Bonding Strategies for Zirconia Fixed Restorations: A Scoping Review of Surface Treatments, Cementation Protocols, and Long-Term Durability.

Abstract

Zirconia's superior mechanical properties and biocompatibility have made it a cornerstone of modern prosthodontics, yet achieving durable biomimetic bonding to tooth structure remains a challenge. This scoping review synthesizes evidence on bonding strategies for zirconia-based fixed dental prostheses (FDPs), evaluating surface treatments, cementation protocols, and long-term performance. Following PRISMA-ScR guidelines, 18 studies from PubMed, Scopus, Web of Science, and Embase were thoroughly analyzed. Key findings indicate that tribochemical silica coating (e.g., Rocatec™) combined with 10-methacryloyloxydecyl dihydrogen phosphate (MDP)-based primers (e.g., Panavia V5) is associated with the highest bond strengths (>40 MPa) and exceptional clinical survival rates (e.g., >95% at 15 years for resin-bonded FDPs). These combined mechanical-chemical strategies can be viewed as an attempt to create a biomimetic, hybrid interface akin to the natural enamel-dentin junction. Additively manufactured zirconia exhibits inferior bonding compared to milled counterparts, while ethyl cellulose coatings applied to the bonding surface effectively prevent contamination from saliva and moisture during intraoral try-in procedures. However, heterogeneous testing protocols and limited long-term clinical data highlight the need for standardized aging models and randomized trials. This review consolidates current evidence, offering clinically actionable recommendations through a biomimetic lens while identifying critical gaps for future research.