 1718
        • Frankenberger R.
        • Hartmann V.E.
        • Krech M.
        • Krämer N.
        • Reich S.
        • Braun A.
        • et al.
        Adhesive luting of new CAD/CAM materials.
        Int J Comput Dent. 2015; 18: 9-20
        • Wahsh M.M.
        • Ghallab O.H.
        Influence of different surface treatments on microshear bond strength of repair resin composite to two CAD/CAM esthetic restorative materials.
        Tanta Dent J. 2015; 12: 178-184
        • Wu X.
        • Xie H.
        • Meng H.
        • Yang L.
        • Chen B.
        • Chen Y.
        • et al.
        Effect of tribochemical silica coating or multipurpose products on bonding performance of a CAD/CAM resin-based material.
        J Mech Behav Biomed Mater. 2019; 90: 417-425
        • Çelik E.
        • Sahin S.C.
        • Dede D.Ö.
        Shear bond strength of nanohybrid composite to the resin matrix ceramics after different surface treatments.
        Photomed Laser Surg. 2018; 36: 424-430
        • Bello Y.D.
        • Di Domenico M.B.
        • Magro L.D.
        • Lise M.W.
        • Corazza P.H.
        Bond strength between composite repair and polymer-infiltrated ceramic-network material: effect of different surface treatments.
        J Esthet Restor Dent. 2019; 31: 275-279
        • Higgins J.P.T.
        • Thompson S.G.
        Quantifying heterogeneity in a meta-analysis.
        Stat Med. 2002; 21: 1539-1558
        • Wiegand A.
        • Stucki L.
        • Hoffmann R.
        • Attin T.
        • Stawarczyk B.
        Repairability of CAD/CAM high density PMMA and composite-based polymers.
        Clin Oral Investig. 2015; 19: 2007-2013
        • Stawarczyk B.
        • Krawczuk A.
        • Ilie N.
        Tensile bond strength of resin composite repair in vitro using different surface preparation conditionings to an aged CAD/CAM resin nanoceramic.
        Clin Oral Investig. 2015; 19: 299-308
        • Subaşı M.G.
        • Alp G.
        Repair bond strengths of non-aged and aged resin nanoceramics.
        J Adv Prosthodont. 2017; 9: 364-370
        • Tatar N.
        • Ural C.
        Repair success of two innovative hybrid materials as a function of different surface treatments.
        Int J Prosthodont. 2018; 31: 267-270
        • Loomans B.
        • Mesko M.
        • Moraes R.R.
        • Ruben J.
        • Bronkhorst E.M.
        • Pereira-Cenci T.
        • et al.
        Effect of different surface treatment techniques on the repair strength of indirect composites.
        J Dent. 2017; 59: 18-25
        • Silva P.N.F.D.
        • Lobo C.M.M.
        • Bottino M.A.
        • Melo R.M.
        • Valandro L.F.
        Bond strength between a polymer-infiltrated ceramic network and a composite for repair: effect of several ceramic surface treatments.
        Braz Oral Res. 2018; 32: e28
        • Raposo L.H.
        • Neiva N.A.
        • da Silva G.R.
        • Carlo H.L.
        • da Mota A.S.
        • do Prado C.J.
        • et al.
        Ceramic restoration repair: report of two cases.
        J Appl Oral Sci. 2009; 17: 140-144
        • Ozcan M.
        • Niedermeier W.
        Clinical study on the reasons for and location of failures of metal-ceramic restorations and survival of repairs.
        Int J Prosthodont. 2002; 15: 299-302
        • Gourav R.
        • Ariga P.
        • Jain A.R.
        • Philip J.M.
        Effect of four different surface treatments on shear bond strength of three porcelain repair systems: an in vitro study.
        J Conserv Dent. 2013; 16: 208-212
        • Rossato D.M.
        • Bandeca M.C.
        • Saade E.G.
        • Lizarelli R.F.Z.
        • Bagnato V.S.
        • Saad J.R.C.
        Influence of Er.YAG laser on surface treatment of aged composite resin to repair restoration.
        Oper Dent. 2013; 38: 1-9
        • Ferracane J.L.
        Hygroscopic and hydrolytic effects in dental polymer networks.
        Dent Mater. 2006; 22: 211-222
        • Elsaka S.E.
        Influence of surface treatments on bond strength of metal and ceramic brackets to a novel CAD/CAM hybrid ceramic material.
        Odontology. 2016; 104: 68-76
        • Özcan M.
        • Cura C.
        • Brendeke J.
        Effect of aging conditions on the repair bond strength of a microhybrid and a nanohybrid resin composite.
        J Adhes Dent. 2010; 12: 451-459
        • Özcan M.
        • Alander P.
        • Vallittu P.K.
        • Huysmans M.C.
        • Kalk W.
        Effect of three surface conditioning methods to improve bond strength of particulate filler composite resins.
        J Mater Sci Mater Med. 2005; 16: 21-27