ABSTRACT
Objective
This scoping review aims to assess the effect of different protocols on the outcome of ceramic restoration repairs.
Materials and Methods
An electronic search was conducted in three databases (PubMed, Cochrane Library, and Embase), up to July 31st 2025, with previously identified MeSH terms.
Results
Out of the 2423 records, title and abstract screening resulted in the exclusion of 2136 and 136 studies, respectively, while full‐text analysis excluded another 37 articles. In addition, 10 records were not included, as full texts could not be obtained after requesting the authors. Twenty‐two cross‐references were added. Thus, 126 studies were included in this review. It is important to emphasize the methodological heterogeneity among studies. Bond strength was the most frequently evaluated outcome, followed by ultrastructural analysis, chemical analysis, color evaluation and mechanical properties.
Conclusions
In ceramic repair procedures, glass ceramics should be treated with a combination of hydrofluoric acid etching and silanization, while metal oxide ceramics demonstrate superior outcomes when air abrasion and an MDP‐containing primer are employed.
Keywords: ceramic fracture, ceramics, intraoral repair, restorative dentistry, surface treatments
1. Introduction
Ceramic restorations have gained widespread use owing to their favorable esthetic and mechanical properties, enabling a broad range of clinical applications [1]. Ceramics are typically classified as either glass or metal oxide ceramics, with the former considered acid‐sensitive and the latter acid‐resistant [2]. Metal oxide ceramics are further categorized into alumina and zirconia, with zirconia emerging as the most employed material in recent years due to their biocompatibility and superior mechanical performance [3, 4]. Glass ceramics, including feldspathic, leucite‐reinforced and lithium disilicate ceramics, are composed of a silica matrix and recognized for their satisfactory optical characteristics [3, 4].
Despite the high success rates associated with these materials, chipping and fractures have been reported [4, 5]. This can be caused by either patient‐related factors, such as parafunctional habits and occlusal patterns, or by restoration‐related features, including design, an inadequate bonding protocol, occlusal adjustments, or the presence of internal defects [4].
Ceramic repair protocols have been introduced taking into account esthetic, functional and biological considerations [6]. In most cases, this procedure allows for a more efficient and conservative approach compared to restoration replacement, as no additional tooth preparation is required and structural integrity and pulp vitality are not compromised [1, 4, 7, 8, 9, 10]. Numerous protocols, either micromechanical or chemical, have been proposed to establish an adequate repair procedure according to the type of restoration and type of fracture [1, 7, 8, 11]. Therefore, structural analyses of treated ceramics and bond strength evaluation of repaired ceramic restorations have been conducted over the years, with the literature presenting heterogeneous results [2].
Literature lacks an adequate systematic and comprehensive review of the different available ceramic repair protocols, considering not only bond strength outcomes, but also surface topography alterations, chemical modifications, esthetic results over time, and other success outcome measures. To date, no comprehensive review has simultaneously addressed these diverse outcomes across all ceramic material types. Given the wide variety of study designs and the need to map the existing evidence, this scoping review aims to assess the effect of different protocols on the outcomes of ceramic restoration repairs.
2. Methodology
This review was reported according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement, extension for Scoping Reviews (PRISMA‐ScR; Data S1), along with the methodological guidelines outlined by Prott et al., to ensure rigorous reporting [12, 13].
2.1. Eligibility Criteria
Inclusion criteria comprised studies written in English that assessed different strategies for ceramic restoration repair. Exclusion criteria included publications that did not mention restoration repair, addressed hybrid or metal ceramics, or employed repair materials other than ceramics or composite resins. In addition, case reports, technique description articles, and papers in which the repair protocol was not fully disclosed were also excluded.
2.2. Information Sources and Search Strategy
A literature search was performed up to July 31, 2025, on PubMed (via Medline), Cochrane Library and Embase. In order to define the search key (Table 1), the following MeSH/Emtree terms were identified: “ceramics,” “dental restoration repair,” “dental bonding,” “tensile strength,” “shear strength,” “flexural strength,” “elastic modulus,” and “survival rate.” A time restriction was applied, with studies up to 2004 not to be considered.
TABLE 1.
Search strategy.
| Search terms | #1 | “ceramics” OR “oxide‐ceramic” OR “oxide ceramic” OR “glass–ceramic” OR “glass ceramic” OR “alumina” OR “zirconia” OR “lithium disilicate” OR “leucite” OR “feldspathic” |
| #2 | “repair” OR “ceramic repair” OR “reparation” OR “rebonding” | |
| #3 | “dental bonding” OR “bond strength” OR “tensile strength” OR “shear strength” OR “mechanical properties” OR “biomechanics” OR “flexural strength” OR “fracture resistance” OR “elastic modulus” OR “elasticity modulus” OR “microhardness” OR “survival rate” OR “color stability” OR “colour stability” OR “aesthetic integration” OR “esthetic integration” OR “methods” OR “technique” | |
| MeSH terms/Emtree terms | #4 | “ceramics” |
| #5 | “dental restoration repair” | |
| #6 | “dental bonding” OR “tensile strength” OR “shear strength” OR “flexural strength” OR “elastic modulus” OR “survival rate” OR “methods” | |
| Search key | (#1 OR #4) AND (#2 OR #5) AND (#3 OR #6) | |
2.3. Selection of Sources of Evidence
The search results from each database were transferred to Zotero reference manager and duplicate identification and removal were conducted. Publications were firstly screened based on title and abstract according to the eligibility criteria, by two independent reviewers. The selected articles were further submitted to a full‐text analysis. In case of disagreement, a third researcher was involved in the eligibility process. To identify cross‐references, all included articles were screened to assess potentially relevant studies within the reference lists.
2.4. Data Extraction
Data extraction from the included studies comprised type of study, sample size, restorative and repair material, control and experimental groups, evaluated outcome, aging, and main findings.
3. Results
The flowchart of the study selection process is presented in Figure 1. The literature search identified 2963 publications, with 2423 remaining after duplicate removal. Title and abstract screening resulted in the exclusion of 2136 and 136 studies, respectively. Subsequently, full‐text analysis excluded 37 articles, while the full text of 10 records could not be retrieved after requesting the authors. In addition, 22 cross‐references were added and a total of 126 studies were included in this review. Methodological data and main results are summarized in Table 2.
FIGURE 1.
Flowchart of the study selection.
TABLE 2.
Data extraction of the included studies.
| Authors (year) | Type of study | n | Restorative material | Control group | Experimental groups | Common procedure | Repair material | Outcome | Aging | Main findings |
|---|---|---|---|---|---|---|---|---|---|---|
| Abdulla and Hasan (2022) | In vitro | n = 5 | Zirconia (DD BioZ Wiso), feldspathic (VITA VM 9), and zirconia with feldspathic ceramic | No surface treatment | Er,Cr:YSGG laser (2780 nm, 300 mJ, 3 W, 10 Hz, 140 μs, at 6 mm for 10 mm) and air abrasion with 50 μm aluminum oxide (10 mm, 90°, 5 s, 80 psi); Cimara Repair System and Ceramic Repair N | — | Composite resin (Tetric N‐Ceram and Arabesk Top) | Bond strength (shear) | Yes | Air abrasion was associated with superior bond strength values in comparison to laser irradiation |
| Akyil et al. (2010) | In vitro | n = 13 | Feldspathic ceramic (Vita VMK) | No surface treatment | 9.5% Hydrofluoric acid (2 min), Er:YAG laser (2940 nm, 1 min, 3 W, 300 mJ, 10 Hz), Nd:YAG laser (1064 nm, 1 min, 1 W, 100 mJ, 10 Hz), Er:YAG laser + hydrofluoric acid, Nd:YAG laser + hydrofluoric acid | Cimara repair system | Composite resin (Arabesk Top) | Bond strength (shear) and surface topography analysis (SEM) | Yes | Hydrofluoric acid etching proved to be the most efficient surface treatment to enhance the bond strength between a repair composite resin and feldspathic ceramic |
| Al Deeb (2020) | In vitro | n = 10 | Lithium disilicate (IPS e.max press) and zirconia (Noritake Alliance) | Diamond bur (30‐μm grit) | Er,Cr:YSGG laser (2.78 μm, 3.75 W, 15 Hz, 60 s), Nd:YAG laser (1064 nm, 2 mm, 60 s, 150 mJ, 10 Hz, 3 W), 9.6% hydrofluoric acid (60 s) + silane, air abrasion with 30 μm silica‐coated aluminum oxide (2.3 bar, 8 mm, 1 min) + silane | Adhesive resin (Heliobond) | Composite resin (Multicore flow) | Bond stregth (shear) | Yes | For lithium disilicate, the use of hydrofluoric acid with silanization appears to be the gold standard. For zirconia, the combination of air abrasion and silane rendered the highest bond strength values |
| Al‐Askary et al. (2024) | In vitro | n = 7 | Zirconia (H. C. Starck) and lithium disilicate (IPS E‐Max CAD) | — | 9.5% Hydrofluoric acid (20 s), air abrasion with 50 μm aluminum oxide (20 s, 10 mm, 3 bar, 90°), diamond bur, Er,Cr:YSGG laser (2780 nm, 3 W, 10 Hz, 200 μs), diamond bur + 9.5% hydrofluoric acid (20 s), air abrasion with 50 μm aluminum oxide (20 s, 10 mm, 3 bar, 90°) + 9.5% hydrofluoric acid (20 s), Er,Cr:YSGG laser (2780 nm, 3 W, 10 Hz, 200 μs) + 9.5% hydrofluoric acid (20 s); G‐Premio Bond universal adhesive and intraoral repair kit | — | Composite resin (Filtek Z250) | Bond strength (shear) | No | The association of air abrasion and hydrofluoric acid led to the highest bond strength values |
| Al‐Hmadi et al. (2022) | In vitro | n = 10 | Zirconia (H.C. Starck) | — | Bisco repair system (9.5% hydrofluoric acid + silane + bond), Clearfil repair system (40% phosphoric acid + Clearfil SE Bond Primer + Clearfil‐SE Bond + Clearfil Porcelain Bond Activator), Ivoclar ceramic repair system (Monobond Plus + Heliobond), Single Bond, Ultradent repair system (9% hydrofluoric acid + Ultradent silane, Peak Universal bond) | Air abrasion with 50 μm aluminum oxide (10s, 0.3 MPa, 10 mm) | Composite resin (Filtek Z250) | Bond strength (shear) | Yes | The repair of zirconia can be successfully achieved with Ivoclar ceramic repair system, Clearfil repair system and Bisco repair systems |
| Al‐Thagafi et al. (2016) | In vitro | NR | Lithium disilicate ceramic (IPS e.max) and zirconia‐reinforced lithium disilicate ceramic (Vita Suprinity) | No surface treatment | 5% Hydrofluoric acid (60 s) + silane (Monobond), 5% hydrofluoric acid (60 s) + silane (Monobond) + adhesive (Heliobond), air abrasion with silica‐coated aluminum oxide (10 mm, 2.8 bar, 15 s) + silane (Monobond) | — | Composite resin (Tetric EvoCeram) | Bond strength (microtensile) and surface topography analysis (SEM) | Yes | The different tested surfaces treatements influence the repair bond strength of lithium disilicate ceramics |
| Al‐Turki et al. (2020) | In vitro | n = 1 | Feldspathic (Vitablocks), zirconia‐reinforced lithium disilicate ceramic (Vita Suprinity) and yttria‐stabilized zirconia (Vita YZ T) | No surface treatment | 5% Hydrofluoric acid (90 s), air abrasion with 50 μm aluminum oxide (5 mm, 10 s) and air abrasion with 45 μm silica‐coated (10 mm, 2.8 bar, 20 s) | Silane + adhesive system (Tetric N‐Collection) | Composite resin (Tetric N‐Collection) | Bond strength (microtensile) | Yes | The repair of feldspathic was associated with better results when hydrofluoric acid was used. On the other hand, the repair of zirconia and zirconia‐reinforced lithium disilicate ceramic resulted in lower bond strength |
| Aladağ and Ayaz (2023) | In vitro | n = 7 | Zirconia (Upcera ST), zirconia‐reinforced lithium disilicate ceramic (Vita Suprinity) and lithium aluminosilicate ceramic reinforced with lithium disilicate (Nice block) | No surface treatment | Er:YAG laser (2940 nm, 2 W, 200 mJ, 10 Hz, 75 μs), Nd:YAG laser (1064 nm, 2 W, 100 mJ, 20 Hz, 150 μs), 5% hydrofluoric acid (20 s), hydrofluoric acid + Er:YAG laser, hydrofluoric acid + Nd:YAG laser, air abrasion with 50 μm aluminum oxide (2 bar, 10 mm, 15 s) | Clearfl Ceramic Primer Plus + bond (single bond universal adhesive) | Composite resin (Estelite Sigma Quick) | Bond strength (shear) | Yes | Laser irradiation enhanced the bond strength for Y‐TZP, while its combination with hydrofluoric acid provided a higher bond strength for ZLS and LD‐LAS ceramics |
| Alnassar (2017) | In vitro | n = 10 | Zirconia | No surface treatment | Primer with MDP, air abrasion with 50 μm aluminum oxide (2.8 bar, 15 s, 10 mm), air abrasion with 50 μm aluminum oxide + primer with MDP, air abrasion with 30 μm silica‐coated aluminum oxide (2.8 bar, 10 mm, 15 s), air abrasion with 30 μm silica‐coated aluminum oxide + primer with MDP | Adhesive resin (VisioBond) | Composite resin (Filtek Z250) | Bond strength (shear) | Yes | Air abrasion with silica‐coated aluminum oxide particles in combination with the use of a MDP‐containg primer rendered the highest bond strength value among groups |
| AlRabiah et al. (2017) | In vitro | n = 10 | Lithium disilicate (IPS e.max) | — | Scotchbond Universal Adhesive, All‐Bond Universal, Futurabond U; with or without silane | 5% Hydrofluoric acid (20 s) | Composite resin (Tetric Ceram) | Bond strength (shear) | Yes | The use of silane improved the results of the different universal adhesive systems |
| Arami et al. (2014) | In vitro | n = 10 | Zirconia (ICE Zirkon) | No surface treatment | Air abrasion with 50 μm aluminum oxide (10 mm, 2.8 bar, 10 s), Er,Cr:YSGG laser (2 W, 10 s, 2940 nm, 10 Hz), Nd: YAG laser (1.5 W, 2 min, 1064 nm, 10 Hz) | Clearfil porcelain bond activator + Clearfil SE Bond primer | Composite resin (Clearfil AP‐X) | Bond strength (shear) and surface roughness analysis | No | A direct correlation between surface roughness and superior bond strength was not observed. Air abrasion proved to be more efficient than laser |
| Atala and Yeğin (2022) | In vitro | n = 20 | Feldspathic (Vitablocs Mark II) | — | All‐Bond Universal (hydrofluoric acid + silane + adhesive system), Prime&Bond (hydrofluoric acid + silane + adhesive system), Clearfil Quick Universal (phosphoric acid + adhesive system), Premio Bond (silane + adhesive system), Optibond XTR (hydrofluoric acid + silane + primer + bond), Tokuyama Universal Bond (adhesive system) | 4air abrasion with 50 μm aluminum oxide | 4composite resin (Filtek Z250) | Bond strength (microtensile) | Yes | All universal adhesive systems tested rendered appropriate bond strength values |
| Ataol and Ergun (2018) | In vitro | n = 14 | Leucite (IPS e.max Ceram), lithium disilicate (IPS e.max CAD), zirconia (IPS e.max Zir‐CAD) and zirconia‐reinforced lithium disilicate ceramic (Vita Suprinity) | Clearfil ceramic primer and silane + clearfil universal bond | 9% Hydrofluoric acid (90 s), air abrasion with 50 μm aluminum oxide (20 s, 10 mm), Er,Cr:YSGG laser (3 W, 2.94 μm wavelength, 50 Hz, 140 μs, 45°, 1 mm) | Clearfil ceramic primer or silane + clearfil universal bond | Composite resin (Clearfil Majesty ES‐2) | Bond strength (shear) and surface topography analysis (SEM) | Yes | Hydrofluoric acid rendered the highest results for the feldspatic and lithium disilicate ceramics. In addition, air abrasion led to the achievement of superior results for zirconia |
| Ataol and Ergun (2018) | In vitro | n = 14 | Feldspatic (Vita VM11), lithium disilicate (IPS e‐max CAD), zirconia‐reinforced lithium disilicate ceramic (Vita Suprinity) and zirconia (IPS e.max Zir‐CAD) | Clearfil ceramic primer and silane + clearfil universal bond | 9% Hydrofluoric acid (90 s), air abrasion with 50 μm aluminum oxide (20 s, 10 mm), Er,Cr:YSGG laser (3 W, 2.94 μm wavelength, 50 Hz, 140 μs, 45°, 1 mm) | Clearfil ceramic primer or silane + clearfil universal bond | Composite resin (Clearfil Majesty ES‐2‐A2) | Bond strength (shear) and surface topography analysis (SEM) | Yes | The application of hydrofluoric acid and air abrasion rendered satisfactory repair bond strength values for each tested ceramic |
| Attia (2010) | In vitro | n = 20 | Zirconia (Vita) and feldspathic ceramic (Vita VM7) | Non‐fractured restorations | Bur, air abrasion with 50 μm aluminum oxide (2.8 bar, 5 s, 10 mm) and air abrasion with 30 μm silica‐coated aluminum oxide (2.8 bar, 20 s, 10 mm) | Bond | Composite resin (Filtek Z250) | Fracture resistance | Yes | Cyclic loading fatigue reduced the fracture loads of all groups. The experimental group including air abrasion with silica‐coated aluminum oxide and silane was associated with the best results |
| Baiomy et al. (2020) | In vitro | n = 20 | Zirconia (Bio ZX2 Zirconium) and feldspatic ceramic (Ceramco PFZ) | — | Air abrasion with 50 μm aluminum oxide (2.8 bar, 10 s), air abrasion with silica‐coated aluminum oxide (2.8 bar, 15 s), laser (3 W, 2780‐nm wavelength, 140 μs, 50 Hz, 50 s, 1 mm), laser + air abrasion with silica‐coated aluminum oxide | Phosphoric acid + Z prime (zirconia)/silane (feldspatic) + bond | Composite resin (Clearfil AP‐X composite) | Bond stregth (shear) | Yes | Air abrasion with silica‐coated aluminum oxide was the most effective pre‐treatment for both ceramics |
| Barchetta et al. (2021) | In vitro | n = 10 | Zirconia (In‐Ceram 2000 YZ) | Adhesive system and silanization (air abrasion: 30 μm silica‐coated Al2O3) | Prophylaxis, alcohol, and triple syringe | Adhesive system or silicatization | Composite resin (Opallis shade A2E) | Bond strength (shear), surface roughness analysis and surface topography analysis (SEM) | Yes | Zirconia should not be exposed in the oral cavity for a long period of time. Ideally, contaminated zirconia should be treated with prophylaxis (pumice stoneand water) or a triple syringe (waterand air jet), followed by silicatization and silane treatment, as to not affect bonding procedures |
| Barragan et al. (2014) | In vitro | n = 10 | Zirconia (Lava Frame Zirconia) | No surface treatment and no primer | Air abrasion with 50 μm aluminum oxide (10 mm, 5 s, 40 psi); Monobond Plus, Z‐Prime Plus, and Experimental Zirkon‐Primer | — | Composite resin (Tetric Evoceram) | Bond strength (shear) | Yes | Air abrasion and the use of Z‐Prime Plus increased the shear bond strength of the resin composite to zirconia |
| Barutcigil and Kirmali (2020) | In vitro | n = 10 | Lithium disilicate (e.max Press) | No surface treatment | 9.6% Hydrofluoric acid (60 s), 37% phosphoric acid (60 s), Er Cr YSGG laser at 1, 2, and 3 W (2.78 μm wavelength, 10 Hz, 10 mm, 20 s) | Single‐bond universal adhesive | Composite resin (Grandio DC) | Bond strength (shear), EDS analysis, and surface topography analysis (SEM) | Yes | Hydrofluoric acid and the laser irradiation at 3 W rendered adequated bond strength values |
| Bayraktar et al. (2021) | In vitro | n = 2 | Feldpatic ceramic (Vita Mark II) | — | Bur (15 s), 9% hydrofluoric acid (60 s), Nd:YAG laser (1064 nm, 1 mm, 3 W, 20 Hz, 200 μm, 20 s). Er:YAG laser (2940 nm, 1 mm, 3 W, 20 Hz, 300 μm, 20 s), ErCr:YSGG laser (2780 nm, 1 mm, 3 W, 20 Hz, 140 μm, 20 s) | Silane + universal bonding agent (Single Bond Universal) | Composite resin (Filtek Z250) | Bond strength (microtensile) and surface topography analysis (SEM) | Yes | Hydrofluoric acid is the most effective method for the felsdpatic ceramic |
| Benli et al. (2022) | In vitro | n = 20 | Zirconia‐reinforced lithium silicate ceramic (Celtra Duo) | — | 4.9% Hydrofluoric acid, Nd:YAG laser (150 mJ, 20 Hz, 3 W, 150 μs pulse duration, 1064 nm), Nd:YAG laser + hydrofluoric acid, Er:YAG laser (400 mJ, 10 Hz, 4 W, 100 μs pulse duration, 2940 nm), Er:YAG laser + hydrofluoric acid | Silane | Composite resin | Bond strength (shear), surface roughness analysis and surface topography analysis (SEM) | No | The association of hydrofluoric acid and Nd:YAG laser yelded the highest bond strength values and significantly increased surface roughness |
| Bergoli et al. (2016) | In vitro | n = 8 | Feldspathis ceramic (Hera Ceram) | No surface treatment and 10% hydrofluoric acid (20 s) | Abrasion with rubber tips (40 s) | Silane + adhesive | Composite resin (Charisma) | Bond strength (microtensile), surface roughness and surface topography analysis (SEM) | Yes | The rubber abrasive tips presented results similar to the hydrofluoric acid control |
| Bessa et al. (2025) | In vitro | n = 15 | Lithium disilicate (Smile‐lithium) | — | Cleaning with water, Ivoclean cleaning paste and air abrasion with 50 μm aluminum oxide (20 s, 10 mm, 2.5 bar, 45°); 5% hydrofluoric acid (20 s) + silane + adhesive and Monobond Etch&Prime | — | Composite resin (Filtek Z350) | Bond strength (shear) and surface topography analysis (SEM) | Yes | Air abrasion and Ivoclean provided effective cleaning for lithium disilicate ceramic prior to repair. Monobond Etch&Prime showed similar results to hydrofluoric acid followed by silane |
| Blum et al. (2012) | In vitro | n = 40 | Leucite (Cerana insert) | No surface conditioning and no adhesive system applied | Ceramic Repair (diamond bur + total etch gel + monobond + heliobond), Cimara (bur + haftsilan + opaquer liquid), Clearfil Repair (diamond bur, etchant gel, mixed Clearfil SE Bond Primer and activator, Clearfil SE Bond), CoJet system (air abrasion with silica‐coated aluminum oxide + visio bond) | — | Composite resin (Nanosit for Clearfil Repair and CoJet system; Tetric EvoCeram for Ceramic repair; Arabesk for Cimara) | Bond strength (microtensile) and surface topography analysis (SEM) | No | The best bonding performance was obtained when the veneering ceramic was pre‐treated with hydrofluoric acid and the zirconia air abraded with silica coated aluminum oxide particles. Ideally, the veneer ceramic should be conditioned previously to the zirconia treatment |
| Çağlayan et al. (2025) | In vitro | n = 10 | Lithium disilicate (CEREC Tessera) and zirconia (Lithoz and INNI‐Cer) | — | Clearfil Majesty Posterior or Filtek Z350 | Zirconia: air abrasion with 50 μm aluminum oxide (10 s, 10 mm, 2.5 bar) and lithium disilicate: 9% hydrofluoric acid (20 s); adhesive system (Tokuyama Bond Force II) | Composite resin (Clearfil Majesty Posterior or Filtek Z350) | Color measurement | Yes | Lithium disilicate demonstrated the most consistent color stability |
| Carrabba et al. (2017) | In vitro | n = 10 | Feldspathic ceramic (Vitablocs Mark II) | Porcelain Repair Kit group and CoJet + Premise Flow group | Air abrasion with 100 μm aluminum oxide (20 s, 4 atm), 9% hydrofluoric acid (120 s), air abrasion + hydrofluoric acid; Vertise Flow, Premise Flow, Optibond Solo Plus + Premise Flow | — | Flowable resin composite (Vertise Flow or Premise Flow) | Bond strength (shear) and surface topography analysis (SEM) | No | The results of this study show that the use of hydrofluoric acid is the most adequate treatment for feldspathic ceramic, while air abrasion did not significantly influenced bond strength values |
| Chaharom et al. (2018) | In vitro | n = 17 | Lithium disilicate (IPS e.max Press) | No surface treatment | 9.5% Hydrofluoric acid (60 s), Nd:YAG laser (30 mJ, 4.5 W, 15 Hz, 1.064 μm, 1 mm, 60 s), Nd:YAG laser (300 mJ, 6 W, 20 Hz, 1.064 μm, 1 mm, 60 s), Er,Cr:YSGG laser (300 mJ, 1.5 W, 2.78 μm, 1 mm, 60 s), Er,Cr:YSGG laser (300 mJ, 6 W, 2.78 μm, 1 mm, 60 s) | Silane + adhesive system (Silorane System Adhesive) | Composite resin | Bond strength (shear) | Yes | Hydrofluoric acid was associated with higher repair bond strength values in comparison the experimental groups using laser |
| Chen et al. (2010) | In vitro | NR | Feldspathic ceramic (GN‐I Ceramic Block) | Air abrasion | Carbon dioxide laser (30 mm), primer/silane and primer/silane + carbon dioxide laser (30 mm) | Air abrasion with 50 μm aluminum oxide (0.2 MPa, 15 s, 20 mm) | Composite resin (Lite‐Fil II A) | Bond strength (shear), Raman spectroscopy, and surface roughness analysis | Yes | The simultaneous use of silane and carbon dioxide laser led to superior shear bond strength between composite resin and ceramic |
| Çınar and Kırmalı (2019) | In vitro | n = 15 | Zirconia (Nacera), feldspathic ceramic (Noritake CZR), and zirconia with feldspathic ceramic | No aging process | 3000, 6000, and 12,000 thermal cycles | Clearfil Repair Kit: diamond bur, phosphoric acid, Clearfil SE Bond | Composite resin (Gradio SO) | Bond strength (shear) | Yes | Thermal cycles reduced the shear bond strength results. Zirconia rendered higher repair bond strength in comparison to the feldspathic veneer ceramic |
| Colares et al. (2013) | In vitro | n = 5 | Lithium disilicate (IPS e.max) | — | 9.5% Hydrofluoric acid (20 s) + silane (dried at 23°C), hydrofluoric acid + silane (dried with warm air at 45°C ± 5°C), air abrasion with 50 μm aluminum oxide (5 s, 30 psi, 10 mm) + silane (dried at 23°C), air abrasion with 50 μm aluminum oxide (5 s, 30 psi, 10 mm) + silane (dried with warm air at 45°C ± 5°C) | Silane (Rely‐X Ceramic Primer) and adhesive system (Adper Single Bond 2) | Composite resin (Filtek Z250) | Bond strength (microtensile) | No | Hydrofluoric acid resulted in adequate repair bond strength values. On the other hand, air abrasion should be avoided for lithium disilicate repair |
| Corazza et al. (2015) | In vitro | n = 6 | Feldspathic ceramic (Vita Mark II) | Non‐aged groups | Blocks were thermocycled and sticks were obtained, sticks were obtained and then subjected to thermocycling, blocks were thermocycled, stored for 6 months at 37°C, and then sticks were obtained, and sticks were obtained and then subjected to thermocycling and stored for 6 months at 37°C | Hydrofluoric acid (10%, 60 s) + silane (Rely X Ceramic Primer) + adhesive (2.0 Adper Single Bond) | Composite resin (A2 TPH) | Bond strength (microtensile) and surface topography analysis (SEM) | Yes | The aging process significantly influenced the repair bond strength |
| Cristoforides et al. (2012) | In vitro | n = 10 | Zirconia (in Ceram) | 96% Isopropanol (with and without resin cement containing MDP) | Air abrasion with 30 μm silica‐coated aluminum oxide (2.8 bar, 10 mm, 15 s) + silane + resin cement with MDP, air abrasion with silica‐coated aluminum oxide + silane, 37% phosphoric acid + Clearfil SE Primer + Porcelain Bond Activator + resin cement with MDP, 37% OP acid + Clearfil SE Primer + Porcelain Bond Activator, air abrasion with 50 μm aluminum oxide (2.8 bar, 10 mm, 15 s) + silane + resin cement with MDP, air abrasion with aluminum oxide + silane, metal/zirconia primer + resin cement with MDP, metal/zirconia primer | — | Composite resin (Clearfil Majesty Esthetic) | Bond strength (shear) | Yes | The use of a resin cement containing MDP was not very effective. Air abrasion with silica‐coated aluminum oxide proved to be the most efficient strategy to zirconia repair with composite resin |
| Cunha et al. (2022) | In vitro | n = 4 | Zirconia‐reinforced lithium disilicate ceramic (Vita Suprinity) and feldspathic ceramic (CEREM blocs) | — | 5% Hydrofluoric acid—20, 40, and 60 s | Adhesive system (Scotchbond Universal) | Composite resin (Filtek 350 XT) | Bond strength (microtensile) and surface topography analysis (AFM) | No | The 40‐s period of etching with hydrofluoric acid was the most effective for the lithium disilicate. For the feldspathic ceramic, all time periods resulted in statistically similar results |
| de Melo et al. (2007) | In vitro | n = 5 | Leucite (Omega 900) | — | 6% Hydrofluoric acid (60 s) and air abrasion with 30 μm silica‐coated aluminum oxide (10 mm, 20 s, 2.8 bar) | Silane (Porcelain Primer) + adhesive system (Single Bond) | Composite resin (Filtek Z250) | Bond strength (microtensile) and surface topography analysis (SEM) | No | Both tested strategies provided similar bond strength values |
| Degirmenci et al. (2021) | In vitro | n = 15 | Lithium disilicate (IPS e.max), leucite (IPS Empress) and feldspathic ceramic (Cerec Blocs) | Diamond bur | 40% Phosphoric acid, air abrasion with 30 μm silica‐coated aluminum oxide (15 s, 2.5 bar, 10 mm), Er,Cr:YSGG laser (27 μm wavelength, 4 W, 14 Hz) | Silane (G‐Multi Primer) + universal adhesive system (G‐Premio Bond) | Composite resin (G‐aenial Antrerior) | Bond strength (shear) and surface topography analysis (SEM) | Yes | Laser irradiation enhanced the repair bond strength in leucite‐reinforced and feldspathic ceramics. On the other hand, for lithium disilicate the application of acid‐etching is preferable |
| Della‐Bona (2005) | Review | Roughening the ceramic surface by hydrofluoric acid etching and silane coating yields the highest bond strength values for acid‐sensitive ceramics. Silica coating acid‐resistant ceramics is important to improve bonding to resin. The microtensile test may be preferable to conventional shear or flexural tests as an indicator of composite‐ceramic bond quality | ||||||||
| Dos Santos et al. (2019) | In vitro | n = 10 | Zirconia (IPS e.max ZirCAD) | Z‐Prime Plus and air abrasion with 50 μm aluminum oxide (15 s) + Z‐Prime Plus | Single Bond Universal, All Bond Universal, Z‐Prime Plus + All Bond Universal, air abrasion with 50 μm aluminum oxide (15 s) + Single Bond Universal, air abrasion with 50 μm aluminum oxide (15 s) + All Bond Universal and air abrasion with 50 μm aluminum oxide (15 s) + Z‐Prime Plus + All Bond Universal | — | Composite resin (Filtek Z350) | Bond strength (shear) and surface topography analysis (SEM) | No | The present study demonstrated that air abrasion is crucial for the process of zirconia repair |
| Duzyol et al. (2015) | In vitro | n = 5 | Feldspathic ceramic (Cerec Blocs) and lithium disilicate (IPS e.max) | Bur | 5% Hydrofluoric acid (5 min), air abrasion with 50 μm aluminum oxide (10 s, 5 mm) and air abrasion with 30 μm silica‐coated aluminum oxide (10 s, 5 mm) | Bur + silane (Rely X Ceramic Primer) + adhesive system (Single Bond Universal) | Composite resin (Filtek Z 550) | Bond strength (microtensile) | Yes | The use of hydrofluoric acid was the most efficient pre‐treatment for lithium disilicate. Any of the pre‐treatements rendered superior results for feldspathic and hybrid ceramics, in comparison to the control groups where bur was used |
| Elraggal and Silikas (2021) | In vitro | n = 30 | Zirconia (IPS e. max Zir‐CAD) | No surface treatment | Air abrasion with 30 μm silica‐coated aluminum oxide (3 bar, 15 s, 10 mm), air abrasion with fluorapatite glass–ceramic (FGC) (3 bar, 15 s, 10 mm) and laser (4 W, 20 Hz, 180 μm, 1 min, 1 mm) | Monobond Plus + adhesive system (Adhese Universal) for the composite resin and resin cement (Multilink Automix) for the ceramics | Composite resin (Tetric Evocerma Bulk Fill), feldspathic ceramic (VITAVM 13) or lithium disilicate (IPS e.max) | Bond strength (shear), crystallinity, surface roughness analysis, EDS analysis and surface topography analysis (SEM) | Yes | The group with laser rendered superior surface roughness in comparison to the air abrasion groups. Air abrasion with FGC provided a superior amount of silica than air abrasion with silica‐coated aluminum oxide |
| Elraggal et al. (2022) | In vitro | n = 40 | Zirconia (IPS e.max ZirCAD) | No surface treatment | Air abrasion with silica‐coated aluminum oxide (3 bar, 15 s, 10 mm) and fluorapatite glass–ceramic (FGC) (3 bar, 15 s, 10 mm); Monobond Plus, Calibra Silane 2, Scotchbond Universal, Futurabond + resin cement (Multikink Automix) | — | Composite resin (Tetric Evoceram Bulk Fill) | Bond strength (shear), surface roughness analysis, EDS analysis and surface topography analysis (SEM) | Yes | The MDP‐containing adhesive enhanced the bond strength values. Air abrasion with FGC rendered superior results than silica‐coated aluminum oxide |
| Erdemir et al. (2014) | In vitro | n = 26 | Lithium disilicate (IPS e.max) | No surface treatment | Air abrasion with 30 μm silica‐coated aluminum oxide (2.5 bar, 10 mm, 10 s), 9.6% hydrofluoric acid (20 s), laser (2.940 nm, 300 mJ, 20 Hz, 6 W, 1 mm, 20 s) and diamond bur (10 s) | Silane | Flowable composite resin (Vertise Flow) | Bond strength (shear) and surface topography analysis (FE‐SEM) | No | Laser and the diamond bur rendered inferior repair bond strength values in comparison to hydrofluoric acid and air abrasion |
| Falah and Ameer (2020) | In vitro | n = 8 | Feldspathic (Cerec block) and lithium disilicate (IPS e.max) | — | Ceramic repair kit, Scothcond universal adhesive and Palfique universal bond | — | Composite resin (Tetric EvoCeram) | Bond strength (shear) | No | Palfique universal bond was associated with the best results for the lithium disilicate. Scothbond universal performed better for the lithium disilicate |
| Fathpour et al. (2023) | In vitro | n = 20 | Zirconia (IPS e.max zirCAD) | — | Air abrasion + Z‐Prime Plus, bur + Z‐Prime Plus, air abrasion + Z‐Prime Plus with G premio bond, bur + Z‐Prime Plus with G premio bond, air abrasion + Z‐Prime Plus with All Bond Universal, bur + Z‐Prime Plus with All Bond Universal, air abrasion + Z‐Prime Plus with Clearfil SE bond, bur + Z‐Prime Plus with Clearfil SE bond, air abrasion + G‐Premio Bond, bur + G‐Premio Bond, air abrasion + All Bond Universal, bur + All Bond Universal, air abrasion + Clearfil SE Bond, bur + Clearfil SE Bond | — | Composite resin (Charisma Diamond) | Bond strength (shear) | Yes | Air abrasion proved to be more efficient than bur roughneing. The experimental groups of Clearfil SE Bond and Z‐Prime Plus + Clearfil SE Bond achieved the best results |
| Flury et al. (2019) | In vitro | n = 15 | Feldspathic (Vitablocs Mark II) | — | Monobond Plus (silane) + Optibond FL adhesive and Scotchbond Universal | Air abrasion with aluminum oxide and silica‐coated aluminum oxide | Composite resin (Filtek Z250) | Bond strength (shear) | Yes | For restoration repair, optimal bond strength values are obtained when a silane and a bonding agent are both used after air abrasion with aluminum oxide |
| Galvão Ribeiro et al. (2018) | In vitro | n = 28 | Zirconia (Lava Zirconia) | — | Air abrasion with 50 μm aluminum oxide (15 s, 0.2 MPa, 10 mm) and air abrasion with 30 μm silica‐coated aluminum oxide; Clearfil SE Bond Primer + Clearfil Porcelain Bond Activator and Rely X primer + Rely X resin cement | — | Composite resin (Filtek Z350) | Bond strength (shear) | Yes | The association of air abrasion with silica‐coated aluminum oxide and Rely X rendered the highest repair bond strength values |
| Gençer et al. (2025) | In vitro | n = 15 | Leucite (IPS Empress) | — | Air abrasion with 50 μm aluminum oxide, 30 μm silica‐coated aluminum oxide or 27 μm bioactive glass (10 s, 15 mm, 2.5 bar); two‐ (Tokuyama Universal) or one‐bottle (G‐Premio) universal adhesive | — | Composite resin (Omnichroma or Essentia Universal) | Bond strength (shear), surface roughness and surface topography analysis (SEM) | No | Bioactive‐glass and silica‐coated alumina caused similar surface roughness and led to similar bond strength values |
| Ghavam et al. (2017) | In vitro | n = 10 | Zirconia (Kuraray Noritake) and feldspathic ceramic (Ceramico) | No surface treatment | Zirconia: Er,Cr:YSGG laser, air abrasion + Z‐Primer Plus, air abrasion + Z‐Primer Plus; feldspathic: Er,Cr:YSGG laser, air abrasion + 9.5% hydrofluoric acid + silane, Er,Cr:YSGG laser + hydrofluoric acid + silane | — | Composite resin (Vertise Flow) | Bond strength (shear) | Yes | The use of laser produces results similar to those of the hydrofluoric acid and air abrasion experimental groups |
| Goia et al. (2006) | In vitro | n = 10 | Alumina reinforced feldspathic ceramic (Vitadur‐α) | — | 9.6% hydrofluoric acid + silane, air abrasion with 110 μm aluminum oxide + silane, air abrasion with 30 μm silica‐coated aluminum oxide + silane | Adhesive system (Single Bond) | Composite resin (W3D‐Master) | Bond strength (microtensile) and surface topography analysis (SEM) | No | Hydrofluoric acid was associated with higher repair bond strength values than air abrasion |
| Gouda et al. (2023) | In vitro | n = 6 | Zirconia (Wieland Dental) | No surface treatment | Air abrasion with 110 μm aluminum oxide and diamond bur; All Bond Universal, Z prime plus and TheraCem | — | Composite resin (Polofil NHT) | Bond strength (shear) and surface topography analysis (SEM) | No | Bur led to superior results in comparison to air abrasion. The chemical pretreatments containing 10‐MDP provided higher bond strength values |
| Guler et al. (2005) | In vitro | n = 12 | Feldspathic ceramic (Vita VMK95) | — | Air abrasion with 50 μm aluminum oxide, air abrasion with 110 μm aluminum oxide, 9.6% hydrofluoric acid, silane, air abrasion with 50 μm aluminum oxide + silane, air abrasion with 110 μm aluminum oxide + silane, hydrofluoric acid + silane, air abrasion with 50 μm aluminum oxide + hydrofluoric acid + silane, air abrasion with 110 μm aluminum oxide + hydrofluoric acid + silane | Adhesive system (Prime&Bond NT) | Composite resin (Arabesk Top) | Bond strength (shear) | No | The experimental group including air abrasion with 50 μm particles, hydrofluoric acid and silane achieved the highest bond strength values |
| Güler et al. (2006) | In vitro | n = 14 | Feldspathic ceramic (Vita VMK95) | No surface treatment | Hydrofluoric acid (9.6%) for 30, 2 × 30, 60, 2 × 60, 120, and 180 s; one step adhesive and self‐etching adhesive system | — | Composite resin (Filtek Z250) | Bond strength (shear) | No | There was no difference between the 60 and the 2 × 30 s group, as well as between 120 and 2 × 60 s. Single Bond adhesive performed better than the self‐etching adhesive system |
| Güler et al. (2009) | In vitro | n = 10 | Feldspathic ceramic (Vita MVK95) | — | Adper Prompt L‐Pop, Quadrant Uni 1 Bond, Te‐Econom, PQ 1, One Step Plus and Prime&Bond NT | Air abrasion with 50 μm Al2O3 + hydrofluoric acid (9.6%) + silane (Silane Bond Enhancer) | Composite resin (Filtek Z250) | Bond strength (shear) | Yes | Adhesive systems with a high filler ratio rendered better results |
| Habib et al. (2021) | In vitro | n = 15 | Zirconia (ZirCAD) with veneer feldspathic ceramic (IPS Ceram e‐max) | — | 9.5% Hydrofluoric acid + porcelain primer + Z‐Prime Plus + bonding resin, Monobond + Heliobond, Signum ceramic bond I and II, Scoth Bond, and Single Bond | — | Composite resin (Tetric Evoceram) | Bond strength (shear) and surface topography analysis (SEM) | Yes | The complete ceramic/zirconia repair systems showed better bond strength between the repaired composite and zirconia core |
| Hakimaneh et al. (2020) | In vitro | n = 10 | Feldspathic | — | 11% Hydrofluoric acid + silane, silane + CO2 laser, CO2 laser + silane, silane + Er:YAG laser, Er:YAG laser + silane, bur + hydrofluoric acid + silane | Adhesive resin | Composite resin (Tetric N‐Ceram) | Bond strength (shear) | Yes | Laser is only effective when applied prior to silane, with results similar to those obtained by the combination of hydrofluoric acid and silane |
| Han et al. (2013) | In vitro | n = 10 | Zirconia | — | Air abrasion with 30 μm silica‐coated aluminum oxide + silane based primer (Rely X) + Adper Single Bond, Ceramic Repair System (zirconia primer + Heliobond), Signum Zirconia Bond | Diamond bur | Composite resin (Filtek Z350) | Bond strength (shear), surface roughness analysis, wettability and surface topography analysis (FE‐SEM) | No | Signum Zirconia Bond and air abrasion with silica‐coated aluminum oxide rendered the highest bond strength values |
| Hassan et al. (2023) | In vitro | n = 11 | Feldspathic ceramic (DeguDent) | Hydrofluoric acid (9.5%) | CO2 laser, CO2 laser + hydrofluoric acid | Porcelain primer and porcelain bonding resin | Composite resin (Trtriv N‐Ceram) | Bond strength (shear), FTIR test, EDS analysis, surface roughness analysis and surface topography analysis (SEM) | No | The subsequent use of laser and hydrofluoric acid led to the highest repair bond strength values |
| Höller et al. (2022) | In vitro | n = 30 | Lithium disilicate (IPS e.max) | No surface treatment | Air abrasion with aluminum oxide + silane and primer; laboratory, rubber dam, and oral conditions | Bonding resin (Heliobond) and composire resin as the luting agent | Lithium disilicate (IPS e.max) | Bond strength (microtensile) | Yes | The use of the Monobond Etch&Prime performed better than the experimental group including air abrasion and silane. Higher bond strength values were achieved when the environment had minimum humidity |
| Huang et al. (2013) | In vitro | n = 15 | Lithium disilicate (IPS Empress 2) | — | Diamond bur and air abrasion with silica‐coated aluminum oxide; 37% phosphoric acid and 9.6% hydrofluoric acid; silane or not | Adhesive resin (XP Bond) | Composite resin (Ceram X Mono) | Bond strength (microtensile) and surface topography analysis (SEM) | Yes | Hydrofluoric acid was the most effective pretreatment, independently of silanisation and surface mechanical treatments |
| Hwang et al. (2018) | In vitro | n = 5 | Leucite (IPS e. max Ceram) | — | Vitablocs Mark II (feldspathic), IPS Empress (leucite), IPS e‐max (lithium disilicate), Vita Enamic (hybrid) and composite resin (Filtek Z250) | 5% Hydrofluoric acid + silane + bonding resin + resin cement | — | Bond strength (microtensile) and surface roughness analysis | Yes | Repair procedures resorting to ceramic in alternative to composite resin provided superior bond strength results |
| Janson et al. (2025) | In vitro | n = 72 | Zirconia (Katana Zirconia HT) | No surface treatment | Air abrasion with 50 μm aluminum oxide (10 s, 2 bar), air abrasion with 110 μm aluminum oxide (10 s, 2 bar); Optibond Universal, Prime&Bond Active, iBond Universal, Clearfil Universal Bond Quick, Monobond Plus and Scotchbond Universal Plus | — | Composite resin (Clearfil Majesty ES‐2 Universal) | Bond strength (shear) and surface topography analysis (SEM) | Yes | Air abrasion of zirconia enhances the bond strength of repair composites. Universal adhesives containing MDP exhibit superior bond strength values |
| Kameyama et al. (2018) | In vitro | n = 8 | Leucite (IPS Empress CAD) | 40% Phosphoric acid (5 s) | Clearfil SE Bond primer + Clearfil Porcelain Bond Activator, atmospheric‐pressure plasma (APP) irradiation, UV irradiation, APP + Clearfil SE Bond primer + Clearfil Porcelain Bond, UV + Clearfil SE Bond primer + Clearfil Porcelain Bond | 40% Phosphoric acid (5 s) + Clearfil SE Bond | Composite resin (Herculite XRV) | Bond strength (microtensile) and wettability | No | The application of phosphoric acid prior to silane led to enhanced repair bond strength values and water contact angle. Both irradiation treatments did not affect the results |
| Kanzow et al. (2019) | Systematic review | The main treatment steps were consistently reported across repair protocols. The included protocols were mainly based on studies with low level of evidence | ||||||||
| Karabulut Gencer et al. (2023) | In vitro | n = 10 | Leucite (IPS Empress) | — | Air abrasion with 30 μm silica‐coated aluminum oxide, 27 μm bioactive glass and 50 μm aluminum oxide | Tokuyama Universal Bond or Multiprimer + G‐premio Bond | Composite resin (Omnichroma or Essentia) | Color measurement | Yes | Surface preparation did not significantly affect color stability |
| Karcı et al. (2018) | In vitro | n = 9 | Leucite (IPS Empress) and lithium disilicate (IPS e.max) | — | Ceramic Repair system (Monobond + Heliobond) and Nova Compo SF | 5% Hydrofluoric acid | Composite resin (Tetric Evoceram) for Ceramic Repair system and flowable composite for Nova Compo SF | Bond strength (shear) | Yes | The two tested repair systems present statistically similar repair bond strength values |
| Kazak et al. (2019) | In vitro | n = 8 | Leucite (IPS Empress) | Distilled water | Pomegranate‐flavored mineral water (pH 3.39), salad dressing with balsamic vinegar + olive oil + lemon + pomegranate molasses + basil + salt + and garlic (pH 2.30), for 24 h | 5% Hydrofluoric acid (60 S) + silane (Monobond) + bonding agent (Heliobond) | Composite resin (Filtek Z550, Aelite Esthetic Enamel, Tetric N‐Ceram Bulk‐ Fill, Clearfil Majesty Esthetic) | Bond strength (shear) and color measurement | No | Both tested liquids, led to enhanced color changes and surface degradation than the control group with distilled water. Among the materials, Aelite Esthetic Enamel displayed the least color change due to its filler composition and distribution |
| Kilinc et al. (2020) | In vitro | n = 11 | Lithium disilicate (IPS e.max) and feldspathic ceramic (Vita Mark II) | No surface treatment | Air abrasion with 50 μm aluminum oxide (10 mm, 3 bar, 20 s), 5% hydrofluoric acid, Er,Cr:YSGG laser (2780 nm, 2 W, 20 mHz, 140 μs, 5 mm, 40 s) | Bonding agent (Single Bond Universal Adhesive) | Composite resin (Filtek Z550) | Bond strength (shear) and surface topography analysis (SEM) | No | Hydrofluoric acid is the most effective pre‐treatment for glass ceramics. The aging process affected the repair bond strength values obtained |
| Kim et al. (2005) | In vitro | n = 10 | Feldspathic (DuceramPlus), lithium disilicate (IPSEmpress2), alumina (In‐Ceram Alumina) and zirconia (Zi‐Ceram) | Feldspathic ceramic | Air abrasion with 50 μm aluminum oxide (40 psi, 5 s), air abrasion with 50 μm aluminum oxide (40 psi, 5 s) + 4% hydrofluoric acid (5 min) and air abrasion with 30 μm silica‐coated aluminum oxide (40 psi, 5 s) | Silane and bonding agent (One‐Step) | Composite resin (Z100 Restorative) | Bond strength (microtensile) and surface topography analysis (SEM) | No | For alumina and zirconia, air abrasion with silica‐coated aluminum oxide was the most efficient pre‐treatment. On the other hand, the use of air abrasion with aluminum oxide, followed by the hydrofluoric acid rendered the highest bond strength values for glass ceramics |
| Kim et al. (2007) | In vitro | n = 5 | Leucite (IPS d.SIGN)—A2, A3 and A3.5 | — | Different shades of composite resin | — | Composite resin (Arabesk Top, Filtek Supreme and Tetric Ceram) | Color measurement | No | Metameric effects varied depending on porcelain shade, resin composite brand, and illuminant, with interactions between these factors |
| Kimmich and Stappert (2013) | Restorations should be treated on the basis of the material that is exposed on the fractured surface. When presented with metal oxide ceramics the CoJet system should be used, followed by the application of a silane and a phosphate monomer. On the other hand, silicate ceramics should be etched with hydrofluoric acid or sandblasted. The application of a silane afterward is crucial to achieve a chemical bond between the resin and the ceramic material | |||||||||
| Kiomarsi et al. (2022) | In vitro | n = 10 | Leucite (IPS Empress) | — | Laser irradation (2 W, 200 mJ, 10 Hz, 1 mm, 10 s) and 90% buffered hydrofluoric acid (60 s); silane and no silane; universal adhesive (Scotchbond Universal Adhesive) and conventional adhesive system (AdperScotchbond) | — | Composite resin (Filtek Z250) | Bond strength (shear) | No | Hydrofluoric acid rendered superior results in comparison to laser. The combination of hydrofluoric acid, silane and a conventional adhesive system led to satisfactory results |
| Kirmali et al. (2015) | In vitro | n = 10 | Zirconia (Y‐TZP Noritake Alliance) | Bur | Air abrasion with 30 μm silica‐coated aluminum oxide (20 s, 10 mm), Nd:YAG laser (1.064 lm, 20 Hz, 200 mJ, 1 W, 300 ms, 20 s, 1 mm), Er,Cr:YSGG laser (2.78 μm, 20 Hz, 0.25–6 W, 20 s, 10 mm), air abrasion with 30 μm silica‐coated aluminum oxide + Nd:YAG laser, air abrasion with 30 μm silica‐coated aluminum oxide + Er,Cr:YSGG laser | Cimara repair system (silane + opaquer liquid) | Composite resin (Grandio) | Bond strength (shear) and surface topography analysis (SEM) | no | The combination of laser and air abrasion enhanced the bond strength for zirconia repair |
| Kirmali et al. (2015) | In vitro | n = 10 | Zirconia (Y‐TZP Noritake Alliance) | No surface treatment | Air abrasion with 30 μm silica‐coated aluminum oxide, Cimara System (cimara bur + silane + opaquer liquid), Z‐Prime Plus System (primer), Clearfil System (etchant + Clearfil SE Bond Primer and activator + Clearfil SE Bond) and Z‐Bond System (primer) | Diamond bur | Composite resin (Grandio) | Bond strength (shear) | No | Cimara System rendered the highest bond strength values |
| Kocaağaoğlu et al. (2017) | In vitro | n = 10 | Zirconia (Zirkozahn SRL), alumina (In‐Ceram Alumina) and feldspathic ceramic (Vitablocks Mark II) | — | Bisco Intraoral Repair Kıt, Cimara & Cimara Zircon Repair System and Clearfil Repair System | — | Composite resin (GrandioSO) | Bond strength (shear) and wettability | Yes | The Cimara repair systems was associated with the highest bond strength values |
| Kukiattrakoon and Thammasitboon (2007) | In vitro | n = 10 | Leucite (IPS Empress) | no surface treatment | 1.23% APF gel (New Age Fluoride Gel) for 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 min and 9.6% hydrofluoric acid for 4 min | Silane (Monobond‐S), primer (Scotchbond Multi‐Purpose Plus primer) and bonding agent (Scotchbond Multi‐Purpose Plus adhesive) | Composite resin (Filtek Z250) | Bond strength (shear) and surface topography analysis (SEM) | No | The application of hydrofluoric acid rendered similar results than 1.23% APF gel applied for 7, 8, 9 and 10 min |
| Külünk and Saraç (2009) | In vitro | n = 8 | Lithium disilicate (IPS Empress 2) and leucite (IPS Empress Esthetic) | — | Ceramic repair kit (37% OP acid for 15 s, silane and adhesive resin), Clearfil repair (40% phosphoric acid, Clearfil Porcelain Bond Activator, primer and bond of Clearfil SE Bond) and air abrasion with 30 μm silica‐coated aluminum oxide (10 mm, 15 s, 3 psi, 90°) + silane + adhesive resin | — | Composite resin (Tetric Ceram) | Bond strength (shear), surface roughness analysis, wettability and surface topography analysis (SEM) | Yes | The use of phosphoric acid proved to be insufficient to achieve adequate bond strength values and significant alterations in surface morphology |
| Kumchai et al. (2020) | In vitro | n = 10 | Feldspathic ceramic (Vita Trilux Forte) | — | Bonding agent (Heliobond) + Tetric EvoCeram, bonding agent (G‐aenial bond) + G‐aenial Evo Flo, silane + resin cement + feldspathic ceramic, silane + resin cement + lithium disilicate | 5% Hydrofluoric acid (60 s) | Composite resin or ceramic (lithium disilicate and feldspathic ceramic) | Fracture resistance and surface topography analysis (SEM) | Yes | The experimental groups using ceramic as the repair material presented superior fracture resistance, with lithium disilicate to perform better than feldspathic ceramic |
| Lee (2007) | In vitro | n = 5 | Leucite (IPS d.SIGN)—A2, A3 and A3.5 | — | Different shades of composite resin | — | Composite resin (Arabesk Top, Filtek Supreme and Tetric Ceram) | Color measurement | Yes | The aging process influenced the translucency of the restoration, leading to a mismatch between the ceramic and the composite resin used for repair |
| Lee et al. (2014) | In vitro | n = 12 | Feldspathic ceramic (Creation AV), zirconia (Lava Zirconia) and alumina (NobelProcera) | 100% Veneering ceramic surface | 100% Alumina surface, 100% zirconia surface, 50% alumina surface, 50% zirconia surface | Air abrasion with 30 μm aluminum oxide (2.5 bar), 35% phosphoric acid, silane primer (Rely X), adhesive system (Adper Single Bond PLus) | Composite resin (Filtek Supreme Plus) | Bond strength (shear) | No | Bond strength was superior for the veneer ceramic surface in comparison to alumina and zirconia, which presented similar results |
| Li et al. (2014) | In vitro | NR | Feldspathic ceramic (VITA VMK 95) | — | Two experimental silane coupling agents; opaque resin with light irradiation, opaque resin without light irradiation and no opaque resin | Clearfil Repair Multi‐Purpose repair kit (40% OP acid + primer with 10‐MDP and silane) | Composite resin (Clearfil Majesty Esthethic) | Bond strength (shear) | Yes | The highest bond strength results in the experimental groups with 30 mol% BTS with 0.05 mol/L hydrochloric acid in an MPTS‐BTS silane mixture, with a prolonged silanation period of 60 min |
| Li et al. (2020) | In vitro | n = 32 | Zirconia (ZS‐B70) | — | Air abrasion with 50 μm aluminum oxide (0.25 MPa, 30 s, 20 mm) and no mechanical pretreatment; monobond and novel silane; Heliobond and Cleafil SE Bond | — | Composite resin (Filtek Z350) | Bond strength (shear) and surface topography analysis (SEM) | Yes | The association of air abrasion, novel silane and bonding agent containing MDP resulted in the highest repair bond strength values |
| Libecki et al. (2017) | In vitro | n = 16 | Zirconia (Cercon) | Silicon carbide paper (negative control), air abrasion with 50 μm aluminum oxide (positive control) | Silicon carbide grinding bur | Primer (Cimara Zircon Primer), adheisve (Cimara Zircon Adhesive), dual‐curing adhesive resin (Bifix) | Self‐curing composite resin (Grandio Core Dual Cure) | Bond strength (microtensile), surface roughness analysis and surface topography analysis (SEM) | Yes | The use of air abrasion or silicon carbide bur led to adequate repair bond strength values |
| Lundvall et al. (2012) | In vitro | n = 10 | Feldspathic ceramic (Hera‐ceram) | — | 9% Hydrofluoric acid (60 s) + two‐part silane (Bis‐Silane) + adhesive resin (Porcelain Bonding Resin) + composite, 9% hydrofluoric acid (60 s) + adhesive resin + composite, 9% hydrofluoric acid (60 s) + one‐part silane (Silane) + adhesive resin + composite, 35% phosphoric acid + Bis‐silane + adhesive resin + composite, 15% HCl + Bis‐silane + adhesive resin + composite, 9% hydrofluoric acid (60 s) + Bis‐Silane + adhesive resin (Porcelain Bonding Resin) + composite cement (Choice) + ceramic, 15% potassium fluoride/hydrogen fluoride (KF·hydrofluoric acid) and carboxymethylcellulose + Bis‐silane, adhesive resin + composite | — | Composite resin (Charisma) or feldspathic ceramic | Bond strength (shear) | Yes | 15% KF·hydrofluoric acid and 9% hydrofluoric acid led to similar bond strength values. The use of ceramic as the repair material rendered superior results in comparison to the use of composite resin |
| Maawadh et al. (2020) | In vitro | n = 10 | Lithium disilicate (IPS e.max) | — | Er,Cr:YSGG laser (2790 nm, 30 Hz, 3.75 W, 140 μs, 120 s), photodynamic therapy using methylene blue photosensitizer (100 mg/L), 9.6% hydrofluoric acid (60 s) + silane, air abrasion with 30 μm silica‐coated aluminum oxide (10 s, 10 mm, 2 bar) + silane | Porcelain Repair Kit + adhesive system (Peak universal bond) | Composite resin (Clearfil Majesty Esthetic) | Bond strength (shear) and surface topography analysis (SEM) | Yes | The use of air abrasion or hydrofluoric acid rendered superior bond strength values in comparison to the use of photodynamic therapy |
| Mahgoli et al. (2019) | In vitro | n = 12 | Zirconia (Cercon) | Porcelain Bonding resin | Z‐Prime Plus, MonoBond (silane), Z‐Prime Plus + Porcelain Bonding resin, MonoBond + Porcelain Bonding resin | — | Composite resin (Z100) | Bond strength (shear) and surface topography analysis (SEM) | Yes | Z‐Prime Plus was more effective to increase the repair bond strength values than the silane. The application of Porcelain Bonding resin potentiated the results |
| Matinlinna and Vallittu (2007) | The repair of a fractured ceramic with silica‐coated aluminum oxide, followed by a silane application is, according to the literature, a relevant adhesion promotion method in prosthetic dentistry | |||||||||
| Meshramkar and Sajjan (2010) | In vitro | n = 7 | Feldspathic ceramic (Vita MK95) | — | Air abrasion with 50 μm aluminum oxide (10 s), 35% phosphoric acid, 8% hydrofluoric acid (4 min), air abrasion with 50 μm aluminum oxide + ceramic primer + Scotchbond adhesive, air abrasion with 50 μm aluminum oxide + Clearfil Liner Bond, 35% phosphoric acid + Scotchbond adhesive, 35% phosphoric acid + Clearfil Liner Bond, 8% hydrofluoric acid (4 min) + Scotchbond adhesive, 8% hydrofluoric acid (4 min) + Clearfil Liner Bond | — | Composite resin | Bond strength (shear) | No | Hydrofluoric acid led to superior results in comparison to air abrasion and phosphoric acid. Regarding the adhesive system, the Clearfill Liner Bond performed better than the Scothbond adhesive |
| Mohamed et al. (2014) | In vitro | n = 22 | Feldspathic ceramic (GC Initial IQ) | No surface treatment | 40% Phosphoric acid (5 s) + silane primer, < 5% hydrofluoric acid (60 s) + 40% phosphoric acid (5 s) + silane primer, air abrasion with 30 μm silica‐coated aluminum oxide (45 psi, 10 mm, 15 s, 90°) + 40% phosphoric acid (5 s) + silane primer; Clearfil Esthetic Cement and Panavia F 2.0 Cement | — | Feldspathic ceramic (GC Initial IQ): treated with < 5% hydrofluoric acid (60 s) + 40% phosphoric acid (5 s) + silane | Bond strength (shear) | Yes | The combination of hydrofluoric acid and phosphoric acid rendered the highest bond strength results. Clearfil Esthetic Cement was associated with lower values in comparison to Panavia F 2.0 Cement |
| Mohammadi et al. (2015) | In vitro | n = 26 | Feldspathic (Ceramco) | — | Adper Single Bond, Clearfil SE Bond, Silorane Adhesive System | Air abrasion with 50 μm aluminum oxide (50 bar, 10 mm, 10 s) + 37% OP acid (2 min) + silane (Pulpdent) | Composite resin (Filtek Z250 or Filtek Silorane) | Bond strength (shear) | Yes | Although the type of composite resin did not affect the bond strength values, the use of Clearfil SE Bond was associated with the worst results, while Adper Single Bond 2 and Silorane Adhesive were similar between them |
| Moravej‐Salehi et al. (2016) | In vitro | n = 17 | Feldspathic ceramic (Ceramco) | 9.5% Hydrofluoric acid (2 min) | Air abrasion with 50 μm aluminum oxide (10 s, 5 mm, 90°) at 2, 3 and 4 bar | Silane (Bis‐Silane) + resin bond (D/E Resin) | Composite resin (AELITET All Purpose Body) | Bond strength (shear) and surface topography analysis (SEM) | Yes | No statistically significant difference was observed between the control and the three experimental groups |
| Naderi et al. (2025) | In vitro | n = 12 | Feldspathis ceramic (VItaBlocks Mark II) and zirconia | No surface treatment | 9% Hydrofluoric acid (60 s), air abrasion with 50 μm aluminum oxide (10 s, 10 mm, 2.5 bar, 90°), silicon carbide grinding (180 μm, 20 s) | Silane + adhesive (Clearfill Universal Bond) | Composite resin (Gradia‐Direct) | Bond strength (microtensile) | No | For the feldspathic ceramic, hydrofluoric acid rendered the highest bond strength values. For zirconia, the different surface treatments did not significantly improve repair bond strength compared to no treatment |
| Neis et al. (2015) | In vitro | n = 3 | Feldspathic ceramic (Vita VM7), leucite (IPS Empress) and lithium disilicate (IPS e.max) | No surface treatment | Diamond bur, 10% hydrofluoric acid (90 s for feldspathic ceramic, 60 s for leucite, 20 s for lithium disilicate), air abrasion with 45 μm silica‐coated aluminum oxide (20 s, 10 mm, 90°, < 2.8 bar) | 37% Phosphoric acid (30 s) + silane + adhesive system (Adapter Singlebond 2) | Composite resin (Filtek Z350) | Bond strength (microtensile) | Yes | Diamond burs are suitable for leucite and feldspathic ceramic. Hydrofluoric acid etching is recommended for lithium disilicate and air abrasion is effective for leucite repairs |
| Nogueira et al. (2023) | The combination of hydrofluoric acid, air abrasion with aluminum oxide or silica‐coated aluminum oxide, plus silane, and an adhesive, led to an improvement in the bond strength of composite resin‐repaired glass–ceramics. For feldspathic materials, air abrasion is an alternative method to hydrofluoric acid etching to improve micromechanical retention. Silane is an essential step, but adhesive is optional when silane is applied. For leucite, quantitative results suggest the use of silica‐coated aluminum oxide is comparable with the use of hydrofluoric acid. For lithium disilicate, alternatives to hydrofluoric acid were not found, but silane is an essential step | |||||||||
| Oh and Shen (2005) | In vitro | n = 1 | Lithium disilicate (Eris) and leucite (IPS Empress) | No surface treatment | Air abrasion with 50 μm aluminum oxide (0.24 Mpa), 5% hydrofluoric acid (2 min), air abrasion + acid etching; steam and flame cleaning | Adhesive resin (Heliobond) | Composite resin (Tetric Ceram) | Bond strength (microtensile) | No | The process of flame cleaning increased the bond strength values |
| Ozcan et al. (2009) | In vitro | n = 10 | Alumina‐reinforced feldspathic ceramics (Vitadur‐α) | — | Biscor Repair Kit: 9.5% hydrofluoric acid (60 s) + silane (Porcelain Primer) + adhesive (One‐Step), CoJet Repair Kit: air abrasion with 30 μm silica‐coated aluminum oxide + silane (ESPE‐Sil) + adhesive resin (Visio‐Bond), Clearfil Repair Kit: diamond bur + 40% phosphoric acid + Clearfil SE Bond Primer + Clearfil Porcelain Bond Activator | — | Composite resin (W3D‐Master) | Bond strength (microtensile) | Yes | The aging process did not interfere with the CoJet system, but instead influenced the bond strength values on Bisco Repair Kit and Clearfil Repair Kit experimental groups |
| Ozcan et al. (2013) | In vitro | n = 10 | Zirconia (Lava Zirconia) and feldspathhic ceramic (VM7) | — | 4% Hydrofluoric acid (90 s) on veneering ceramic + air abrasion with 50 μm aluminum oxide on zirconia (10 mm, 20 s, 2.8 bar), air abrasion with aluminum oxide on zirconia (with the veneering ceramic exposed) + hydrofluoric acid on veneering ceramic, hydrofluoric acid on veneering ceramic + air abrasion with 30 μm silica‐coated aluminum oxide on zirconia and air abrasion with silica‐coated aluminum oxide on zirconia (with the veneering ceramic exposed) + hydrofluoric acid on veneering ceramic | Silane (ESPE‐Sil) + adhesive resin (VisioBond) | Composite resin (Quadrant Posterior) | Bond strength (shear) and surface topography analysis (SEM) | Yes | The best bonding performance was obtained when the veneering ceramic was pre‐treated with hydrofluoric acid and the zirconia air abraded with silica coated aluminum oxide particles. Ideally, the veneer ceramic should be conditioned previously to the zirconia treatment |
| Özdemir and Yanikoglu (2017) | In vitro | n = 40 | Feldspathic ceramic (VMK95 and IPS Classic) | Air abrasion with 50 μm aluminum oxide | 9.5% Hydrofluoric acid + silane and air abrasion with 50 μm aluminum oxide + silane | — | Composite resin (Grandio or Ceram‐X) | Bond strength (shear) and surface topography analysis (SEM) | Yes | Hydrofluoric acid led to superior bond strength values in comparison to air abrasion. There were differences between the two types of feldspathic ceramic |
| Panah et al. (2008) | In vitro | n = 2 | Lithium disilicate (IPS Empress 2) | No surface treatment | Air abrasion with 50 μm aluminum oxide (35 psi, 10 mm, 15 s), 9.6% hydrofluoric acid (30 s), silane, air abrasion + hydrofluoric acid, air abrasion + silane, hydrofluoric acid + silane, air abrasion + hydrofluoric acid + silane | Bonding resin (Heliobond) | Composite resin (Tetric Ceram) | Bond strength (shear) | No | The combination of air abrasion with aluminum oxide, hydrofluoric acid and silane rendered the highest repair bond strength values |
| Pedrazzi et al. (2012) | In vitro | n = 10 | Feldspathic ceramic (Ceranco 3) | 37% Phosphoric acid (15 s) | Laser (760 mW), laser (760 mW) + 37% OP acid (15 s), laser (900 mW), laser (900 mW) + 37% OP acid (15 s), 10% hydrofluoric acid (2 min) | Silane + adhesive system | Composite resin | Bond strength (shear) and surface topography analysis (SEM) | Yes | The use of Ti:sapphire laser rendered similar results to hydrofluoric acid, both superior to the control group where only phosphoric acid was used |
| Polat et al. (2021) | In vitro | n = 10 | Zirconia (ICE Zirkon Translucent), feldspathic ceramic (Vita VMK) and zirconia with feldspathic ceramic | Diamond bur | Air abrasion with 50 μm aluminum oxide (4 bar, 20 s, 1 mm, 90°), Er,Cr:YSGG (2.78 μm, 10 mm, 200 μs, 20 Hz, 1.5 W), Er,Cr:YSGG (2.78 μm, 10 mm, 140 μs, 20 Hz, 1.5 W) | Clearfil Repair Kit (40% phosphoric acid was used only for the veneer ceramic) | Composite resin (Clearfil Majesty Esthetic) | Bond strength (shear) and surface topography analysis (SEM) | No | For zirconia, the control group (diamond bar) was the one where the highest values were achieved. With the combination of zirconia and veneer ceramic, both the laser and air abrasion treatment rendered similar results |
| Queiroz et al. (2012) | In vitro | n = 2 | Feldspathic ceramic (Vita Mark II blocks) | — | Air abrasion with 30 μm silica‐coated aluminum oxide + silane, 10% hydrofluoric acid (60 s) + silane, hydrofluoric acid + Metal/Zirconia Primer, hydrofluoric acid + Clearfil Primer, hydrofluoric acid + Alloy Primer, hydrofluoric acid + V‐Primer, Metal/Zirconia Primer, Clearfil Primer, Alloy Primer, V‐Primer | Adhesive system (Scotchbond Multipurpose) | Composite resin (microhybrid, W3D Master, and nanofiller, Filtek Supreme) | Bond strength (microtensile) | Yes | The exclusive use of primers led to inferior bond strength values and mechanical pre‐treatments should be introduced in order to enhance the results |
| Rosa et al. (2024) | The present review summarized the scientific literature regarding protocols used for intraoral repairs of monolithic indirect restorations and observed that repairing with resin composite seems to be an interesting alternative for prolonging the longevity of indirect monolithic restorations | |||||||||
| Sadeghi et al. (2015) | In vitro | n = 12 | Feldspathic ceramic (VITA Zahnfabrik) | No surface pretreatment | 9% Hydrofluoric acid (90 s), Er:YAG laser (2 W, 100 mJ, 2.94 μm, 20 Hz, 20 s), Er:YAG laser (3 W, 150 mJ, 2.94 μm, 20 Hz, 20 s), Er:YAG laser (4 W, 200 mJ, 2.94 μm, 20 Hz, 20 s), Er:YAG laser (5 W, 250 mJ, 2.94 μm, 20 Hz, 20 s) | Silane (Ultradent) + adhesive (OptiBond XTR) | Composite resin (Point 4) | Bond strength (shear) | Yes | Hydrofluoric acid led to superior bond strength values than all experimental groups employing laser |
| Sagen et al. (2025) | In vitro | n = 10 | Feldspathic ceramic (Initial Zr‐FS) | — | P220 rotating diamond disc and 9.5% hydrofluoric acid (90 s); universal adhesive and silane primer + adhesive | — | Composite resin (Filtek Supreme) | Bond strength (shear) | Yes | The separate silane primer and adhesive demonstrated superior bond strength over the universal adhesive. |
| Sanal and Kilinc (2020) | In vitro | n = 24 | Feldspathic ceramic (VITA VM 9, VITA VM 13, VITA VMK 95) and leucite (IPS e.max Ceram) | — | Fusio Liquid Dentin (self‐adhesive flowable composite resin), Constic (self‐adhesive flowable composite resin), Vertise Flow (self‐adhesive flowable composite resin) and Bisco Repair Kit + Filtek Supreme (composite resin) | Diamond bur + air abrasion with 50 μm aluminum oxide (2 atm, 5 mm, 5 s) + hydrofluoric acid (60 s) | Composite resin (depending on the experimental group) | Bond strength (shear), color stability and surface topography analysis (SEM) | Yes | The evaluation of color stability showed unsatisfactory results for all the repair materials tested. The self‐adhesive flowable composite resins Fusio Liquid Dentin and Constic can be used as a replacement for the association of the repair kit and composite resin, for feldspathic ceramic. |
| Saraç et al. (2013) | In vitro | n = 15 | Zirconia (ICE Zircon Translucent) and feldspathic ceramic (VITA Zahnfabrik) | No surface treatment | 4% Hydrofluoric acid (5 min), Er:YAG laser (2 W, 200 mJ/pulse, 10 Hz, 10 s), CO2 laser (10.6 μm, 1000 Hz, 160 ms, 3 W), air abrasion with 50 μm aluminum oxide (10 mm, 2.5 bar, 15 s) and air abrasion with 30 μm silica‐coated aluminum oxide (10 mm, 20 s) | Silane primer (Porcelain Primer) + adhesive system (One‐Step Plus) | Composite resin (Reflexions) | Bond strength (shear) and surface topography analysis (SEM) | Yes | Air abrasion with silica‐coated aluminum oxide led to the highest bond strength values |
| Sattabanasuk et al. (2016) | In vitro | n = 10 | Leucite (IPS Empress) | — | 5% Hydrofluoric acid (60 s) and non‐etched; silane (RelyX) and not silanized; Adper Scotchbond Multi‐Purpose Adhesive and Scotchbond Universal | 37% Phosphoric acid (15 s) | Composite resin (Filtek Z350) | Bond strength (shear), surface contact angle and surface topography analysis (SEM) | No | The application of silane as a separated step appears to be beneficial |
| Schellenber and Ozcan (2021) | In vitro | n = 10 | Zirconia (IPS e.max ZirCAD), feldspathic ceramic (Creation), zirconia with feldspathic ceramic | Zirconia treated with air abrasion with 30 μm silica‐coated aluminum oxide (2.5 bar, 10 mm, 15 s) and feldspathic ceramic treated with 9.6% hydrofluoric acid (120 s) separately | Monobond Plus + adhesive resin (Heliobond), Clearfil Ceramic Primer Plus, Z prime Plus; both substrates treated with hydrofluoric acid + air abrasion + Monobond + Heliobond and both substrates treated with air abrasion + hydrofluoric acid + Monobond + Heliobond | — | Composite resin (Empress Esthetic Enamel) | Bond strength (shear) | Yes | From the three tested ceramic primers, Monobond Plus achieved the highest bond strength values. The sequence in which ceramic surface preparation was conducted did not influence the bond strength results |
| Seabra et al. (2014) | In vitro | n = 10 | Zirconia (Lava Frame Zirconia) | — | Z‐Prime Plus (1 coat, without light‐curing), Z‐Prime Plus (1 coat, light‐cured), Z‐Prime Plus (2 coats, without light‐curing), Z‐Prime Plus (2 coats, light‐cured), All‐Bond Universal and ScotchBond Universal Adhesive | Air abrasion with 50 μm aluminum oxide (0.25 Mpa, 15 s, 10 mm) | Composite resin (Filtek Z250) | Bond strength (shear) | No | Regarding the zirconia primer, the best bond strength results for Z‐Prime Plus were obtained when two coats were applied followed by light‐curing. Both MDP‐containing adhesives (All‐Bond Universal and ScotchBond Universal Adhesive) rendered effective bond strength results |
| Shafiei et al. (2019) | In vitro | n = 10 | Zirconia (Amann Girrbach) | No primer or resin | Alloy Primer, Z‐Prime Plus (without light polymerization), Z‐Prime Plus (with light polymerization), Alloy Primer + bonding resin (Clearfil SE Bond) and Z‐Prime Plus + bonding resin (Clearfil SE Bond) | Air abrasion with 35 μm aluminum oxide (2.5 bar, 10 mm, 15 s) | Composite resin (Clearfil APX) | Bond strength (shear) | Yes | Z‐Prime Plus combined with an additional resin layer provided the highest bond strength among the tested groups |
| Shoorgashti et al. (2024) | Hydrofluoric acid etching combined with silane application is the most effective method for enhancing bond strength in the repair of glass ceramic restorations | |||||||||
| Şişmanoğlu et al. (2020) | In vitro | n = 1 | Feldspathic ceramic (Vitablocks Mark II) | No surface treatment | 9% Hydrofluoric acid (60 s), air abrasion with 50 μm aluminum oxide (10 mm, 2.5 bar), air abrasion with 30 μm silica‐coated aluminum oxide (10 mm, 2.5 bar); Clearfil Ceramic Primer Plus or no silane coupling agent | Adhesive system (Single Bond Universal) | Composite resin (Filtek Ultimate Flowable Restorative) | Bond strength (shear), surface roughness analysis and surface topography analysis (SEM) | No | The association of a mechanical surface treatment and the application of silane rendered the highest bond strength values. |
| Soares et al. (2024) | In vitro | n = 15 | Zirconia (IPS e.max ZirCAD) | Air abrasion with 50 μm aluminum oxide (2 bar, 10 mm, 10 s) + 10‐MDP primer | Air abrasion with 30 μm silica‐coated aluminum oxide (2 bar, 10 mm, 10 s) + MDP‐containing silane, air abrasion with 30 μm silica‐coated aluminum oxide (2 bar, 10 mm, 10 s) + MDP primer, universal adhesive system (Adhese Universal) | Diamond bur | Composite resin (Tetric EvoCeram) | Bond strength (shear), surface roughness analysis, flexural strength, finite element analysis and surface topography analysis (SEM) | Yes | The combination of mechanical and chemical approaches are crucial for ensuring durable bond strength and mechanical stability in zirconia repairs. |
| Soares et al. (2024) | In vitro | n = 15 | Zirconia (IPS e.max ZirCAD) | — | Nanohybrid resin composite (Tetric Evo Ceram), bulk‐fill resin composite (Tetric PowerFill), and flowable resin (Tetric PowerFlow) | Diamond bur + air abrasion with 50 μm aluminum oxide (10 mm, 2.8 bar, 10 s) + 10‐MDP primer (Alloy primer) | Composite resin (Tetric Evo Ceram, Tetric PowerFill) and flowable composite resin (Tetric PowerFlow) | Bond strength (shear), flexural fatigue strength and finite element analysis | Yes | The different types of composite resin did not achieve statistically distinct results |
| Soares et al. (2024) | In vitro | n = 6 | Lithium disilicate (IPS e.max) and composite block (Tetric CAD) | — | Brushing movement parallel to the bonding interface of the repair and perpendicular to the bonding interface of the repair | Lithium disilicate: primer (Monobond Etch & Prime) | Composite resin (Clearfil AP‐X) | Surface roughness analysis and surface topography analysis (SEM) | No | Brushing simulation influenced the surface roughness of ceramic restorations compared with composite resin |
| Suárez‐Moya et al. (2019) | In vitro | n = 10 | Feldspathic ceramic (Vitablocs TriLuxe) | — | Single Bond Universal, Adper Single Bond 2, silane + Single Bond Universal, silane + Adper Single Bond 2, 9.6% hydrofluoric acid (90 s) + silane + Single Bond Universal, 9.6% hydrofluoric acid (90 s) + silane + Adper Single Bond 2 | Air abrasion with 50 μm aluminum oxide (10 mm, 2.5 bar, 90°, 10 s) | Composite resin (Filtek Z350) | Bond strength (shear) | No | Both adhesive systems rendered similar bond strength values but the independent application of silane is crucial to enhance bonding performance |
| Tarcin et al. (2011) | In vitro | n = 20 | Leucite (Vitablocs) | No surface mechanical treatment with both adhesive systems | Er:YAG laser (2.94 μm, 10 Hz, 200 mJ, 300 μs, 2 W, 20 s) and air abrasion with 50 μm aluminum oxide (2.5 bar, 10 mm, 15 s, 90°); 36% OP acid + One‐Step Plus + silane (Monobond) and All‐Bond SE + silane (Monobond) | — | Composite resin (Aelite Flo LV) | Bond strength (shear) | No | The combination of chemical and mechanical surface treatments led to the highest bond strength values |
| Tavares et al. (2024) | In vitro | n = 11 | Lithium disilicate (IPS e.max press) | No surface treatment | Three different designs of the top surface (flat, single 2‐mm‐deep plateau, or double 2‐mm‐deep plateau); 5% hydrofluoric acid (20 s) and air abrasion with 50 μm aluminum oxide (5 mm, 10 s) | Silane (Rely X Ceramic Primer) + adhesive system (Single Bond Universal) | Composite resin (Filtek Z350) | Bond strength (microtensile) and surface topography analysis (SEM) | Yes | The experimental groups pre‐treated with hydrofluoric acid presented higher bond strength values than the samples treated with air abrasion. |
| Tokar et al. (2019) | In vitro | n = 10 | Zirconia (ICE Zirkon Translucent) and feldspathic ceramic (Vita VMK Master) | Diamond bur | Er,Cr:YSGG laser (2.78 mm, 20 Hz, 0.25 mm, 6.0 W): pulse duration was set 140 ms for short‐pulse and 200 ms for long‐pulse | Ceramic Repair N (Monobond + Heliobond) | Composite resin (Tetric N‐Ceram) | Bond strength (shear) and surface topography analysis (SEM) | No | Although not statistically significant, short pulse laser irradiation achieved superior results in comparison to long pulse rate. The control group was associated with the highest bond strength values |
| Turunç‐Oğuzman and Şişmanoğlu (2023) | In vitro | n = 12 | Feldspathic (Vita Mark II) and lithium disilicate (IPS e.max) | No surface treatment, with adhesive system or silane + adhesive system | Air abrasion with 50 μm aluminum oxide (10 mm, 1.5 bar), 9% hydrofluoric acid (60 s) and Monobond Etch and Prime; Clearfil Ceramic Primer Plus + adhesive system (Heliobond) and adhesive system (Single Bond Universal) | — | Composite resin (Filtek Ultimate Flowable) | Bond strength (shear) and surface topography analysis (SEM) | No | For lithium disilicate, the best bonding performance was achieved with Monobond Etch and Prime + conventional adhesive (Heliobond). For the feldspathic ceramic, the use of hydrofluoric acid rendered the best bond strength results |
| Ueda et al. (2021) | In vitro | n = 6 | Lithium disilicate (IPS e.max) | No surface treatment (only for surface roughness analysis) | Monobond Etch & Prime, K‐etchant GEL + Clearfil Universal Bond, Bondmer Lightless, K‐etchant GEL + G‐Multi PRIMER | — | Composite resin (Clearfil AP‐X) | Bond strength (shear), surface roughness and surface topography analysis (SEM) | Yes | Monobond Etch & Prime was associated with the highest bond strength results |
| Üstün et al. (2018) | In vitro | n = 10 | Lithium disilicate (IPS e.max) and zirconia‐reinforced lithium disilicate ceramic (Vita Suprinity) | — | IPS e.max and Vita Suprinity: 9% hydrofluoric acid (20 s); Ceramic Repair (37% phosphoric acid (5 s) + Monobond S + Heliobond) and 40% phosphoric acid + Clearfil SE Bond Primer + Clearfil Porcelain Bond Activator + Clearfil SE Bond | — | Composite resin (Tetric N Ceram or Filtek Z250) | Bond strength (shear) and surface topography analysis (SEM) | Yes | For lithium disilicate ceramic, Clearfil Repair achieved superior bond strength results than Ceramic Repair. |
| Uzun et al. (2015) | In vitro | n = 10 | Zirconia (ICE Zirkon) and feldspathic ceramic (Cerabien Zr) | Bur | Air abrasion with 50 μm aluminum oxide (2.8 bar, 10 mm, 15 s) and Er,Cr:YSGG laser (2940 nm, 400 μm, 2 W, 10 s) | Silane (Cimara Zircon‐Primer) + adhesive (Cimara Zircon‐Adhesive) | Composite resin (Grandio SO) | Bond strength (shear) and surface topography analysis (SEM) | no | The control group (bur) was associated with the highest bond strength values, for both types of ceramic |
| Valian et al. (2021) | In vitro | n = 10 | Feldspathic ceramic (Ceramco 3) | Two‐part silane (Bis‐Silane) + porcelain bonding resin (Porcelain Bond) | Single Bond Universal adhesive, silane (Bis‐silane) + Single Bond Universal adhesive, All Bond Universal bonding agent, silane (Bis‐silane) + All Bond Universal bonding agent, FuturaBond Universal bonding agent and silane (Bis‐silane) + FuturaBond Universal bonding agent | 9.5% Hydrofluoric acid (2 min) | Composite resin (Filtek Z250) | Bond strength (shear) | Yes | The use of hydrofluoric acid should be associated with the separated application of silane |
| Veríssimo et al. (2020) | In vitro | n = 10 | Zirconia‐reinforced lithium disilicate ceramic (Vita Suprinity) | No surface treatment | Diamond bur + adhesive system (Single Bond Universal), diamond bur + silane + adhesive system (Amber), 10% hydrofluoric acid (20 s) + silane + adhesive system (Amber), air abrasion with 30 μm silica‐coated aluminum oxide (20 s, 15 mm, 2.5 bar) + silane + adhesive system (Amber), air abrasion with aluminum oxide (20 s, 15 mm, 2.5 bar) + silane + adhesive system (Amber) | — | Composite resin (Filtek Z350) | Bond strength (shear), fungal and bacterial colony forming units, EDS analysis, surface roughness analysis and surface topography analysis (SEM) | Yes | Acid etching followed by silanization rendered the highest bond strength values for zirconia‐reinforced lithium disilicate ceramic |
| Yildirim et al. (2019) | In vitro | n = 12 | Feldspathic ceramic (Vitablocks Mark II) | — | 5% Hydrofluoric acid (60 s) + silane (Monobond Plus), Monobond Etch and Prime, air abrasion with 50 μm aluminum oxide (5 s, 10 mm, 0.5 bar) + silane (Monobond Plus) and air abrasion + Monobond Etch and Prime | Bonding resin (Heliobond) | Composite resin (Tetric Evo Ceram) | Bond strength (shear) and surface topography analysis (SEM) | Yes | The experimental group with hydrofluoric acid treatment rendered the highest bond strength values |
| Zaghloul et al. (2014) | In vitro | n = 2 | Leucite (Paradigm C) and resin composite block (Paradgim MZ100) | — | Diamond bur + 30% phosphoric acid (30 s), diamond bur + 30% phosphoric acid (30 s) + silane (RelyX Ceramic Primer), 3% hydrofluoric acid (90 s), 3% hydrofluoric acid (90 s) + silane, air abrasion with 30 μm silica‐coated aluminum oxide (2.5 bar, 10 s, 10 mm), air abrasion + silane | Adhesive system (Single Bond Universal) | Composite resin (Filtek Z350) | Bond strength (shear) and surface topography analysis (SEM) | No | The association of hydrofluoric acid and silane led to the highest bond strength values |
Out of the total 126 publications considered, 7 papers are reviews [1, 2, 4, 5, 14, 15, 16] while the others are in vitro studies [7, 8, 9, 10, 11, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131]. The considered ceramics included glass ceramics [7, 9, 11, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 130, 131] and metal oxide ceramics [7, 8, 9, 10, 11, 18, 22, 35, 43, 44, 48, 50, 53, 56, 59, 62, 67, 84, 90, 92, 93, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 131]. The absence of surface treatment was the most used control among publications [8, 9, 10, 11, 19, 23, 24, 27, 31, 34, 37, 48, 54, 63, 67, 70, 73, 78, 80, 82, 91, 93, 100, 108, 109, 110, 115, 118, 120, 121, 122, 125, 126, 129]. Composite resin was used as the repair material in 97.5% of the included papers [7, 8, 9, 10, 11, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 62, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 119, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131], while ceramic was employed in 2.5% [39, 63, 86, 120]. Bond strength was the most frequently evaluated outcome among the included publications [7, 8, 9, 10, 11, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 50, 51, 52, 54, 55, 56, 57, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 80, 81, 82, 83, 84, 85, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 125, 126, 127, 128, 129, 130], followed by ultrastructural analysis [10, 18, 22, 23, 24, 25, 26, 28, 30, 31, 32, 33, 34, 37, 38, 39, 40, 43, 46, 47, 50, 52, 57, 59, 61, 62, 64, 65, 66, 67, 70, 72, 75, 78, 79, 81, 83, 86, 88, 91, 94, 97, 98, 99, 100, 101, 103, 104, 106, 109, 110, 111, 114, 116, 118, 119, 123, 126, 129, 130], chemical analysis [23, 38, 88, 109, 110, 126], color evaluation [20, 49, 58, 61, 87, 131], and mechanical properties [53, 86, 98, 111]. Long‐term evaluation resorting to aging methods was conducted in 63.9% of the papers [7, 8, 9, 11, 17, 21, 23, 25, 26, 27, 28, 29, 30, 32, 33, 34, 35, 39, 40, 41, 42, 43, 44, 46, 48, 53, 54, 55, 56, 58, 60, 61, 62, 63, 65, 66, 67, 71, 72, 74, 76, 77, 78, 81, 84, 85, 86, 87, 88, 89, 90, 94, 95, 96, 97, 98, 101, 103, 105, 107, 109, 110, 111, 112, 113, 114, 115, 118, 120, 121, 125, 126, 127, 129, 131].
4. Discussion
Ceramic type, repair material, surface treatment, and aging process are parameters that can influence the evaluation of repair procedures. Several types of ceramics were tested among the included studies, with the majority focusing on feldspathic ceramics [7, 9, 11, 17, 18, 21, 22, 26, 27, 28, 29, 31, 32, 34, 35, 36, 38, 42, 43, 44, 46, 48, 50, 51, 52, 53, 55, 56, 57, 59, 60, 61, 63, 65, 67, 70, 71, 72, 74, 76, 77, 81, 82, 83, 84, 85, 86, 88, 93, 95, 117, 121, 128, 129], followed by zirconia [7, 8, 9, 10, 11, 18, 22, 35, 43, 44, 48, 50, 53, 56, 59, 62, 67, 84, 90, 92, 93, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 122, 131], lithium disilicate [18, 19, 21, 23, 25, 27, 30, 31, 33, 36, 37, 40, 41, 43, 52, 54, 62, 65, 66, 69, 73, 78, 79, 89, 90, 92, 94, 120, 125, 131], leucite [20, 24, 27, 30, 39, 41, 43, 45, 47, 49, 58, 61, 64, 65, 68, 73, 75, 80, 87, 91, 130], zirconia‐reinforced lithium silicate ceramics [8, 9, 33, 43, 54, 57, 62, 119, 123, 126, 127], alumina [18, 56, 117], and lithium aluminosilicate ceramics reinforced with lithium disilicate [8]. Substrate identification is a crucial step in establishing a ceramic repair protocol; therefore, literature interpretation should always consider the type of ceramic involved.
The vast majority of the in vitro studies included in this review employed composite resin as the repair material, either in a flowable or medium consistency form. Studies comparing different composite resins reported no statistically significant differences in bond strength values [29, 55, 98]. Furthermore, flexural fatigue was also not influenced by the type of composite resin employed [98]. Apart from composite resin, ceramic was also tested as a repair material resulting in enhanced bond strength values compared to composite resin [39, 85, 86, 110]. In addition, it is noteworthy that repair with lithium disilicate rendered higher bond strength values than feldspathic ceramic [110], and the former was also associated with superior fracture resistance [86].
4.1. Bond Strength
Bond strength was the most frequently evaluated outcome among the included publications, assessed either by shear [7, 8, 10, 11, 17, 19, 20, 22, 23, 24, 25, 26, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 40, 41, 42, 43, 44, 48, 50, 51, 52, 56, 59, 60, 61, 62, 63, 64, 65, 67, 68, 70, 71, 72, 74, 75, 76, 80, 82, 83, 84, 85, 88, 89, 90, 92, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 121, 122, 123, 125, 126, 128, 130] or microtensile [9, 18, 21, 27, 39, 45, 46, 47, 54, 55, 57, 66, 69, 73, 77, 78, 81, 91, 93, 104, 119, 120, 127, 129] testing. Although 77.7% of the studies resorted to shear testing, this method can be associated with inconsistent and heterogeneous stress distribution, consequently influencing the interpretation of results [2, 54, 55, 91, 105].
Regarding glass ceramics, hydrofluoric acid has been widely recognized as the most effective surface conditioning treatment [8, 21, 31, 37, 125, 129], due to its ability to dissolve the glass phase, expose the crystalline matrix and enhance micromechanical retention [1, 9, 31, 34, 37, 43, 45, 60, 69, 83, 114, 128]. Over the years, studies have shown a tendency to use lower hydrofluoric acid concentrations and shorter etching times [1]. It is noteworthy that, in contrast to hydrofluoric acid, phosphoric acid is unable to interact effectively with glass ceramics [23, 30, 66].
Although literature recognizes the role of hydrofluoric acid as an effective ceramic surface treatment, some of the included articles express concerns regarding its potential harmful effects upon contact with soft tissues during intraoral repair of ceramic restorations [9, 34, 120]. Taking into account the associated risks, the use of absolute isolation under rubber dam is mandatory [4, 27, 125], as bond strength values are also exponentiated under these conditions [120, 132]. In addition, it is noteworthy that alternative pretreatments, such as air abrasion, also require rubber dam isolation [27, 133].
Hydrofluoric acid was associated with higher repair bond strength values than air abrasion for all glass ceramics [21, 26, 31, 37, 52, 60, 63, 72, 93, 119, 128]. Regarding the abrasive particles, silica‐coated aluminum oxide increases the silica content on the ceramic surface, favoring subsequent interactions with silane [27, 47], while residual aluminum oxide particles may hinder the interaction with bonding agents [120]. Although some reports indicate that air abrasion yields similar results to hydrofluoric acid treatment [47], this pretreatment only leads to the highest bond strength values among experimental groups when direct comparison with hydrofluoric acid is not performed and, therefore, is considered insufficient to achieve optimal bonding on its own [30].
As an alternative to the effect of hydrofluoric acid or air abrasion on glass ceramics, different authors tested the influence of laser treatment [8, 11, 22, 23, 31, 32, 34, 35, 37, 38, 40, 43, 46, 48, 50, 59, 62, 65, 67, 68, 71, 80, 88, 90, 121, 123, 125]. In the majority of the included publications, laser irradiation rendered inferior bond strength results compared to hydrofluoric acid [37, 40, 43, 62, 67, 90, 92, 121, 125], but comparisons with air abrasion were contradictory [35, 65, 67]. As there is no clear consensus regarding the optimal power settings for laser irradiation [23], some reports indicate that excessive heat generation can cause significant damage to the outer ceramic layer, thereby hindering the subsequent bonding process [40].
Other alternative surface treatments have been tested, such as atmospheric‐pressure plasma and UV irradiation, but neither has achieved results comparable to those obtained with hydrofluoric acid [45].
In addition to mechanical pretreatments, silane is to increase surface energy and wettability [8, 16, 23, 26, 54, 89]. Its interaction with the ceramic crystalline phase and the organic matrix of the resin allows for the creation of a strong bonding interface [34, 83]. Literature is consensual in stating that the sole use of a universal adhesive containing silane cannot be equated to a separate silanization step, which has been proven to be more effective [51, 64, 70, 74, 89, 95]. This can be explained by the inactivation of the condensation reaction induced by silane when different components are mixed together within the same bottle [89]. Although the use of a bonding agent is believed to be advantageous [7, 128], available literature fails to provide comparable bond strength results with or without the application of a bonding resin.
Overall, the combination of hydrofluoric acid etching and silanization provided the strongest bond between composite resin and glass ceramics [5, 39, 40, 62, 64, 70, 78, 90]. The concomitant use of air abrasion in addition to this combination can further potentiate bonding interactions [18, 19, 60]. Some of the included studies reported results regarding a self‐etching ceramic primer, Monobond Etch & Prime (Ivoclar Vivadent, Schaan, Liechtenstein) [25, 52, 72, 79, 94, 120], which attempts to simplify the repair protocol by combining etching and silanization steps. Although some studies reported bond strength results superior to air abrasion [120] but similar [94] or inferior [72] to hydrofluoric acid, the literature lacks more direct comparisons with the latter.
Apart from conventional glass ceramics, publications evaluating zirconia‐reinforced lithium disilicate ceramics [8, 9, 33, 43, 54, 57, 62, 119, 123, 126, 127] or lithium aluminosilicate ceramics reinforced with lithium disilicate [8] demonstrated these materials' sensitivity to hydrofluoric acid [8, 62], as a consequence of their elevated silica content. Therefore, acid etching followed by silanization rendered the highest bond strength values [126]. It is noteworthy that, for both materials, laser irradiation did not have a significant impact [8].
In comparison to glass ceramics, silica‐free ceramics, such as zirconia and alumina, are less susceptible to etching [2, 4, 9, 11]. For this reason, hydrofluoric acid does not have the ability to increase surface roughness [9]. As a consequence, air abrasion is more efficient for the repair of metal oxide ceramics [62], significantly improving the bond strength between ceramic and composite resin [103].
The use of silica‐coated aluminum oxide particles led to better results compared to aluminum oxide particles alone [18, 35, 107, 108, 112]. This can be explained by the fact that the increased silica content on the surface promotes stronger chemical interaction with the subsequently applied bonding agent [35, 108, 110, 112]. Despite this, it is noteworthy that, because silica remains superficially attached rather than chemically bonded to the ceramic, it can dislodge over time, compromising the long‐term interaction [109, 110].
Air abrasion results in superior bond strength values compared to laser treatment [10, 35, 90], with studies reporting either statistically similar [10] or superior [11] surface roughness for air abrasion, leading to enhanced wettability and mechanical interlocking [11]. In addition, the combination of laser and air abrasion has been reported to potentiate bond strength for metal oxide ceramic repairs [122]. Nevertheless, laser treatment is more effective in zirconia repair than in glass ceramics [35].
Mechanical pretreatments have been shown to improve bonding performance by creating microretentions; however, this alone is insufficient to achieve clinically acceptable bond strength values [102]. Silane coupling agents are less effective on zirconia than on glass ceramics due to the lower silica content [35, 68, 106]. Conversely, to achieve a proper chemical bond to zirconia, primers containing MDP (10‐methacryloyloxydecyl dihydrogen phosphate) monomer should be used [11, 35, 103, 104, 106, 118], as they promote interaction between the oxidic substrate and the composite resin [112].
In addition to the studies that conducted the repair protocol on a homogeneous surface, seven articles evaluated the repair bond strength for hybrid substrates [7, 11, 43, 44, 59, 84, 117], simulating a clinical scenario in which the fracture exposes more than one material. While the majority focused on the simultaneous exposure of zirconia and feldspathic ceramics [2, 6, 43, 66, 106, 119], combinations such as zirconia/leucite [43], alumina/feldspathic [117], and lithium disilicate/leucite [43] were also reported. Most of the included studies employed the same treatment strategy for both exposed substrates [11, 43, 59, 117]. Furthermore, in this scenario, most articles avoided the use of hydrofluoric acid [11, 44, 59, 117].
Studies that adapted the surface treatment to the exposed substrate, conditioned zirconia with air abrasion with silica‐coated aluminum oxide and feldspathic ceramic with hydrofluoric acid [7, 84]. Although one paper reported that the sequence of ceramic surface preparation did not influence bond strength results [84], another demonstrated that, ideally, the glass ceramic should be conditioned before zirconia treatment [7]. It is noteworthy that, although the materials were prepared individually, the authors do not mention any isolation method to prevent cross‐contamination, which may be a fundamental consideration for intra‐oral workflows.
4.2. Ultrastructural Analysis
In addition to bond strength tests, the majority of studies conducted surface topography analysis through scanning electron microscopy (SEM) [18, 22, 23, 24, 25, 26, 28, 30, 31, 32, 33, 34, 38, 40, 43, 46, 47, 50, 52, 59, 61, 62, 64, 65, 66, 67, 70, 72, 75, 78, 79, 81, 83, 86, 91, 94, 97, 99, 100, 101, 103, 109, 110, 111, 114, 116, 118, 119, 123, 126, 129, 130], field‐emission scanning electron microscopy (FE‐SEM) [37, 106], atomic force microscopy (AFM) [57], and surface roughness measurements [10, 25, 30, 38, 39, 70, 79, 88, 104, 106, 109, 110, 111, 114, 123, 126, 129, 130].
The evaluation of surface topography demonstrated the induction of deep surface irregularities in glass ceramics treated with hydrofluoric acid [28, 34, 43]; however, this effect was not observed in zirconia [62]. For glass ceramics, air abrasion can lead to the formation and propagation of cracks [126], and fewer microporosities are created compared to the hydrofluoric acid treatment [37, 43, 62]. On the other hand, air abrasion is able to induce significant surface modifications in zirconia [99, 100, 109, 110]. Self‐etching ceramic primers are also associated with higher surface roughness than untreated ceramic surfaces; consequently, increasing micromechanical retention [25].
Furthermore, laser treatment induces surface modifications characterized by homogenous, shallow and evenly distributed roughness, with no associated cracks or fissures [22, 34, 38]; however, it is considered insufficient to influence bond strength results compared to hydrofluoric acid [37, 43, 46, 62] and air abrasion [43, 62]. Higher laser power settings lead to added surface irregularities [125], with Nd:YAG lasers producing more pronounced alterations than Er:YAG lasers [34].
Publications have reported enhanced wettability associated with surface treatments that induce greater surface alterations [30, 45, 56, 106]. Although surface topography analysis should be interpreted alongside bond strength evaluation, it is important to keep in mind that surface structural modifications are not the sole factor influencing bond strength outcomes [37].
4.3. Chemical Analysis
Six studies included chemical analysis of the treated ceramics, performed using either energy dispersive spectroscopy (EDS) [23, 38, 109, 110, 126], Fourier‐transform infrared spectroscopy (FTIR) [38], or Raman spectroscopy [88].
Some studies report that repair protocols have minimal effect on the material's overall composition [126] while others demonstrate significant differences, although a correlation with other outcomes, such as bond strength results, cannot always be established [23]. EDS analysis of feldspathic ceramics revealed that surface treatment with hydrofluoric acid is strongly associated with chemical alterations, with a reduction in the concentrations of Si, K, Al, and Na, along with the introduction of new elements. In addition, conditioning of zirconia‐reinforced lithium disilicate showed a more consistent elemental composition across groups, as the dissolution of the silica matrix and consequent exposure of zirconia particles caused by hydrofluoric acid was not sufficient to alter the chemical content [126].
Elraggal et al. compared the use of air abrasion with fluorapatite glass–ceramic powder and silica‐coated aluminum oxide on zirconia [109, 110]. EDS analysis demonstrated a higher silica content after air abrasion with fluorapatite glass–ceramic powder compared to silica‐coated aluminum oxide [109, 110], which was also associated with superior bond strength values for that experimental group [109].
The remaining studies reporting chemical analysis evaluated the effect of carbon dioxide laser treatment on feldspathic ceramics, with FTIR spectra confirming good interaction between laser and the ceramic substrate [38], and Raman spectroscopy revealing that the reduction of isolated Si–OH groups caused by laser irradiation potentiates the interaction with silane [88]. This result was also associated with superior bond strength [88].
4.4. Color
Color evaluation was reported in six publications [20, 49, 58, 61, 87, 131]. The aging process influenced the translucency of the restorations, leading to a mismatch between the ceramic and the composite resin used for repair [87]. Translucency and color differences also varied under different illuminants [87].
As color stability is directly associated with water sorption and the hydrophilicity of repair materials, Sanal et al. assessed the color stability of ceramic repairs with four different composite resins, using coffee as a staining agent. All experimental groups presented unsatisfactory results, with ΔE exceeding the acceptability thresholds [61]. Furthermore, Kim et al. assessed the metameric color differences between various leucite shades and several composite resins. Metameric effects varied depending on porcelain shade, resin composite brand, and illuminant, with interactions observed between these factors [49].
Air abrasion with aluminum oxide, silica‐coated aluminum oxide and bioactive glass did not interfere with the color stability of leucite ceramics [58]. It is noteworthy that this study did not mention the use of hydrofluoric acid. In addition, two universal shade composites were compared after different surface preparations, with Essentia (GC Corp., Tokyo, Japan) presenting better color stability than Omnichroma (Tokuyama Dental Corp., Tokyo, Japan) [58].
Although color stability is recognized as a key factor in the success of repaired restorations, it should be taken into account that few studies address strategies to minimize optical differences between substrates, such as creating a bevel [21, 97] in the ceramic substrate before the repair procedure.
4.5. Mechanical Properties
Four publications assessed the mechanical properties of repaired ceramic restorations, either through flexural strength [98, 111] or fracture resistance [53, 86] evaluation.
Both studies evaluating flexural strength in repaired zirconia [98, 111] concluded that surface treatments can influence mechanical behavior, with air abrasion with silica‐coated aluminum oxide and an MDP‐containing silane achieving not only the highest bond strength values, but also the highest flexural strength values [111]. The authors hypothesized that the combination of mechanical and chemical treatments reinforces the repaired restoration and, therefore, this association is crucial for optimal zirconia repair [111]. In contrast, the use of different types of composite resins did not result in statistically significant differences in flexural strength outcomes [98].
Regarding fracture resistance, zirconia treatment with air abrasion using silica‐coated aluminum oxide particles and silane rendered the highest results compared to treatment with a bur or conventional aluminum oxide air abrasion [53]. It is noteworthy that cyclic loading diminished the fracture resistance of all repaired zirconia crowns, regardless of the pretreatment employed [53]. The other study assessing fracture resistance evaluated veneered zirconia repaired with either composite resin or ceramic [86]. Ceramic repair rendered superior fracture resistance compared to composite resin, with lithium disilicate performing better than feldspathic ceramic [86].
5. Limitations
The primary limitation of this review is the substantial methodological heterogeneity among the included studies and the total absence of randomized clinical trials on this topic. In addition, 3 publications failed to report the sample size, and only 19 studies included sample size calculation [31, 35, 41, 52, 58, 63, 72, 91, 92, 93, 98, 102, 108, 111, 115, 118, 126, 129, 130]. When reported, sample size ranged from 1 to 72, although it should be taken into account that some authors considered an entire ceramic block, while others considered only a disk. Furthermore, it should be noted that a wide variety of outcomes were evaluated, and that many studies lack adequate control groups or did not align with authentic clinical conditions, with papers reporting the use of ultrasonic cleaning as a fractured ceramic pretreatment before the repair protocol, which cannot be performed in an actual clinical scenario. Another major limitation is the reduced number of publications reporting repair protocols on hybrid substrates requiring distinct pretreatments, which would more accurately reflect the clinical complexity and inherent risk of cross‐contamination.
6. Conclusion
Based on this scoping review, the following conclusions can be drawn:
Methodological heterogeneity among studies and the absence of clinical trials precludes the establishment of definitive clinical conclusions;
In ceramic repair procedures, glass ceramics should be treated with a combination of hydrofluoric acid etching and silanization, while metal oxide ceramics demonstrate superior outcomes when air abrasion and an MDP‐containing primer are employed;
Standardized methodologies should be established to enable the design of more consistent and comparable laboratory and clinical studies.
Funding
The authors have nothing to report.
Disclosure
The authors have nothing to report.
Conflicts of Interest
The authors declare no conflicts of interest.
Supporting information
Data S1: Supporting Information.
Acknowledgments
The authors have nothing to report.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data S1: Supporting Information.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.