Which Bonding Protocol Provides the Most Durable Zirconia Adhesion after In Vitro Artificial Aging: A Systematic Review

Aim: This study aims to compare various bonding protocols and zirconia surface treatments to identify the most effective method for achieving strong and durable bonding with resin luting cements after aging protocols.Materials and methods: The research was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, via Medline (PubMed), Cochrane Library, and Science Direct databases using Medical Subject Headings (MeSH) terms, synonyms, and combinations of the keywords "dental bonding," "zirconium oxide," "shear strength," "yttria-stabilized tetragonal zirconia," and "longevity," using Boolean operators ("AND" and "OR") applied to refine results.The included studies were identified based on clearly defined inclusion and exclusion criteria established prior to the review process.In order to obtain recent results, only articles published after 2014 were included.Results: The search yielded 714 records, of which 15 studies met the eligibility criteria and were included after screening and full-text review.Data such as type of zirconia, surface pretreatment, assembly material, bond strength obtained, and aging were extracted and listed in different tables.Risk of bias assessment with the Joanna Briggs Institute (JBI) tool showed that 75% of the included studies presented a low risk and 25% a moderate risk.Conclusion: According to our findings, air-particle abrasion (APA) represents the most effective pretreatment strategy, particularly when combined with the application of a 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) primer and a self-adhesive resin cement, resulting in durable and reliable bonding to zirconia.Clinical significance: The core objective of prosthetic treatment is to ensure the long-term success of zirconia restorations, which largely depends on the bonding protocol selected by the clinician.According to this review, the most effective approach is airborne-particle abrasion (APA) combined with 10-MDP-containing primers or universal adhesives, as this protocol provides durable and reliable adhesion to zirconia.