Influence of Surface Pretreatment Protocols on the Shear Bond Strength of Hybrid Ceramic Restorations: A Systematic Review and Meta-analysis

Introduction: Durable adhesion of hybrid ceramics requires appropriate surface pretreatment. Their distinct microstructures influence their response to mechanical and chemical conditioning. This systematic review and meta-analysis evaluated surface treatments affecting SBS and identified effective adhesion strategies.

Methods: The review followed PRISMA 2020 guidelines. Electronic searches of PubMed, Scopus, Web of Science, and Cochrane Library identified peer-reviewed studies (2020–2025) reporting quantitative SBS outcomes. Studies were screened using predefined eligibility criteria. Risk of bias was assessed with RoBDEMAT. Random-effects meta-analyses in RevMan 5.4 used standardized mean differences and 95% confidence intervals.

Results: Among 585 records, 18 studies met the eligibility criteria for qualitative synthesis, and 5 were suitable for meta-analysis. Treatments included HFA etching, sandblasting, laser, tribochemical silica coating, plasma, and silanization. HFA significantly increased SBS for Vita Enamic (MD = 11.70 MPa; 95% CI: 5.04–18.37; p = 0.0006) and Lava Ultimate (MD = 8.14 MPa; 95% CI: 1.86–14.43; p = 0.01), but not Cerasmart (MD = 9.72 MPa; 95% CI: −0.52–19.95; p = 0.06). Sandblasting significantly improved SBS for Vita Enamic (MD = 6.26 MPa; 95% CI: 4.96–7.55; p < 0.00001), Lava Ultimate (MD = 7.86 MPa; 95% CI: 1.04–14.69; p = 0.02), and Shofu Block HC (MD = 11.28 MPa; 95% CI: 6.29–16.26; p < 0.00001). Heterogeneity was considerable (I² = 87–95%), except for sandblasting in Vita Enamic (I² = 1%). The remaining 13 studies showed material-dependent responses, with combined micromechanical–chemical protocols generally favorable, while laser and plasma treatments showed promising but heterogeneous results.

Conclusions: HFA etching and sandblasting significantly improved SBS for several hybrid ceramics, with material-dependent effects. Combined micromechanical–chemical conditioning was favorable, supporting tailored pretreatment. HFA appears appropriate for silica-containing ceramics, whereas sandblasting may be more effective for resin-rich materials. Laser and plasma require further validation.