Bond strength of resin composite to glass-based, oxide, and polymer-infiltrated ceramics after different surface pretreatment methods: Systematic review and network meta-analysis

Objective: To assess the impact of different surface pretreatment protocols on the repair bond strength of resin composite to different ceramics. Study selection: Laboratory studies reporting (micro-)tensile bond strength of resin composite to full contour/monolithic ceramics following different surface pretreatment methods. Sources: Electronic databases (MEDLINE via PubMed, EMBASE via Ovid, Web of Science, and Scopus) were searched in October 2024. Data: A total of 32 sources reporting on 31 studies were entered in frequentist network meta-analyses (glass-based ceramics: 21 studies, polymer-infiltrated ceramics: 11 studies, oxide ceramics: two studies). Various surface pretreatment methods for glass-based and polymer-infiltrated ceramics were compared to the application of an adhesive only (control group), and P-scores were used to rank their efficacy. For glass-based ceramics, highest bond strengths were achieved following hydrofluoric acid etching + silane (multi-)primer + adhesive (+24.37 MPa, 95 %-CI: 13.18-35.56; P-score: 0.92) followed by silica coating + silane (multi-)primer + adhesive (+20.58 MPa, 95 %-CI: 8.25-32.92; P-score: 0.74). Regarding polymer-infiltrated ceramics, diamond bur roughening + silane (multi-)primer + adhesive (+13.15 MPa, 95 %-CI: 4.97-21.33; P-score: 0.86), silica coating + silane (multi-)primer + adhesive (+11.52 MPa, 95 %-CI: 1.64-21.39; P-score: 0.78), and hydrofluoric acid etching + silane (multi-)primer + adhesive (+11.36 MPa, 95 %-CI: 3.38-19.33, P-score: 0.78) were most effective. On oxide ceramics, no surface pretreatment increased bond strength compared to the application of a silane (multi-)primer and an adhesive. Conclusions: Different surface pretreatment protocols are required for different types of ceramic substrates to achieve optimal bond strength to resin composite. Clinical significance: Depending on the type of ceramic substrate the appropriate pretreatment method must be employed to optimise the repair bond strength between ceramic and resin composite.