Adhesion to high-performance polymers applied in dentistry: A systematic review

ObjectiveThe aim of this systemic review, conducted in accordance with the PRISMA statement, was to investigate the impact of surface pretreatments on the bonding strength of high performance polymers (HPPs).MethodsEight databases were searched through March 2019. Risk of bias was assessed and random effects meta-analyses were applied to analyze mean differences in shear bond strength (SBS) and tensile bond strength (TBS), considering surface pretreatments and bonding agents after 24h and thermocycling.ResultsA total of 235 relevant titles and abstracts were found, yielding 11 final selections. Low risk of bias was observed in most studies. For polyetheretherketone (PEEK) specimens, random-effect models showed that, compared to non-treated controls, pretreatments associated with Visio.link® (Bredent, Senden, GE) increased TBS by 26.72 MPa (95% confidence interval (CI), 19.69–33.76; p < 0.00001) and increased SBS by 4.86 MPa (95% CI, 2.61–7.10; p < 0.00001). Air abrasion improved SBS by 4.90 MPa (95% CI, 3.90–5.90; p < 0.00001) (50 μm alumina) and 4.51 MPa (95% CI, 1.85–7.18; p = 0.0009) (silica-coated CoJet). In comparison to non-treated controls, Visio.link® and Signum PEEK Bond® (Heraeus Kulzer, Hanau, GE) increased SBS by 33.76 MPa (95% CI, 18.72–48.81; p < 0.00001) and 33.28 MPa (95% CI, 17.48–49.07; p < 0.00001), respectively. No differences were found between Visio.link® and Signum PEEK Bond® or Monobond Plus/Heliobond® (Ivoclar Vivadent, Schaan, LH) (p > 0.05). Similar results were observed for polyetherketoneketone (PEKK) specimens.SignificanceThis review shows improved HPP bonding following the application of various surface pretreatments, including air abrasion and bonding agents.