Purpose: To systematically review all clinical studies focusing on the clinical outcomes of zirconia restorations bonded to different types of tooth or implant abutments and to provide practical clinical guidelines.
Materials and methods: A search was performed for English-language articles in dental journals published up to September 2020 using a combination of free-text words and MeSH terms. Studies were identified for review according to certain inclusion and exclusion criteria.
Results: A total of 2,856 studies were identified, and 24 studies were finally included. The included studies featured different types of surface pretreatment methods, primers, resin cements, tooth and implant abutments, zirconia restorations, and designs. The relatively limited number of identified studies and the heterogeneity of the extracted data did not allow for meta-analysis.
Conclusion: Airborne-particle abrasion (APA) and tribochemical silica (TBS) APA surface pretreatment methods yielded positive clinical outcomes on zirconia/resin bonding to all types of tooth surfaces identified. Chemically activating the APA and the TBS APA zirconia surfaces with an MDP monomer-based primer, along with an MDP monomer or phosphoric ester monomer-based resin cement, seems to be a durable bonding protocol for all types of tooth surfaces identified. Skipping the surface pretreatment method step in the bonding protocol did not affect the clinical outcomes of certain types of zirconia restorations on most types of tooth or implant abutment surfaces identified. Type of resin cement seems to be a less influential factor.