A Pilot Study for "In Vitro" Testing the Surface Conditioning Effects on CAD/CAM Hybrid Nanoceramic Adhesion

Background/Objectives: The clinical application of CAD/CAM restorative materials continues to evolve due to increasing demand for aesthetic, durable, and minimally invasive indirect restorations. Hybrid nanoceramics, such as Grandio disc (VOCO GmbH, Cuxhaven, Germany), are increasingly used in indirect restorative dentistry due to their favourable combination of mechanical strength, polishability, wear resistance, and bonding potential. One challenge associated with adhesive protocols for CAD/CAM materials lies in achieving durable bonds with resin cements. Extensive post-polymerization during fabrication reduces the number of unreacted monomers available for chemical interaction, thereby limiting the effectiveness of traditional adhesive strategies and necessitating specific surface conditioning approaches. This study aimed to evaluate, in a preliminary, non-inferential manner, the influence of several combined conditioning protocols on surface micromorphology, elemental composition, and descriptive SBS trends of a CAD/CAM hybrid nanoceramic. This work was designed as a preliminary pilot feasibility study. Due to the limited number of specimens (two discs per protocol, each providing two independent enamel bonding measurements), all bond strength outcomes were interpreted descriptively, without inferential statistical testing. This in vitro study investigated the effects of various surface conditioning protocols on the adhesive performance of CAD/CAM hybrid nanoceramics (Grandio disc, VOCO GmbH, Cuxhaven, Germany) to dental enamel. Hydrofluoric acid (HF) etching was performed to improve adhesion to indirect resin-based materials using two commercially available gels: 9.5% Porcelain Etchant (Bisco, Inc., Schaumburg, IL, USA) and 4.5% IPS Ceramic Etching Gel (Ivoclar Vivadent, Schaan, Liechtenstein), in combination with airborne-particle abrasion (APA), silanization, and universal adhesive application. HF may selectively dissolve the inorganic phase, while APA increases surface texture and micromechanical retention. However, existing literature reports inconsistent results regarding the optimal conditioning method for hybrid composites and nanoceramics, and the relationship between micromorphology, elemental surface changes, and adhesion remains insufficiently clarified. Methods: A total of ten composite specimens were subjected to five conditioning protocols combining airborne-particle abrasion with varying hydrofluoric acid (HF) concentrations and etching times. Bonding was performed using a dual-cure resin cement (BiFix QM) and evaluated by shear bond strength (SBS) testing. Surface morphology was examined through environmental scanning electron microscopy (ESEM), and elemental composition was analyzed via energy-dispersive X-ray spectroscopy (EDS). Results: indicated that dual treatment with HF and sandblasting showed descriptively higher SBS, with values ranging from 5.01 to 6.14 MPa, compared to 1.85 MPa in the sandblasting-only group. ESEM revealed that higher HF concentrations (10%) created more porous and irregular surfaces, while EDS indicated an increased fluorine presence trend and silicon reduction, indicating deeper chemical activation. However, extending HF exposure beyond 20 s did not further improve bonding, suggesting the importance of protocol optimization. Conclusions: The preliminary observations suggest a synergistic effect of mechanical and chemical conditioning on hybrid ceramic adhesion, but values should be interpreted qualitatively due to the pilot nature of the study. Manufacturer-recommended air abrasion alone may provide limited adhesion under high-stress conditions, although this requires confirmation in studies with larger sample sizes and ageing simulations. Future studies should address long-term durability and extend the comparison to other hybrid CAD/CAM materials and to other etching protocols.