title: Is there a potential for durable adhesion to zirconia restorations? A systematic review.
abstract: BACKGROUND
  With a number of zirconia ceramic materials currently available for clinical use, an overview of the scientific literature on the adhesion methods and their potential influence is indicated.
  
  
  OBJECTIVE
  The purpose of this systematic review was to classify and analyze the existing methods and materials proposed to improve adhesion to zirconia surfaces.
  
  
  METHODS
  The current literature of in vitro studies examining the bond strength on zirconia ceramics, including clinical studies from 1998 until 2014, was analyzed. A search of the English language literature was undertaken using MEDLINE and PubMed, and a hand search was made for any relevant research paper from the library of a dental school. Papers evaluating only alumina restoration bond or ceramic-zirconia bond were excluded.
  
  
  RESULTS
  A total of 134 publications were identified for analysis. Different adhesive techniques with different testing methods were reviewed. Results were difficult to compare in that the parameters varied in each research protocol.
  
  
  CONCLUSIONS
  Airborne-particle abrasion and tribochemical silica coating are reference pretreatment methods. Adhesive monomers are necessary for chemical bonding. Surface contamination and aging have negative effects on adhesion to zirconia. Many factors influence each combination of zirconia material, such as surface treatment, adhesive medium, and aging conditions. Laboratory studies should be confirmed by clinical trials.
authors.affiliation: Doctoral student, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Emmanouil-George C
authors.initials: EG
authors.lastname: Tzanakakis
authors.affiliation: Professor, Department of Operative Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Ioannis G
authors.initials: IG
authors.lastname: Tzoutzas
authors.affiliation: Professor and Chairman, Department of Fixed Prosthesis & Implant Prosthodontics Aristotle University of Thessaloniki, Thessaloniki, Greece. Electronic address: pkoidis@dent.auth.gr.
authors.forename: Petros T
authors.initials: PT
authors.lastname: Koidis
mesh_terms: D000537:Aluminum Oxide; D002516:Ceramics; D001840:Dental Bonding; D003776:Dental Porcelain; D003799:Dental Stress Analysis; D006801:Humans; D008422:Materials Testing; D019279:Resin Cements; D013499:Surface Properties; D015040:Zirconium
chemical_list: D019279:Resin Cements; D003776:Dental Porcelain; D015040:Zirconium; D000537:Aluminum Oxide