Zirconia Cementation: A Systematic Review of the Most Currently Used Protocols

Objective A systematic review of the existing literature was conducted and in vitro studies from 2019 to 2023 were analyzed on Zirconia's most resistant cementation protocol. Methods A systematic review of studies on the bond strength between zirconia and resin cement was carried out using different surface treatment protocols. The search was performed in two electronic databases, PubMed and Cochrane. Results Electronic searches yielded 1225 non-duplicated articles of which 388 were chosen after screening the titles and abstracts. After examining the full texts of these articles, a further 340 were excluded. There remained 48 studies to which the selection by inclusion and exclusion criteria was applied, eliminating 31 articles, of which 17 were finally included for the qualitative study. Conclusion Under the limitations of the present systematic review, it can be concluded that treating Zirconia with a combination of surface modifying agents, both mechanical and chemical, substantially improves its adhesive ability with resin cement. Aluminum oxide sandblasting, hydrofluoric acid etching, tribochemical silica coating, laser, and etching with a combination of acids in the Zircos E system are micromechanical treatments that improve the bond strength between zirconia and resin cements. MDP silane agent is an effective chemical treatment to improve the bond strength between zirconia and resin cements. Coating exclusively with a silica layer does not improve the bond strength between zirconia and resin cement.