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

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. PURPOSE: 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. RESULTS: 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%). CONCLUSIONS: 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.

Effect of Thickness, Processing Technique and Cooling Rate Protocol on the µTBS of a Bilayer Ceramic System.

PURPOSE: To evaluate the influence of different processing techniques, ceramic thicknesses, and cooling rate protocols on the µTBS of a veneering ceramic to zirconia (Y-TZP). MATERIALS AND METHODS: Eighty Y-TZP ceramic blocks (VITA In-Ceram 2000) with dimensions of 10 x 7 x 5 mm were obtained. The blocks were sintered in a special furnace at 1500° for 2 h, wet ground, and divided into 8 groups according to the factors "processing technique" (P: pressed/veneering ceramic PM9; or V: layered/ veneering ceramic VM9), "thickness" (2 mm and 4 mm), and "cooling protocol" (S: slow [10°C/s]; F: fast [50°C/s]). The Y-TZP/veneering ceramic blocks were sectioned to produce non-trimmed bar specimens (bonded area: 1±0.1 mm2), which were submitted to 1200 thermal cycles (5°C and 55°C, 30-s dwell time) and stored for 1 week in distilled water (37°C) before microtensile testing in a universal test machine (EMIC, 1 mm/min). The data in MPa were analyzed statistically using three-way ANOVA and Tukey's test. RESULTS: ANOVA revealed that only the factor processing technique was significant (p=0.015), unlike the factors thickness (p=0.111) and cooling protocol (p=0.202). The majority of the failures were classified as adhesive. CONCLUSION: Layered application of a thin veneering ceramic using a fast cooling rate resulted in improved bonding between veneering ceramic and zirconia.