Mechanical and adhesive properties of monolithic zirconia and their clinical implications: a narrative review

Monolithic zirconia has become increasingly popular in clinical dentistry as an indirect restorative material fabricated using computer-aided design/computer-aided manufacturing (CAD/CAM) technology. It is widely used due to its favorable combination of mechanical strength, aesthetic potential, and biocompatibility. Its monolithic design reduces the risk of veneer chipping, thereby improving restoration longevity. To narratively review the mechanical and adhesive properties of monolithic zirconia and discuss their clinical implications. This narrative review was based on a comprehensive, non-systematic literature search conducted using PubMed/MEDLINE, Scopus, and Web of Science. English-language publications addressing monolithic zirconia, mechanical behavior, surface treatments, adhesive strategies, and clinical performance were considered. Additional studies were identified through manual screening of reference lists. Study selection was guided by relevance to the review topic rather than predefined inclusion or exclusion criteria. Monolithic zirconia demonstrates high flexural strength and fracture toughness, supporting its use in posterior load-bearing restorations. However, direct exposure to the oral environment may promote low-temperature degradation (LTD), potentially affecting long-term mechanical stability. Despite improvements in translucency, aesthetic performance remains a consideration. Adhesive durability depends largely on appropriate surface conditioning and the use of functional primers, particularly those containing 10-methacryloyloxydecyl dihydrogen phosphate (MDP), which enhance chemical bonding to zirconia. Monolithic zirconia offers a reliable balance between strength and clinical durability. Nevertheless, its long-term performance is influenced by environmental exposure and adhesive protocols. Further research is needed to optimize the resin-zirconia interface while maintaining both mechanical reliability and aesthetic outcomes.