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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Dent. Med.</journal-id><journal-title-group>
<journal-title>Frontiers in Dental Medicine</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Dent. Med.</abbrev-journal-title></journal-title-group>
<issn pub-type="epub">2673-4915</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fdmed.2026.1778379</article-id>
<article-version article-version-type="Version of Record" vocab="NISO-RP-8-2008"/>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Original Research</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Effect of different surface treatments on the bond strength of zirconia to resin cement. An <italic>in vitro</italic> study</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author"><name><surname>El Feghaly</surname><given-names>Aya</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref><uri xlink:href="https://loop.frontiersin.org/people/3391962/overview" /><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="methodology" vocab-term-identifier="https://credit.niso.org/contributor-roles/methodology/">Methodology</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Data curation" vocab-term-identifier="https://credit.niso.org/contributor-roles/data-curation/">Data curation</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="investigation" vocab-term-identifier="https://credit.niso.org/contributor-roles/investigation/">Investigation</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="validation" vocab-term-identifier="https://credit.niso.org/contributor-roles/validation/">Validation</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="visualization" vocab-term-identifier="https://credit.niso.org/contributor-roles/visualization/">Visualization</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; original draft" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-original-draft/">Writing &#x2013; original draft</role></contrib>
<contrib contrib-type="author"><name><surname>Nasr</surname><given-names>Elie</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; review &#x0026; editing" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing &#x2013; review &#x0026; editing</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="validation" vocab-term-identifier="https://credit.niso.org/contributor-roles/validation/">Validation</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="visualization" vocab-term-identifier="https://credit.niso.org/contributor-roles/visualization/">Visualization</role></contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Lukomska-Szymanska</surname><given-names>Monika</given-names></name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<xref ref-type="corresp" rid="cor1">&#x002A;</xref><uri xlink:href="https://loop.frontiersin.org/people/61414/overview"/><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; review &#x0026; editing" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing &#x2013; review &#x0026; editing</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Data curation" vocab-term-identifier="https://credit.niso.org/contributor-roles/data-curation/">Data curation</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; original draft" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-original-draft/">Writing &#x2013; original draft</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Funding acquisition" vocab-term-identifier="https://credit.niso.org/contributor-roles/funding-acquisition/">Funding acquisition</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Formal analysis" vocab-term-identifier="https://credit.niso.org/contributor-roles/formal-analysis/">Formal analysis</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="resources" vocab-term-identifier="https://credit.niso.org/contributor-roles/resources/">Resources</role></contrib>
<contrib contrib-type="author"><name><surname>Zmys&#x0142;owska-Polakowska</surname><given-names>Ewa</given-names></name>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref><uri xlink:href="https://loop.frontiersin.org/people/2394948/overview" /><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="visualization" vocab-term-identifier="https://credit.niso.org/contributor-roles/visualization/">Visualization</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; review &#x0026; editing" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing &#x2013; review &#x0026; editing</role></contrib>
<contrib contrib-type="author"><name><surname>Najjar</surname><given-names>Georges</given-names></name>
<xref ref-type="aff" rid="aff5"><sup>5</sup></xref><uri xlink:href="https://loop.frontiersin.org/people/1694736/overview" /><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="investigation" vocab-term-identifier="https://credit.niso.org/contributor-roles/investigation/">Investigation</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="software" vocab-term-identifier="https://credit.niso.org/contributor-roles/software/">Software</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; review &#x0026; editing" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing &#x2013; review &#x0026; editing</role></contrib>
<contrib contrib-type="author"><name><surname>Harouni</surname><given-names>Ryan</given-names></name>
<xref ref-type="aff" rid="aff6"><sup>6</sup></xref><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="software" vocab-term-identifier="https://credit.niso.org/contributor-roles/software/">Software</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; review &#x0026; editing" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing &#x2013; review &#x0026; editing</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="investigation" vocab-term-identifier="https://credit.niso.org/contributor-roles/investigation/">Investigation</role></contrib>
<contrib contrib-type="author"><name><surname>Bourgi</surname><given-names>Rim</given-names></name>
<xref ref-type="aff" rid="aff6"><sup>6</sup></xref><uri xlink:href="https://loop.frontiersin.org/people/2628094/overview" /><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="validation" vocab-term-identifier="https://credit.niso.org/contributor-roles/validation/">Validation</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="methodology" vocab-term-identifier="https://credit.niso.org/contributor-roles/methodology/">Methodology</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; review &#x0026; editing" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing &#x2013; review &#x0026; editing</role></contrib>
<contrib contrib-type="author"><name><surname>Hardan</surname><given-names>Louis</given-names></name>
<xref ref-type="aff" rid="aff6"><sup>6</sup></xref><uri xlink:href="https://loop.frontiersin.org/people/3231344/overview" /><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Funding acquisition" vocab-term-identifier="https://credit.niso.org/contributor-roles/funding-acquisition/">Funding acquisition</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="conceptualization" vocab-term-identifier="https://credit.niso.org/contributor-roles/conceptualization/">Conceptualization</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Formal analysis" vocab-term-identifier="https://credit.niso.org/contributor-roles/formal-analysis/">Formal analysis</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="resources" vocab-term-identifier="https://credit.niso.org/contributor-roles/resources/">Resources</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Project administration" vocab-term-identifier="https://credit.niso.org/contributor-roles/project-administration/">Project administration</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="supervision" vocab-term-identifier="https://credit.niso.org/contributor-roles/supervision/">Supervision</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; review &#x0026; editing" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing &#x2013; review &#x0026; editing</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; original draft" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-original-draft/">Writing &#x2013; original draft</role></contrib>
</contrib-group>
<aff id="aff1"><label>1</label><institution>Resident at the Department of Aesthetic and Prosthetic Dentistry, Faculty of Dental Medicine, Saint Joseph University of Beirut</institution>, <city>Beirut</city>, <country country="lb">Lebanon</country></aff>
<aff id="aff2"><label>2</label><institution>Department of Prosthodontic Dentistry, Faculty of Dental Medicine, Saint-Joseph University</institution>, <city>Beirut</city>, <country country="lb">Lebanon</country></aff>
<aff id="aff3"><label>3</label><institution>Department of General Dentistry, Medical University of Lodz</institution>, <city>Lodz</city>, <country country="pl">Poland</country></aff>
<aff id="aff4"><label>4</label><institution>Department of Endodontics, Medical University of Lodz</institution>, <city>&#x0141;&#x00F3;d&#x017A;</city>, <country country="pl">Poland</country></aff>
<aff id="aff5"><label>5</label><institution>Department of Removable Dentistry, Faculty of Dental Medicine, Saint-Joseph University</institution>, <city>Beirut</city>, <country country="lb">Lebanon</country></aff>
<aff id="aff6"><label>6</label><institution>Department of Restorative and Esthetic Dentistry, Faculty of Dental Medicine, Saint-Joseph University of Beirut</institution>, <city>Beirut</city>, <country country="lb">Lebanon</country></aff>
<author-notes>
<corresp id="cor1"><label>&#x002A;</label><bold>Correspondence:</bold> Monika Lukomska-Szymanska <email xlink:href="mailto:monika.lukomska-szymanska@umed.lodz.pl">monika.lukomska-szymanska@umed.lodz.pl</email></corresp>
</author-notes>
<pub-date publication-format="electronic" date-type="pub" iso-8601-date="2026-02-26"><day>26</day><month>02</month><year>2026</year></pub-date>
<pub-date publication-format="electronic" date-type="collection"><year>2026</year></pub-date>
<volume>7</volume><elocation-id>1778379</elocation-id>
<history>
<date date-type="received"><day>30</day><month>12</month><year>2025</year></date>
<date date-type="rev-recd"><day>25</day><month>01</month><year>2026</year></date>
<date date-type="accepted"><day>03</day><month>02</month><year>2026</year></date>
</history>
<permissions>
<copyright-statement>&#x00A9; 2026 El Feghaly, Nasr, Lukomska-Szymanska, Zmys&#x0142;owska-Polakowska, Najjar, Harouni, Bourgi and Hardan.</copyright-statement>
<copyright-year>2026</copyright-year><copyright-holder>El Feghaly, Nasr, Lukomska-Szymanska, Zmys&#x0142;owska-Polakowska, Najjar, Harouni, Bourgi and Hardan</copyright-holder><license><ali:license_ref start_date="2026-02-26">https://creativecommons.org/licenses/by/4.0/</ali:license_ref><license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License (CC BY)</ext-link>. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</license-p></license>
</permissions>
<abstract><sec><title>Introduction</title>
<p>Achieving a durable and stable bond between zirconium dioxide (zirconia) and resin cement remains a significant clinical challenge. This study aimed to investigate the effects of two novel zirconia surface treatments on the shear bond strength (SBS) between zirconia and resin cement following thermocycling.</p>
</sec><sec><title>Methods</title>
<p>Seventy-five CAD/CAM zirconia specimens (8&#x2009;&#x00D7;&#x2009;10&#x2009;&#x00D7;&#x2009;8&#x2009;mm) were fabricated and randomly assigned to five groups (<italic>n</italic> &#x003D; 15): control (no treatment); air particle abrasion (APA); Zircos-E etching; APA&#x002B;Zircos-E; Biomic LiSi Connect. All specimens were bonded using a zirconia primer, adhesive system, and dual-cure resin cement, except for Biomic LiSi Connect, which did not receive the zirconia primer treatment. Subsequently, all specimens underwent thermo-cycling. SBS was measured, and failure modes were classified. Statistical analysis revealed significant differences in SBS among the groups (<italic>p</italic>&#x2009;&#x003C;&#x2009;0.001).</p>
</sec><sec><title>Results and Discussion</title>
<p>Zircos-E etching, APA&#x002B;Zircos-E and Biomic LiSi Connect exhibited significantly higher bond strength than the control, with Biomic LiSi Connect demonstrating the highest mean SBS (<italic>p</italic>&#x2009;&#x003C;&#x2009;0.001). Failure mode analysis showed no statistically significant differences among groups. Both Zircos-E and Biomic LiSi Connect significantly enhanced the bond strength.</p>
</sec>
</abstract>
<kwd-group>
<kwd>biomic LiSi connect</kwd>
<kwd>resin cement</kwd>
<kwd>shear bond strength</kwd>
<kwd>surface treatment</kwd>
<kwd>thermocycling</kwd>
<kwd>zirconia</kwd>
<kwd>Zircos-E</kwd>
</kwd-group><funding-group><funding-statement>The author(s) declared that financial support was not received for this work and/or its publication.</funding-statement></funding-group><counts>
<fig-count count="2"/>
<table-count count="2"/><equation-count count="0"/><ref-count count="30"/><page-count count="7"/><word-count count="0"/></counts><custom-meta-group><custom-meta><meta-name>section-at-acceptance</meta-name><meta-value>Dental Materials</meta-value></custom-meta></custom-meta-group>
</article-meta>
</front>
<body><sec id="s1" sec-type="intro"><label>1</label><title>Introduction</title>
<p>Reliable bonding to zirconia restorations remains a persistent clinical challenge in adhesive dentistry. Despite zirconia&#x0027;s widespread use for crowns, fixed dental prostheses, and implant-supported restorations, debonding failures continue to occur, particularly with conventional adhesive protocols. These complications affect restoration longevity and may require retreatment, increasing biological and financial burdens for clinicians and patients (<xref ref-type="bibr" rid="B1">1</xref>&#x2013;<xref ref-type="bibr" rid="B4">4</xref>). The development of high-strength ceramics, including aluminum oxide (Al&#x2082;O&#x2083;) and zirconium dioxide (ZrO&#x2082;), has provided superior mechanical performance and long-term stability (<xref ref-type="bibr" rid="B5">5</xref>, <xref ref-type="bibr" rid="B6">6</xref>). However, while the incorporation of ZrO&#x2082; enhances mechanical strength, it simultaneously reduces the glassy matrix and silica content, making the material more resistant to acid attack (<xref ref-type="bibr" rid="B7">7</xref>). Although HF etching effectively enhances the surface roughness and wettability of silica-based ceramics (<xref ref-type="bibr" rid="B8">8</xref>), its impact on zirconia is minimal (<xref ref-type="bibr" rid="B9">9</xref>). Due to its chemically inert nature, zirconia therefore requires alternative surface modification strategies to achieve durable adhesion with resin cement.</p>
<p>Several surface treatment methods have been introduced to improve zirconia&#x0027;s bondability, including aluminium oxide (Al<sub>2</sub>O<sub>3</sub>) particle air abrasion, tribochemical silica coating, erbium-doped yttrium aluminium garnet (Er:YAG) laser conditioning, primer application, and silica nanofilm deposition. Among these, the use of 10-methacryloyloxydecyl dihydrogen phosphate (MDP)&#x2013;containing agents has become the gold standard for zirconia surface treatment, as MDP forms a stable chemical bond with the zirconia surface (<xref ref-type="bibr" rid="B9">9</xref>). The combination of Al&#x2082;O&#x2083; air abrasion followed by the application of MDP-containing primers or resin cements is currently regarded as the most reliable and effective bonding protocol in clinical practice (<xref ref-type="bibr" rid="B10">10</xref>). However, despite its widespread clinical acceptance, this protocol is not without limitations, particularly with respect to long-term bond durability under thermal and mechanical stresses encountered in the oral environment.</p>
<p>On the other hand, novel multi-acid etching solutions such as Zircos-E have been developed to modify zirconia surfaces by enhancing surface roughness (<xref ref-type="bibr" rid="B11">11</xref>). <italic>In vitro</italic> studies have provided valuable insights into the shear bond strength (SBS) and surface behaviour of zirconia treated with Zircos-E (<xref ref-type="bibr" rid="B6">6</xref>, <xref ref-type="bibr" rid="B12">12</xref>). These emerging approaches aim to simplify clinical procedures while improving bonding predictability; however, their effectiveness relative to established protocols remains a subject of ongoing investigation.</p>
<p>Moreover, LiSi Connect (Aidite, Qinhuangdao, China) has been introduced as an innovative surface treatment system designed to address the limitations of conventional zirconia pretreatments (<xref ref-type="bibr" rid="B13">13</xref>, <xref ref-type="bibr" rid="B14">14</xref>). It combines the mechanical resilience of zirconia with the chemical reactivity of silica-based ceramics, potentially improving micromechanical retention and chemical bonding (<xref ref-type="bibr" rid="B14">14</xref>, <xref ref-type="bibr" rid="B15">15</xref>).</p>
<p>Thus, this <italic>in vitro</italic> study aimed to assess the impact of different surface treatments on adhesion between zirconia and resin cement after thermocycling. The null hypothesis stated that air particle abrasion, Zircos-E and Biomic LiSi Connect would have no significant effect on the SBS or failure mode of zirconia bonded to resin cement compared to conventional surface treatments after thermocycling.</p>
</sec>
<sec id="s2" sec-type="methods"><label>2</label><title>Materials and methods</title>
<p>A total of 75 CAD/CAM zirconia specimens (8&#x2009;&#x00D7;&#x2009;10&#x2009;&#x00D7;&#x2009;8&#x2005;mm) were prepared for this study, which was approved by the Ethical Committee of Saint-Joseph University of Beirut (Beirut, Lebanon; ref. USJ-2023-260). The sample size was determined by a one-way ANOVA power analysis using G&#x002A;Power software (version 3.1.9.7; Heinrich Heine University, D&#x00FC;sseldorf, Germany), with a power of 0.9, an alpha level of 0.05, and an effect size of 0.55. This analysis indicated that a minimum of 75 specimens (15 per group) were required for five groups. Following the assigned treatments, all specimens were bonded using a zirconia primer, bonding agent, and dual-cure resin cement. To simulate oral aging, thermocycling was performed for 5,000 cycles between 5&#x00B0;C and 55&#x00B0;C. SBS was measured using a universal testing machine, and failure modes were examined under a stereomicroscope (Olympus SZ51, Japan) at 10&#x00D7; magnification.</p>
<sec id="s2a"><label>2.1</label><title>Materials and equipment</title>
<p>The materials and instruments utilized in this study included zirconia discs Ceramill ZI D Shape (AmannGirrbach, Herrschaftswiesen/6842 Kobtach, Austria), bonding agents (3M&#x2122; Adper&#x2122; Single Bond 2, 3M ESPE, St Paul, MN, USA), Bisco zirconia primers (BISCO Z-Prime, Bisco, Schaumburg, IL, USA), resin cement (DMG PermaCem 2.0, Ridgefield Park, NJ, USA), zirconia etchant Zircos-E (Bio Den Co., Ltd., Seoul, South Korea), and zirconia primer Biomic LiSi Connect (Aidite, Qinhuangdao, China).</p>
</sec>
<sec id="s2b"><label>2.2</label><title>Zirconia specimen preparation</title>
<p>Using CAD/CAM milling machine, 75 zirconia cubes were milled out of 4 zirconia discs (AmannGirrbach Ceramill ZI D Shape). The design of each zirconia specimens (8&#x2005;mm&#x2009;&#x00D7;&#x2009;10&#x2005;mm&#x2009;&#x00D7;&#x2009;8&#x2005;mm) was drawn and exported as Standard Triangulation Language (STL) file to CAD/CAM software. Each disc was mounted in the milling machine in dry mode. Following milling, each cube underwent a cleaning process using air jets, followed by air drying and placement in a ceramic oven for sintering in accordance with the manufacturer&#x0027;s instructions. The sintering process involved reaching a temperature of 1,550&#x2009;&#x00B0;C with an increasing rate of 100 &#x00B0;C/min, maintaining this temperature for 2&#x2005;h, and then decreasing the temperature at a rate of 100&#x2009;&#x00B0;C/min. After that, the specimens were polished with 600&#x2005;&#x03BC;m sandpaper under water-cooling conditions to achieve a flat surface. The specimens were cleaned in an ultrasonic bath with distilled water for 5&#x2005;min, followed by drying with an air jet and finally assigned to their respective groups for surface treatment.</p>
</sec>
<sec id="s2c"><label>2.3</label><title>Surface treatment</title>
<p>The zirconia specimens were randomly assigned to five treatment groups. Control received no surface treatment. In group Air Particle Abrasion (APA), the zirconia samples were air-abraded using 110&#x2005;&#x00B5;m aluminium oxide particles Cobra (Renfert GmbH, Hilzingen, Germany) for 20&#x2005;s at a distance of 10&#x2005;mm and a pressure of 2 bar with a sandblasting machine (Pudeng Enterprises Co., Ltd., Hsinchu, Taiwan). In group Zircos-E etching, the specimens were immersed in ZE for 30&#x2005;min in an ultrasonic cleaner filled with water, operating at a frequency range of 20&#x2013;60&#x2005;kHz and a power of 0.2&#x2013;1.0&#x2005;W/cm<sup>2</sup>. After etching, the specimens were rinsed under cold running water for 2&#x2005;min and then steamed for 30&#x2005;s.</p>
<p>Group APA&#x2009;&#x002B;&#x2009;Zircos-E involved a combination of air abrasion as described for APA followed by ZE etching. In group Biomic LiSi Connect, after milling and sintering, the specimens were cleaned using a steam machine, and the LiSi Connect coating was evenly sprayed 1&#x2013;2 times from a distance of 10&#x2013;15&#x2005;cm on the bonding surface. The specimens were then sintered according to specific parameters: initial temperature 450&#x2009;&#x00B0;C with a drying time of 1&#x2005;min, heating rate of 80&#x2009;&#x00B0;C/min, maximum temperature of 900&#x2009;&#x00B0;C with a holding time of 1.5&#x2005;min, and a vacuum rate of 100&#x0025; at an opening temperature of 300&#x2009;&#x00B0;C. The LiSi Connect layer crystallizes on the zirconia into a lithium-disilicate-type (Li<sub>2</sub>Si<sub>2</sub>O<sub>5</sub>) coating that is tightly integrated with the zirconia substrate.</p>
<p>After surface treatments, all zirconia specimens were cleaned, rinsed with water, and air-dried for 30&#x2005;s. In all groups (except for Biomic LiSi Connect), zirconia primer (Z-Prime Plus, Bisco) was applied evenly with a microbrush for 60&#x2005;s and gently air-dried to remove excess solvent. A thin layer of bonding agent (3M&#x2122; Adper&#x2122; Single Bond 2 Adhesive) was then applied over the primed surface, air-dried for 5&#x2005;s, and light- cured using the Eighteeth curing pen (Eighteeth, Changzhou, China) for 20&#x2005;s according to the manufacturer&#x0027;s instructions.</p>
<p>For LiSi Connect group, hydrofluoric acid gel 9.5&#x0025; (Bisco) was applied to the LiSi Connect&#x2013;treated surface for 60&#x2005;s, thoroughly rinsed with water for 30&#x2005;s, and air-dried for 30&#x2005;s. Silane (Porcelain Primer, Bisco) was applied with a microbrush and allowed to set for 60&#x2005;s, then the same bonding protocol was per-formed as performed in other groups.</p>
<p>A cylindrical polyethylene mould with an internal diameter of 2.38&#x2005;mm and a height of 2.15&#x2005;mm (Bonding Jig, Ultradent Products, Inc., South Jordan, UT, USA) was placed on the adhesive-coated zirconia surface. Dual-cure self-adhesive resin cement (PermaCem 2.0) was injected from the bottom to the top of the mould to prevent air bubble formation and then light-cured for 40&#x2005;s.</p>
</sec>
<sec id="s2d"><label>2.4</label><title>Thermocycling</title>
<p>The zirconia&#x2013;resin assemblies were stored in distilled water at 37&#x2009;&#x00B0;C for 24&#x2005;h and subsequently subjected to thermocycling for 5,000 cycles between 5&#x2009;&#x00B0;C and 55&#x2009;&#x00B0;C to simulate six months of clinical service (<xref ref-type="fig" rid="F1">Figure&#x00A0;1</xref>).</p>
<fig id="F1" position="float"><label>Figure&#x00A0;1</label>
<caption><p>Specimens placed in the thermocycler, moving from the 5-degree tank to the 55-degrees.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="fdmed-07-1778379-g001.tif"><alt-text content-type="machine-generated">Laboratory setup showing two digitally controlled water baths, with specimens placed in the thermocycler and cycled between the five-degree Celsius and fifty-five-degree Celsius tanks using submerged containers and specimen holders.</alt-text>
</graphic>
</fig>
</sec>
<sec id="s2e"><label>2.5</label><title>Shear bond strength and failure modes</title>
<p>SBS was measured using a universal testing machine (YLE GmbH Waldstrabe Bad Konig, Germany) at a crosshead speed of 1&#x2005;mm/min until fracture (<xref ref-type="fig" rid="F2">Figure&#x00A0;2</xref>) in accordance with ISO/TS 11405:2015. A blunt knife-edge blade was positioned perpendicularly, touching only the bonding interface: between the zirconia and the resin cement, aiming to assess the maximum shear bond strength at the failure point between zirconia and the resin cement.</p>
<fig id="F2" position="float"><label>Figure&#x00A0;2</label>
<caption><p>Universal testing machine measuring the shear strength of resin on a zirconia block.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="fdmed-07-1778379-g002.tif"><alt-text content-type="machine-generated">Universal testing machine setup for mechanical testing, with a circular specimen secured in a vice and loaded by a metal rod under controlled conditions on a metal base, measuring the shear bond strength of resin cement on a zirconia block.</alt-text>
</graphic>
</fig>
<p>The failure load of each specimen was measured in Newtons. The SBS was calculated as follows: SBS (MPa)&#x2009;&#x003D;&#x2009;load (N)/area (mm2). The mode of fracture was then evaluated by inspecting the fractured surfaces under a stereo microscope (Olympus SZ51 Stereo Zoom Microscope, Japan) at 10&#x00D7; magnification and classified as adhesive, cohesive, or mixed failures (<xref ref-type="bibr" rid="B16">16</xref>):
<list list-type="simple">
<list-item>
<p><bold>Adhesive:</bold> Failure occurred at the interface between the ceramic surface and the bonding material, with no visible resin residue on the ceramic surface.</p></list-item>
<list-item>
<p><bold>Cohesive:</bold> Failure occurred within the resin, leaving visible resin residue on the ceramic surface.</p></list-item>
<list-item>
<p><bold>Mixed:</bold> Resin residue was visible on part of the ceramic surface, while other areas showed no residue.</p></list-item>
</list></p>
</sec>
<sec id="s2f"><label>2.6</label><title>Statistical analysis</title>
<p>Data analysis was performed using RStudio Version 2024.12.0. Normality was assessed using the Shapiro&#x2013;Wilk test and homogeneity of variances using Levene&#x0027;s test. Differences in shear bond strength were analyzed using Welch&#x0027;s one-way ANOVA followed by the Games&#x2013;Howell <italic>post hoc</italic> test. Failure mode distribution was evaluated using Fisher&#x0027;s Exact Test. Statistical significance was set at <italic>p</italic>&#x2009;&#x2264;&#x2009;0.05.</p>
</sec>
</sec>
<sec id="s3" sec-type="results"><label>3</label><title>Results</title>
<sec id="s3a"><label>3.1</label><title>Bond strength comparison</title>
<p>The bond strength values for the five surface treatment groups were analysed using descriptive statistics, and a one-way ANOVA was initially performed to evaluate intergroup differences. The analysis revealed a significant difference in bond strength among the groups (<xref ref-type="table" rid="T1">Table&#x00A0;1</xref>). The primary objective was to assess the adhesive performance and durability of the various bonding protocols by measuring bond strength (MPa).</p>
<table-wrap id="T1" position="float"><label>Table&#x00A0;1</label>
<caption><p>Shear bond strength data for different surface treatment groups.</p></caption>
<table>
<colgroup>
<col align="left"/>
<col align="center"/>
<col align="center"/>
<col align="center"/>
</colgroup>
<thead>
<tr>
<th valign="top" align="left">Group</th>
<th valign="top" align="center">Mean</th>
<th valign="top" align="center">Median</th>
<th valign="top" align="center">SD</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Control</td>
<td valign="top" align="center">8.53</td>
<td valign="top" align="center">8</td>
<td valign="top" align="center">7.11</td>
</tr>
<tr>
<td valign="top" align="left">APA</td>
<td valign="top" align="center">29.3</td>
<td valign="top" align="center">25</td>
<td valign="top" align="center">23.8</td>
</tr>
<tr>
<td valign="top" align="left">Zircos-E Etching</td>
<td valign="top" align="center">34.9</td>
<td valign="top" align="center">30</td>
<td valign="top" align="center">20.3</td>
</tr>
<tr>
<td valign="top" align="left">APA&#x2009;&#x002B;&#x2009;Zircos-E</td>
<td valign="top" align="center">53.4</td>
<td valign="top" align="center">48</td>
<td valign="top" align="center">31</td>
</tr>
<tr>
<td valign="top" align="left">LiSi Connect</td>
<td valign="top" align="center">101.0</td>
<td valign="top" align="center">98</td>
<td valign="top" align="center">15.6</td>
</tr>
</tbody>
</table>
</table-wrap>
<p>The shear bond strength values of the five surface treatment groups are summarized in <xref ref-type="table" rid="T1">Table&#x00A0;1</xref>. showing that the LiSi Connect exhibited the highest mean bond strength, whereas control showed the lowest values.</p>
<p>As the assumption of homogeneity of variances was violated (<italic>p</italic>&#x2009;&#x003D;&#x2009;0.005), Welch&#x0027;s one-way ANOVA was used for intergroup comparison. This analysis revealed a statistically significant difference in bond strength among groups [<italic>F</italic> (4, 32.06)&#x2009;&#x003D;&#x2009;105.78, <italic>p</italic>&#x2009;&#x003C;&#x2009;0.001].</p>
</sec>
<sec id="s3b"><label>3.2</label><title>Pairwise comparisons</title>
<p>Given the significant result of Welch&#x0027;s one-way ANOVA, pairwise comparisons were performed using the Games&#x2013;Howell <italic>post hoc</italic> test. (<xref ref-type="table" rid="T2">Table&#x00A0;2</xref>).</p>
<table-wrap id="T2" position="float"><label>Table&#x00A0;2</label>
<caption><p>Results of the pairwise comparisons.</p></caption>
<table>
<colgroup>
<col align="left"/>
<col align="center"/>
<col align="center"/>
<col align="center"/>
<col align="center"/>
</colgroup>
<thead>
<tr>
<th valign="top" align="left">Comparison</th>
<th valign="top" align="center">Difference</th>
<th valign="top" align="center">Lower bound</th>
<th valign="top" align="center">Upper bound</th>
<th valign="top" align="center">Adjusted <italic>p</italic>-value</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">APA vs. Control</td>
<td valign="top" align="center">20.73</td>
<td valign="top" align="center">&#x2212;0.082</td>
<td valign="top" align="center">42.28</td>
<td valign="top" align="center">0.063</td>
</tr>
<tr>
<td valign="top" align="left">Zircos-E Etching vs. Control</td>
<td valign="top" align="center">26.33</td>
<td valign="top" align="center">4.78</td>
<td valign="top" align="center">47.88</td>
<td valign="top" align="center">0.011&#x002A;</td>
</tr>
<tr>
<td valign="top" align="left">APA&#x2009;&#x002B;&#x2009;Zircos-E vs. Control</td>
<td valign="top" align="center">44.87</td>
<td valign="top" align="center">23.32</td>
<td valign="top" align="center">66.42</td>
<td valign="top" align="center">&#x003C;0.001</td>
</tr>
<tr>
<td valign="top" align="left">LiSi Connect vs. Control</td>
<td valign="top" align="center">92.20</td>
<td valign="top" align="center">78.90</td>
<td valign="top" align="center">105.40</td>
<td valign="top" align="center">&#x003C;0.001&#x002A;</td>
</tr>
<tr>
<td valign="top" align="left">Zircos-E Etching vs. Air Abrasion</td>
<td valign="top" align="center">5.6</td>
<td valign="top" align="center">&#x2212;15.95</td>
<td valign="top" align="center">27.15</td>
<td valign="top" align="center">0.901</td>
</tr>
<tr>
<td valign="top" align="left">APA&#x2009;&#x002B;&#x2009;Zircos-E vs. APA</td>
<td valign="top" align="center">24.13</td>
<td valign="top" align="center">2.58</td>
<td valign="top" align="center">45.68</td>
<td valign="top" align="center">0.022&#x002A;</td>
</tr>
<tr>
<td valign="top" align="left">APA&#x2009;&#x002B;&#x2009;Zircos-E vs. Zircos-E Etching</td>
<td valign="top" align="center">18.53</td>
<td valign="top" align="center">&#x2212;3.02</td>
<td valign="top" align="center">40.08</td>
<td valign="top" align="center">0.116</td>
</tr>
<tr>
<td valign="top" align="left">LiSi Connect vs. APA</td>
<td valign="top" align="center">71.53</td>
<td valign="top" align="center">49.80</td>
<td valign="top" align="center">93.10</td>
<td valign="top" align="center">&#x003C;0.001&#x002A;</td>
</tr>
<tr>
<td valign="top" align="left">LiSi Connect vs. Zircos-E Etching</td>
<td valign="top" align="center">65.87</td>
<td valign="top" align="center">46.50</td>
<td valign="top" align="center">85.20</td>
<td valign="top" align="center">&#x003C;0.001&#x002A;</td>
</tr>
<tr>
<td valign="top" align="left">LiSi Connect vs. APA&#x2009;&#x002B;&#x2009;Zircos-E</td>
<td valign="top" align="center">47.33</td>
<td valign="top" align="center">20.60</td>
<td valign="top" align="center">74.00</td>
<td valign="top" align="center">&#x003C;0.001&#x002A;</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="TF2a"><label>&#x002A;</label>
<p>The important values for this study showing significant results of <italic>p</italic> value.</p></fn>
</table-wrap-foot>
</table-wrap>
<p>Post hoc pairwise comparisons using the Games&#x2013;Howell test indicate that, LiSi Connect exhibited significantly higher bond strength than all other groups, while Control demonstrated significantly lower bond strength compared to Zircos-E Etching, APA&#x2009;&#x002B;&#x2009;Zircos-E, and LiSi Connect. APA did not differ significantly from Control, Zircos-E Etching, or APA&#x2009;&#x002B;&#x2009;Zircos-E.</p>
<p>Failure modes were categorized as adhesive, cohesive, or mixed. The distribution of failure types varied among the groups, with the control group predominantly exhibiting adhesive failures, whereas Zircos-E Etching and APA&#x2009;&#x002B;&#x2009;Zircos-E showed higher proportions of cohesive and mixed failures (<xref ref-type="fig" rid="F3">Figure 3</xref>). However, Fisher&#x0027;s Exact Test (<italic>p</italic>&#x2009;&#x003D;&#x2009;0.1472) indicated that no statistically significant association was observed between failure type and surface treatment.</p>
<fig id="F3" position="float"><label>Figure&#x00A0;3</label>
<caption><p>Stacked bar chart showing proportion of cohesive, adhesive and mixed failures.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="fdmed-07-1778379-g003.tif"><alt-text content-type="machine-generated">Stacked bar chart illustrating the distribution of three failure types&#x2014;adhesive, mixed, and cohesive&#x2014;by proportion across five groups. Cohesive failures increase from left to right, while adhesive failures decrease. Mixed failures show moderate variation. Color key labels failure type categories.</alt-text>
</graphic>
</fig>
</sec>
</sec>
<sec id="s4" sec-type="discussion"><label>4</label><title>Discussion</title>
<p>The longevity and clinical success of indirect restorations depend on the bond between the restoration and the tooth substrate influenced by material selection and protocols. Bonding to zirconia presents challenges due to its polycrystalline structure and lack of silica phase, rendering etching ineffective (<xref ref-type="bibr" rid="B16">16</xref>). Surface treatments such as air abrasion and acid etching with resin cements, are critical for zirconia retention. Although HF etching was considered ineffective for zirconia, recent evidence suggests that specific conditions can alter the surface morphology to improve bonding (<xref ref-type="bibr" rid="B17">17</xref>).</p>
<p>Based on the literature, sandblasting with alumina particles of varying sizes and pressures has been widely investigated to improve zirconia bonding (<xref ref-type="bibr" rid="B15">15</xref>, <xref ref-type="bibr" rid="B18">18</xref>&#x2013;<xref ref-type="bibr" rid="B21">21</xref>). Moderate-pressure air-borne particle abrasion (APA) has consistently been shown to enhance surface roughness and micromechanical retention while minimizing the risk of subsurface damage or tetragonal-to-monoclinic phase transformation (<xref ref-type="bibr" rid="B12">12</xref>, <xref ref-type="bibr" rid="B22">22</xref>, <xref ref-type="bibr" rid="B23">23</xref>). Consequently, the sandblasting parameters used in the present study were selected to represent a clinically &#x201C;safe&#x201D; and effective protocol that balances bonding efficacy with material integrity (<xref ref-type="bibr" rid="B12">12</xref>). While excessive air abrasion can induce subsurface damage or tetragonal-to-monoclinic phase transformation, the moderate pressure and particle size used in this study were selected based on protocols known to enhance bonding while minimizing such risks (<xref ref-type="bibr" rid="B12">12</xref>, <xref ref-type="bibr" rid="B22">22</xref>).</p>
<p>Zircos-E is a multi-acid etching system developed for the chemical surface modification of zirconia ceramics. Unlike mechanical pretreatments, Zircos-E chemically activates the inert zirconia surface through acid reactions that generate micro-porosities and surface hydroxyl groups, increasing surface energy and reactivity (<xref ref-type="bibr" rid="B12">12</xref>). This hydroxylated surface promotes chemical interaction with phosphate-based functional monomers, such as 10-MDP, facilitating stable Zr&#x2013;O&#x2013;P bonding while preserving the crystalline integrity of zirconia.</p>
<p>The present study evaluated SBS and failure modes among five experimental groups. For the Zircos-E treatment, etching significantly improved bond strength compared to air abrasion and untreated controls. This increase is likely due to surface modifications at the grain boundaries, creating micro-porosities that enhance mechanical retention. Moreover, specimens subjected to combined etching and APA exhibited higher SBS than control, APA or Zircos-E etching. This observation is supported by literature (<xref ref-type="bibr" rid="B19">19</xref>, <xref ref-type="bibr" rid="B24">24</xref>). The combined mechanical and chemical treatments provide a compounded effect: air abrasion improves micromechanical retention, while chemical etching enhances surface reactivity, promoting superior adhesion (<xref ref-type="bibr" rid="B25">25</xref>). Although APA effectively increases surface roughness and facilitates micromechanical retention, it provides limited chemical activation of the zirconia surface, which may explain its comparatively lower bonding effectiveness when used alone (<xref ref-type="bibr" rid="B18">18</xref>, <xref ref-type="bibr" rid="B26">26</xref>). Chemical etching with Zircos-E further enhances bonding by creating micro-porosities of varying morphologies and increasing the effective bonding area, possibly resulting in a more stable resin&#x2013;zirconia interface (<xref ref-type="bibr" rid="B12">12</xref>, <xref ref-type="bibr" rid="B22">22</xref>, <xref ref-type="bibr" rid="B23">23</xref>).</p>
<p>On the other hand, LiSi Connect is a pretreatment system intended for the surface modification of zirconia ceramics. The ultra-thin coating (&#x223C;6&#x2013;10&#x2005;&#x00B5;m) is designed to preserve the original geometry of the restoration while converting the inert zirconia surface into a substrate with a glass-ceramic-like bonding behaviour and, will penetrates slightly into the zirconia surface and crystallises it, producing a lithium disilicate micro-coating embedded on the zirconia (<xref ref-type="bibr" rid="B15">15</xref>). It highlights the additive benefits of mechanical and chemical surface modifications and the efficacy of the novel LiSi Connect approach. LiSi Connect method enables conventional adhesive protocols without altering zirconia&#x0027;s intrinsic physical properties. Hydrofluoric acid etching subsequently generates hydroxyl groups (-OH) on the surface, improving resin cement affinity and chemical bonding (<xref ref-type="bibr" rid="B27">27</xref>). The superior bonding performance observed with LiSi Connect is in agreement with previous studies reporting that lithium-silicate coatings on zirconia produce bond strengths comparable to those achieved with lithium disilicate ceramics (<xref ref-type="bibr" rid="B12">12</xref>, <xref ref-type="bibr" rid="B27">27</xref>, <xref ref-type="bibr" rid="B28">28</xref>). From a clinical perspective, this strategy offers a promising means of improving bonding predictability and durability without compromising zirconia&#x0027;s intrinsic mechanical properties.</p>
<p>Failure mode analysis revealed a shift from predominantly adhesive failures in untreated specimens toward mixed and cohesive failures in chemically treated groups, suggesting improved interfacial integrity. Although no statistically significant association between failure mode and surface treatment was detected, the observed trends align with existing literature indicating that chemical surface conditioning enhances zirconia&#x2013;resin adhesion (<xref ref-type="bibr" rid="B28">28</xref>, <xref ref-type="bibr" rid="B29">29</xref>). These observations support prior findings, highlighting those mechanical treatments alone may not achieve optimal zirconia bonding (<xref ref-type="bibr" rid="B28">28</xref>). Whereas chemical surface conditioning significantly enhances resin&#x2013;zirconia adhesion, potentially approaching the bond strength observed in enamel (<xref ref-type="bibr" rid="B20">20</xref>, <xref ref-type="bibr" rid="B30">30</xref>). Further investigations encompassing a broader range of materials and clinical conditions are warranted to optimize zirconia bonding strategies.</p>
<p>To conclude, based on the current literature and the findings of this study, advanced chemical conditioning systems such as Zircos-E and LiSi Connect demonstrated superior results. The significant increase in SBS obtained with LiSi Connect, even after thermocycling equivalent to six months of clinical aging, confirms its potential for long-term durability.</p>
<p>Several limitations of this study should be acknowledged. Although thermocycling was applied to simulate thermal aging, the <italic>in vitro</italic> design cannot fully reproduce the complex intraoral environment, where restorations are subjected to cyclic mechanical loading, moisture, enzymatic activity, and pH fluctuations. In addition, only one generation of zirconia was evaluated, which limits the generalizability of the findings to other zirconia formulations that may respond differently to surface treatments. Furthermore, both Zircos-E and LiSi Connect are technique-sensitive procedures that require strict control of application parameters and appropriate safety measures, potentially affecting their reproducibility in clinical practice. Importantly, any claims regarding clinical equivalence or long-term durability should be interpreted with caution, as the present findings are limited to short-term <italic>in vitro</italic> performance, and long-term bonding stability remains to be demonstrated. Therefore, future studies should include different generations of zirconia, extended aging protocols, and well-designed clinical trials to validate the long-term durability, safety, and clinical applicability of these surface treatment strategies.</p>
</sec>
<sec id="s5" sec-type="conclusions"><label>5</label><title>Conclusions</title>
<p>Within the constraints of the present study, it can be concluded that:
<list list-type="order">
<list-item>
<p>Surface treatment protocols exert a significant influence on shear bond strength (SBS).</p></list-item>
<list-item>
<p>The combination of Zircos-E etching with air abrasion results in a synergistic enhancement of SBS.</p></list-item>
<list-item>
<p>Among the surface treatments evaluated, the LiSi Connect system achieves the highest SBS values. Therefore, LiSi Connect demonstrates promising results for augmenting zirconia bonding through the integration of mechanical and chemical modifications, though further long-term clinical validation is needed.</p></list-item>
</list></p>
</sec>
</body>
<back>
<sec id="s6" sec-type="data-availability"><title>Data availability statement</title>
<p>The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.</p>
</sec>
<sec id="s7" sec-type="author-contributions"><title>Author contributions</title>
<p>AE: Methodology, Data curation, Investigation, Validation, Visualization, Writing &#x2013; original draft. EN: Writing &#x2013; review &#x0026; editing, Validation, Visualization. ML-S: Writing &#x2013; review &#x0026; editing, Data curation, Writing &#x2013; original draft, Funding acquisition, Formal analysis, Resources. EZ-P: Visualization, Writing &#x2013; review &#x0026; editing. GN: Investigation, Software, Writing &#x2013; review &#x0026; editing. RH: Software, Writing &#x2013; review &#x0026; editing, Investigation. RB: Validation, Methodology, Writing &#x2013; review &#x0026; editing. LH: Funding acquisition, Conceptualization, Formal analysis, Resources, Project administration, Supervision, Writing &#x2013; review &#x0026; editing, Writing &#x2013; original draft.</p>
</sec>
<sec id="s9" sec-type="COI-statement"><title>Conflict of interest</title>
<p>The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s10" sec-type="ai-statement"><title>Generative AI statement</title>
<p>The author(s) declared that generative AI was not used in the creation of this manuscript.</p>
<p>Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.</p>
</sec>
<sec id="s11" sec-type="disclaimer"><title>Publisher&#x0027;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<ref-list><title>References</title>
<ref id="B1"><label>1.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tzanakakis</surname> <given-names>EG</given-names></name> <name><surname>Tzoutzas</surname> <given-names>IG</given-names></name> <name><surname>Koidis</surname> <given-names>PT</given-names></name></person-group>. <article-title>Is there a potential for durable adhesion to zirconia restorations? A systematic review</article-title>. <source>J Prosthet Dent</source>. (<year>2016</year>) <volume>115</volume>(<issue>1</issue>):<fpage>9</fpage>&#x2013;<lpage>19</lpage>. <pub-id pub-id-type="doi">10.1016/j.prosdent.2015.09.008</pub-id><pub-id pub-id-type="pmid">26548872</pub-id></mixed-citation></ref>
<ref id="B2"><label>2.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Quigley</surname> <given-names>NP</given-names></name> <name><surname>Loo</surname> <given-names>DS</given-names></name> <name><surname>Choy</surname> <given-names>C</given-names></name> <name><surname>Ha</surname> <given-names>WN</given-names></name></person-group>. <article-title>Clinical efficacy of methods for bonding to zirconia: a systematic review</article-title>. <source>J Prosthet Dent</source>. (<year>2021</year>) <volume>125</volume>(<issue>2</issue>):<fpage>231</fpage>&#x2013;<lpage>40</lpage>. <pub-id pub-id-type="doi">10.1016/j.prosdent.2019.12.017</pub-id><pub-id pub-id-type="pmid">32115220</pub-id></mixed-citation></ref>
<ref id="B3"><label>3.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fabbri</surname> <given-names>G</given-names></name> <name><surname>Ban</surname> <given-names>G</given-names></name> <name><surname>Pulcini</surname> <given-names>C</given-names></name> <name><surname>Cerutti</surname> <given-names>A</given-names></name> <name><surname>&#x00D6;zcan</surname> <given-names>M</given-names></name></person-group>. <article-title>Clinical performance of complete-arch implant-supported rehabilitations using monolithic lithium disilicate restorations bonded to CAD/CAM titanium and zirconia frameworks up to 5 years</article-title>. <source>Eur J Prosthodontics Restorative Dentistry</source>. (<year>2022</year>) <volume>30</volume>(<issue>4</issue>):<fpage>296</fpage>&#x2013;<lpage>304</lpage>. <pub-id pub-id-type="doi">10.1922/EJPRD_2069Fabbri09</pub-id></mixed-citation></ref>
<ref id="B4"><label>4.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Shahmiri</surname> <given-names>R</given-names></name> <name><surname>Standard</surname> <given-names>OC</given-names></name> <name><surname>Hart</surname> <given-names>JN</given-names></name> <name><surname>Sorrell</surname> <given-names>CC</given-names></name></person-group>. <article-title>Optical properties of zirconia ceramics for esthetic dental resto-rations: a systematic review</article-title>. <source>J Prosthet Dent</source>. (<year>2018</year>) <volume>119</volume>(<issue>1</issue>):<fpage>36</fpage>&#x2013;<lpage>46</lpage>. <pub-id pub-id-type="doi">10.1016/j.prosdent.2017.07.009</pub-id><pub-id pub-id-type="pmid">28927925</pub-id></mixed-citation></ref>
<ref id="B5"><label>5.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chaiyabutr</surname> <given-names>Y</given-names></name> <name><surname>McGowan</surname> <given-names>S</given-names></name> <name><surname>Phillips</surname> <given-names>KM</given-names></name> <name><surname>Kois</surname> <given-names>JC</given-names></name> <name><surname>Giordano</surname> <given-names>RA</given-names></name></person-group>. <article-title>The effect of hydrofluoric acid surface treat-ment and bond strength of a zirconia veneering ceramic</article-title>. <source>J Prosthet Dent</source>. (<year>2008</year>) <volume>100</volume>(<issue>3</issue>):<fpage>194</fpage>&#x2013;<lpage>202</lpage>. <pub-id pub-id-type="doi">10.1016/S0022-3913(08)60178-X</pub-id><pub-id pub-id-type="pmid">18762031</pub-id></mixed-citation></ref>
<ref id="B6"><label>6.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Qi</surname> <given-names>B</given-names></name> <name><surname>Liang</surname> <given-names>S</given-names></name> <name><surname>Li</surname> <given-names>Y</given-names></name> <name><surname>Zhou</surname> <given-names>C</given-names></name> <name><surname>Yu</surname> <given-names>H</given-names></name> <name><surname>Li</surname> <given-names>J</given-names></name></person-group>. <article-title>Zro2 matrix toughened ceramic material-strength and toughness</article-title>. <source>Adv Eng Mater</source>. (<year>2022</year>) <volume>24</volume>(<issue>6</issue>):<fpage>2101278</fpage>. <pub-id pub-id-type="doi">10.1002/adem.202101278</pub-id></mixed-citation></ref>
<ref id="B7"><label>7.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Smielak</surname> <given-names>B</given-names></name> <name><surname>Klimek</surname> <given-names>L</given-names></name></person-group>. <article-title>Effect of hydrofluoric acid concentration and etching duration on select surface roughness parameters for zirconia</article-title>. <source>J Prosthet Dent</source>. (<year>2015</year>) <volume>113</volume>(<issue>6</issue>):<fpage>596</fpage>&#x2013;<lpage>602</lpage>. <pub-id pub-id-type="doi">10.1016/j.prosdent.2015.01.001</pub-id><pub-id pub-id-type="pmid">25799283</pub-id></mixed-citation></ref>
<ref id="B8"><label>8.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sales</surname> <given-names>A</given-names></name> <name><surname>Rodrigues</surname> <given-names>SJ</given-names></name> <name><surname>Mahesh</surname> <given-names>M</given-names></name> <name><surname>Ginjupalli</surname> <given-names>K</given-names></name> <name><surname>Shetty</surname> <given-names>T</given-names></name> <name><surname>Pai</surname> <given-names>UY</given-names></name><etal/></person-group> <article-title>Effect of different surface treatments on the micro-shear bond strength and surface characteristics of zirconia: an <italic>in vitro</italic> study</article-title>. <source>Int J Dent</source>. (<year>2022</year>) <volume>2022</volume>(<issue>1</issue>):<fpage>1546802</fpage>. <pub-id pub-id-type="doi">10.1155/2022/1546802</pub-id><pub-id pub-id-type="pmid">35464102</pub-id></mixed-citation></ref>
<ref id="B9"><label>9.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sadid-Zadeh</surname> <given-names>R</given-names></name> <name><surname>Strazzella</surname> <given-names>A</given-names></name> <name><surname>Li</surname> <given-names>R</given-names></name> <name><surname>Makwoka</surname> <given-names>S</given-names></name></person-group>. <article-title>Effect of zirconia etching solution on the shear bond strength between zirconia and resin cement</article-title>. <source>J Prosthet Dent</source>. (<year>2021</year>) <volume>126</volume>(<issue>5</issue>):<fpage>693</fpage>&#x2013;<lpage>7</lpage>. <pub-id pub-id-type="doi">10.1016/j.prosdent.2020.09.016</pub-id><pub-id pub-id-type="pmid">33162113</pub-id></mixed-citation></ref>
<ref id="B10"><label>10.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yue</surname> <given-names>X</given-names></name> <name><surname>Hou</surname> <given-names>X</given-names></name> <name><surname>Gao</surname> <given-names>J</given-names></name> <name><surname>Bao</surname> <given-names>P</given-names></name> <name><surname>Shen</surname> <given-names>J</given-names></name></person-group>. <article-title>Effects of MDP-based primers on shear bond strength between resin cement and zirconia</article-title>. <source>Exp Ther Med</source>. (<year>2019</year>) <volume>17</volume>(<issue>5</issue>):<fpage>3564</fpage>&#x2013;<lpage>72</lpage>. <pub-id pub-id-type="doi">10.3892/etm.2019.7382</pub-id><pub-id pub-id-type="pmid">30988738</pub-id></mixed-citation></ref>
<ref id="B11"><label>11.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cho</surname> <given-names>J</given-names></name> <name><surname>Kim</surname> <given-names>SJ</given-names></name> <name><surname>Shim</surname> <given-names>JS</given-names></name> <name><surname>Lee</surname> <given-names>KW</given-names></name></person-group>. <article-title>Effect of zirconia surface treatment using nitric acid- hydrofluoric acid on the shear bond strengths of resin cements</article-title>. <source>J Adv Prosthodont</source>. (<year>2017</year>) <volume>9</volume>(<issue>2</issue>):<fpage>77</fpage>&#x2013;<lpage>84</lpage>. <pub-id pub-id-type="doi">10.4047/jap.2017.9.2.77</pub-id><pub-id pub-id-type="pmid">28435615</pub-id></mixed-citation></ref>
<ref id="B12"><label>12.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Conner</surname> <given-names>C</given-names></name> <name><surname>Andretti</surname> <given-names>F</given-names></name> <name><surname>Hernandez</surname> <given-names>AI</given-names></name> <name><surname>Rojas-Rueda</surname> <given-names>S</given-names></name> <name><surname>Azpiazu-Flores</surname> <given-names>FX</given-names></name> <name><surname>Morrow</surname> <given-names>BR</given-names></name><etal/></person-group> <article-title>Surface evaluation of a novel acid-etching solution for zirconia and lithium disilicate</article-title>. <source>Materials (Basel)</source>. (<year>2025</year>) <volume>18</volume>(<issue>12</issue>):<fpage>2912</fpage>. <pub-id pub-id-type="doi">10.3390/ma18122912</pub-id><pub-id pub-id-type="pmid">40573041</pub-id></mixed-citation></ref>
<ref id="B13"><label>13.</label><mixed-citation publication-type="other"><person-group person-group-type="author"><name><surname>Shen</surname> <given-names>D</given-names></name> <name><surname>Wang</surname> <given-names>H</given-names></name> <name><surname>Shi</surname> <given-names>Y</given-names></name> <name><surname>Su</surname> <given-names>Z</given-names></name> <name><surname>Hannig</surname> <given-names>M</given-names></name> <name><surname>Fu</surname> <given-names>B</given-names></name></person-group>. <article-title>The effect of surface treatments on zirconia bond strength and durability</article-title>. <source>J Funct Biomater</source>. (<year>2023</year>) <volume>14</volume>(<issue>2</issue>):<fpage>89</fpage>. <pub-id pub-id-type="doi">10.3390/jfb14020089</pub-id></mixed-citation></ref>
<ref id="B14"><label>14.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chen</surname> <given-names>Z</given-names></name> <name><surname>Zhou</surname> <given-names>Y</given-names></name> <name><surname>Li</surname> <given-names>D</given-names></name> <name><surname>Zhang</surname> <given-names>M</given-names></name> <name><surname>Zhou</surname> <given-names>B</given-names></name> <name><surname>Hao</surname> <given-names>P</given-names></name></person-group>. <article-title>Does the internal surface treatment technique for enhanced bonding affect the color, transparency, and surface roughness of ultra-transparent zirconia?</article-title> <source>Clin Oral Investig</source>. (<year>2024</year>) <volume>28</volume>(<issue>9</issue>):<fpage>473</fpage>. <pub-id pub-id-type="doi">10.1007/s00784-024-05847-4</pub-id><pub-id pub-id-type="pmid">39110133</pub-id></mixed-citation></ref>
<ref id="B15"><label>15.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wu</surname> <given-names>SH</given-names></name> <name><surname>Lai</surname> <given-names>SY</given-names></name> <name><surname>Lee</surname> <given-names>IT</given-names></name> <name><surname>Mine</surname> <given-names>Y</given-names></name> <name><surname>Huang</surname> <given-names>HY</given-names></name> <name><surname>Peng</surname> <given-names>TY</given-names></name></person-group>. <article-title>Handheld nonthermal plasma augmentation of glass&#x2013;ceramic spray deposition on zirconia surface characterization and MG-63/HGF-1 cell behavior: an <italic>in vitro</italic> study</article-title>. <source>J Funct Biomater</source>. (<year>2025</year>) <volume>16</volume>(<issue>11</issue>):<fpage>421</fpage>. <pub-id pub-id-type="doi">10.3390/jfb16110421</pub-id><pub-id pub-id-type="pmid">41295076</pub-id></mixed-citation></ref>
<ref id="B16"><label>16.</label><mixed-citation publication-type="thesis"><person-group person-group-type="author"><name><surname>Priyavardhini</surname> <given-names>P</given-names></name></person-group>. <source>Assessment of different surface treatments and bonding agents on the shear bond strength of aged composite-an in vitro study</source> (Master&#x2019;s thesis). <publisher-name>Rajiv Gandhi University of Health Sciences</publisher-name>, <publisher-loc>India</publisher-loc>.</mixed-citation></ref>
<ref id="B17"><label>17.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ria</surname> <given-names>A</given-names></name> <name><surname>Ibrahim</surname> <given-names>H</given-names></name></person-group>. <article-title>Adhesion to zirconia: factors affect bonding to zirconia</article-title>. <source>ERU Res J</source>. (<year>2025</year>) <volume>4</volume>(<issue>1</issue>):<fpage>2190</fpage>&#x2013;<lpage>209</lpage>. <pub-id pub-id-type="doi">10.21608/erurj.2025.318931.1181</pub-id></mixed-citation></ref>
<ref id="B18"><label>18.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Moon</surname> <given-names>JE</given-names></name> <name><surname>Kim</surname> <given-names>SH</given-names></name> <name><surname>Lee</surname> <given-names>JB</given-names></name> <name><surname>Han</surname> <given-names>JS</given-names></name> <name><surname>Yeo</surname> <given-names>IS</given-names></name> <name><surname>Ha</surname> <given-names>SR</given-names></name></person-group>. <article-title>Effects of airborne-particle abrasion protocol choice on the surface characteristics of monolithic zirconia materials and the shear bond strength of resin cement</article-title>. <source>Ceram Int</source>. (<year>2016</year>) <volume>42</volume>(<issue>1</issue>):<fpage>1552</fpage>&#x2013;<lpage>62</lpage>. <pub-id pub-id-type="doi">10.1016/j.ceramint.2015.09.104</pub-id></mixed-citation></ref>
<ref id="B19"><label>19.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Su</surname> <given-names>N</given-names></name> <name><surname>Li</surname> <given-names>Y</given-names></name> <name><surname>Yunmao</surname> <given-names>L</given-names></name> <name><surname>Wenjia</surname> <given-names>L</given-names></name> <name><surname>Hai</surname> <given-names>Z</given-names></name> <name><surname>Xin</surname> <given-names>L</given-names></name><etal/></person-group> <article-title>The effect of various sandblasting conditions on surface changes of dental zirconia and shear bond strenght between zirconia core and indirect composite resin</article-title>. <source>J Adv Prosthodont</source>. (<year>2015</year>) <volume>7</volume>(<issue>3</issue>):<fpage>214</fpage>&#x2013;<lpage>23</lpage>. <pub-id pub-id-type="doi">10.4047/jap.2015.7.3.214</pub-id><pub-id pub-id-type="pmid">26140173</pub-id></mixed-citation></ref>
<ref id="B20"><label>20.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Scaminaci Russo</surname> <given-names>D</given-names></name> <name><surname>Cinelli</surname> <given-names>F</given-names></name> <name><surname>Sarti</surname> <given-names>C</given-names></name> <name><surname>Giachetti</surname> <given-names>L</given-names></name></person-group>. <article-title>Adhesion to zirconia: a systematic review of current condi-tioning methods and bonding materials</article-title>. <source>Dentistry Journal</source>. (<year>2019</year>) <volume>7</volume>(<issue>3</issue>):<fpage>74</fpage>. <pub-id pub-id-type="doi">10.3390/dj7030074</pub-id><pub-id pub-id-type="pmid">31374820</pub-id></mixed-citation></ref>
<ref id="B21"><label>21.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zhang</surname> <given-names>Q</given-names></name> <name><surname>Yao</surname> <given-names>C</given-names></name> <name><surname>Yuan</surname> <given-names>C</given-names></name> <name><surname>Zhang</surname> <given-names>H</given-names></name> <name><surname>Liu</surname> <given-names>L</given-names></name> <name><surname>Zhang</surname> <given-names>Y</given-names></name><etal/></person-group> <article-title>Evaluation of surface properties and shear bond strength of zirconia substructure after sandblasting and acid etching</article-title>. <source>Mater Res Express</source>. (<year>2020</year>) <volume>7</volume>(<issue>9</issue>):<fpage>095403</fpage>. <pub-id pub-id-type="doi">10.1088/2053-1591/abb5c9</pub-id></mixed-citation></ref>
<ref id="B22"><label>22.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kui</surname> <given-names>A</given-names></name> <name><surname>Buduru</surname> <given-names>S</given-names></name> <name><surname>Labune&#x021B;</surname> <given-names>A</given-names></name> <name><surname>Sava</surname> <given-names>S</given-names></name> <name><surname>Pop</surname> <given-names>D</given-names></name> <name><surname>Bara</surname> <given-names>I</given-names></name><etal/></person-group> <article-title>Air particle abrasion in dentistry: an over-view of effects on dentin adhesion and bond strength</article-title>. <source>Dentistry Journal</source>. (<year>2024</year>) <volume>13</volume>(<issue>1</issue>):<fpage>16</fpage>. <pub-id pub-id-type="doi">10.3390/dj13010016</pub-id><pub-id pub-id-type="pmid">39851592</pub-id></mixed-citation></ref>
<ref id="B23"><label>23.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lee</surname> <given-names>JH</given-names></name> <name><surname>Kim</surname> <given-names>SH</given-names></name> <name><surname>Han</surname> <given-names>JS</given-names></name> <name><surname>Yeo</surname> <given-names>IL</given-names></name> <name><surname>Yoon</surname> <given-names>HI</given-names></name></person-group>. <article-title>Optical and surface properties of monolithic zirconia after sim-ulated tooth-brushing</article-title>. <source>Materials (Basel)</source>. (<year>2019</year>) <volume>10</volume>:<fpage>1158</fpage>. <pub-id pub-id-type="doi">10.3390/ma12071158</pub-id></mixed-citation></ref>
<ref id="B24"><label>24.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pilo</surname> <given-names>R</given-names></name> <name><surname>Dimitriadi</surname> <given-names>M</given-names></name> <name><surname>Palaghia</surname> <given-names>A</given-names></name> <name><surname>Eliades</surname> <given-names>G</given-names></name></person-group>. <article-title>Effect of tribochemical treatments and silane reactivity on resin bonding to zirconia</article-title>. <source>Dent Mater</source>. (<year>2018</year>) <volume>34</volume>(<issue>2</issue>):<fpage>306</fpage>&#x2013;<lpage>16</lpage>. <pub-id pub-id-type="doi">10.1016/j.dental.2017.11.006</pub-id><pub-id pub-id-type="pmid">29183673</pub-id></mixed-citation></ref>
<ref id="B25"><label>25.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kim</surname> <given-names>M-J</given-names></name> <name><surname>Kim</surname> <given-names>YK</given-names></name> <name><surname>Kim</surname> <given-names>K-H</given-names></name> <name><surname>Kwon</surname> <given-names>T-Y</given-names></name></person-group>. <article-title>Shear bond strengths of various luting cements to zirconia ceramic: surface chemical aspects</article-title>. <source>J Dent</source>. (<year>2011</year>) <volume>39</volume>(<issue>11</issue>):<fpage>795</fpage>&#x2013;<lpage>803</lpage>. <pub-id pub-id-type="doi">10.1016/j.jdent.2011.08.012</pub-id><pub-id pub-id-type="pmid">21907260</pub-id></mixed-citation></ref>
<ref id="B26"><label>26.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Al-Amari</surname> <given-names>AS</given-names></name> <name><surname>Saleh</surname> <given-names>MS</given-names></name> <name><surname>Albadah</surname> <given-names>AA</given-names></name> <name><surname>Almousa</surname> <given-names>AA</given-names></name> <name><surname>Mahjoub</surname> <given-names>WK</given-names></name> <name><surname>Al-Otaibi</surname> <given-names>RM</given-names></name><etal/></person-group> <article-title>A comprehensive review of techniques for enhancing zirconia bond strength: current approaches and emerging innovations</article-title>. <source>Cureus</source>. (<year>2024</year>) <volume>16</volume>(<issue>10</issue>). <pub-id pub-id-type="doi">10.7759/cureus.70893</pub-id><pub-id pub-id-type="pmid">39497891</pub-id></mixed-citation></ref>
<ref id="B27"><label>27.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ver&#x00ED;ssimo</surname> <given-names>AH</given-names></name> <name><surname>Moura</surname> <given-names>DM</given-names></name> <name><surname>Tribst</surname> <given-names>JP</given-names></name> <name><surname>Ara&#x00FA;jo</surname> <given-names>AM</given-names></name> <name><surname>Leite</surname> <given-names>FP</given-names></name></person-group>. <article-title>Effect of hydrofluoric acid concentration and etching time on resin-bond strength to different glass ceramics</article-title>. <source>Braz Oral Res</source>. (<year>2019</year>) <volume>33</volume>:<fpage>e041</fpage>. <pub-id pub-id-type="doi">10.1590/1807-3107bor-2019.vol33.0041</pub-id></mixed-citation></ref>
<ref id="B28"><label>28.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Peng</surname> <given-names>T-Y</given-names></name> <name><surname>Kang</surname> <given-names>C-M</given-names></name> <name><surname>Feng</surname> <given-names>S-W</given-names></name> <name><surname>Hung</surname> <given-names>C-Y</given-names></name> <name><surname>Iwaguro</surname> <given-names>S</given-names></name> <name><surname>Dan-Jae Lin</surname> <given-names>D-J</given-names></name></person-group>. <article-title>Effects of glass-ceramic spray deposition manipulation on the surface characteristics of zirconia dental restorations</article-title>. <source>Ceram Int</source>. (<year>2022</year>) <volume>48</volume>(<issue>20</issue>):<fpage>29873</fpage>&#x2013;<lpage>81</lpage>. <pub-id pub-id-type="doi">10.1016/j.ceramint.2022.06.252</pub-id></mixed-citation></ref>
<ref id="B29"><label>29.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kim</surname> <given-names>SH</given-names></name> <name><surname>Choi</surname> <given-names>YS</given-names></name> <name><surname>Kang</surname> <given-names>KH</given-names></name> <name><surname>Att</surname> <given-names>W</given-names></name></person-group>. <article-title>Effects of thermal and mechanical cycling on the mechanical strength and surface properties of dental CAD-CAM restorative materials</article-title>. <source>J Prosthet Dent</source>. (<year>2022</year>) <volume>128</volume>(<issue>1</issue>):<fpage>79</fpage>&#x2013;<lpage>88</lpage>. <pub-id pub-id-type="doi">10.1016/j.prosdent.2020.11.014</pub-id><pub-id pub-id-type="pmid">33546857</pub-id></mixed-citation></ref>
<ref id="B30"><label>30.</label><mixed-citation publication-type="book"><person-group person-group-type="author"><name><surname>Aschheim</surname> <given-names>KW</given-names></name></person-group>. <source>Esthetic Dentistry: A Clinical Approach to Techniques and Materials</source>. <publisher-loc>St. Louis (MO)</publisher-loc>: <publisher-name>Elsevier Health Sciences</publisher-name> (<year>2014</year>).</mixed-citation></ref></ref-list>
<fn-group>
<fn id="n1" fn-type="custom" custom-type="edited-by"><p>Edited by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/993863/overview">Nick Silikas</ext-link>, The University of Manchester, United Kingdom</p></fn>
<fn id="n2" fn-type="custom" custom-type="reviewed-by"><p>Reviewed by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1966229/overview">Hsu Zenn Yew</ext-link>, National University of Malaysia, Malaysia</p>
<p><ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/3342019/overview">Athanasios Rigos</ext-link>, Texas A&#x0026;M University Baylor College of Dentistry, United States</p></fn>
</fn-group>
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</article>