A Comprehensive Review of Techniques for Enhancing Zirconia Bond Strength: Current Approaches and Emerging Innovations.

The increasing use of zirconia in dental restorations necessitates a comprehensive understanding of effective bonding techniques to ensure long-term clinical success. Zirconia's unique chemical composition presents challenges in achieving a durable bond as it lacks the glass phase necessary for traditional etching and silanization processes. This review evaluates current methods and emerging innovations for enhancing zirconia bond strength to resin cements. Our findings emphasize the importance of mechanical surface treatments such as air-particle abrasion and tribochemical silica-coating, which significantly improve micromechanical retention. Laser irradiation, while less commonly used, also shows promise in enhancing bond strength without compromising zirconia's structural integrity; 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) primers emerged as critical agents in forming stable P-O-Zr bonds, particularly when used with resin cements containing 10-MDP. However, variations in formulation and application methods impact their overall efficacy. Resin cement demonstrated superior bond strength compared to conventional cement, but clinical outcomes varied, highlighting the importance of cement-primer compatibility and strict procedural adherence. Emerging technologies such as polymer-infiltrated ceramic networks (PICNs) and additive manufacturing (AM) of zirconia offer potential for future advancements, although they require further research to address mechanical and aesthetic challenges. In conclusion, while established methods such as sandblasting and the use of MDP primers remain reliable, ongoing research into novel materials and techniques continues to offer opportunities for enhancing zirconia bonding. Clinicians must balance effectiveness, procedural complexity, and clinical practicality when selecting the most appropriate bonding protocols for zirconia restorations.