Evidence on Surface Conditioning Methods for Durable and Reliable Bonding to Zirconia Restorations: An Umbrella...

This umbrella review aims to synthesize existing evidence on surface conditioning methods to identify the most effective strategies for achieving long-term, reliable bonding to zirconia restorations.

A comprehensive search was carried out in MEDLINE, Embase, the Cochrane Database of Systematic Reviews (SRs), and Scopus between 21 November 2024 and 20 June 2025. In addition, the PROSPERO database was searched to identify ongoing or forthcoming SRs. Consistent with the methodology of umbrella reviews, no restriction on the year of publication was applied. Specifically, the SRs included in this umbrella review range from 2014 onwards. Eligible studies were SRs, with or without meta-analyses, published in English or French. A manual search was also performed using keyword combinations such as "surface treatments," "bonding," and "zirconia."To assess the degree of overlap among primary studies included in the reviews, the corrected covered area (CCA) was calculated.Essential data from the publications included in this study were retrieved using a data extraction form developed by the working group. This form collected information on each article, including authors and year of publication, study design, number of studies and specimens included, control group, artificial aging protocol used, publication range, grading tool used, and whether a meta-analysis was conducted.

A total of 134 records were identified through database and manual searches. After screening and full-text assessment, eight SRs met the inclusion criteria, encompassing a total of 389 primary studies. A weak overlap was observed between the reviews using the CCA = 0.038, suggesting minimal redundancy across reviews. A wide range of surface treatment protocols was evaluated across the included SRs. The most frequently studied protocols included airborne-particle abrasion (APA), application of MDP-based primers, nano-coating, and selective infiltration etching (SIE).

In summary, APA combined with 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) primers remains the most validated and clinically reliable protocol for achieving durable bonding to zirconia restorations. However, the field continues to evolve with the introduction of novel surface treatment techniques. Among these, nano-coating and SIE show promising potential but require further high-quality evidence before they can be recommended for routine clinical application.

While APA combined with 10-MDP primers currently represents the most validated and clinically reliable, crucial, future research should focus on establishing consistent artificial aging protocols that closely mimic intraoral conditions to ensure meaningful interpretation of in vitro results and investigating the long-term chemical and mechanical stability of the adhesive interface under clinical stresses. How to cite this article: Nasri S, Jaâfoura S, Fejjari M, et al. Evidence on Surface Conditioning Methods for Durable and Reliable Bonding to Zirconia Restorations: An Umbrella Review. J Contemp Dent Pract 2025;26(10):1011-1024.