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Background:
Systematic Review

Effectiveness of Surface Treatments on the Bond Strength to 3D-Printed Resins: A Systematic Review and Meta-Analysis

by
Rim Bourgi
1,2,3,
Olivier Etienne
1,4,5,
Ahmed A. Holiel
2,6,
Carlos Enrique Cuevas-Suárez
7,*,
Louis Hardan
3,
Tatiana Roman
1,4,5,
Abigailt Flores-Ledesma
8,
Mohammad Qaddomi
9,
Youssef Haikel
1,4,10 and
Naji Kharouf
1,10,*
1
Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, University of Strasbourg, 67000 Strasbourg, France
2
Department of Restorative Sciences, Faculty of Dentistry, Beirut Arab University, Beirut 115020, Lebanon
3
Department of Restorative Dentistry, School of Dentistry, Saint-Joseph University, Beirut 1107 2180, Lebanon
4
Department of Prosthetic Dentistry, Faculty of Dental Medicine, Strasbourg University, 67000 Strasbourg, France
5
Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 67000 Strasbourg, France
6
Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria 5424041, Egypt
7
Dental Materials Laboratory, Academic Area of Dentistry, Autonomous University of Hidalgo State, San Agustín Tlaxiaca 42160, Mexico
8
Dental Materials and Biomaterials Laboratory, Faculty of Stomatology, Meritorious Autonomous University of Puebla, Puebla 72000, Mexico
9
Esthetic and Prosthetic Dentistry, School of Dentistry, Saint-Joseph University, Beirut 1107 2180, Lebanon
10
Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg, 67000 Strasbourg, France
*
Authors to whom correspondence should be addressed.
Prosthesis 2025, 7(3), 56; https://doi.org/10.3390/prosthesis7030056
Submission received: 24 April 2025 / Revised: 13 May 2025 / Accepted: 20 May 2025 / Published: 23 May 2025
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Abstract

:
Objectives: The widespread adoption of three-dimensional (3D)-printed resins in restorative dentistry has introduced significant challenges in establishing strong and lasting bonds with resin-based cements. Despite the development of numerous surface treatment techniques designed to improve adhesion, a clear consensus on the most effective approach remains elusive. This systematic review and meta-analysis critically examined the impact of various surface treatment protocols on the bond strength of 3D-printed resins. By comparing treated versus untreated surfaces, the study aimed to determine the most reliable strategies for enhancing adhesion, ultimately offering evidence-based guidance to inform clinical decision-making. Methods: This review identified relevant studies through a comprehensive search of MEDLINE via PubMed, Web of Science, Scielo, Scopus, and EMBASE databases, supplemented by manual reference checks, to identify in vitro studies published up to February 2025. Studies assessing the bonding of 3D-printed resins following various surface treatments and bonding protocols were included. Data on bond strength outcomes, such as shear bond strength, microtensile bond strength, and microshear bond strength, were extracted. Data extraction included study details, type of 3D-printed resin and printing technology, surface treatment protocols, bond strength testing methods, storage conditions, and results. The quality of included studies was assessed using the ROBDEMat tool. Meta-analyses were performed using the Review Manager Software (version 5.4, The Cochrane Collaboration, Copenhagen, Denmark), with statistical significance set at p < 0.05. Statistical heterogeneity among studies was evaluated using the Cochran Q test and the I2 inconsistency test. Results: Nine studies met the criteria for qualitative analysis, with eight included in the meta-analysis. The findings revealed that surface treatment protocols significantly enhanced the immediate bond strength to 3D-printed resins (p = 0.01), with only sandblasting and silane demonstrating a statistically significant effect (p < 0.007). Similarly, after aging, surface treatments continued to improve bond strength (p = 0.01), with sandblasting and hydrofluoric acid being the only methods to produce a significant increase in bond strength values (p < 0.001). Conclusions: This meta-analysis underscores the importance of combining mechanical and chemical surface treatments, especially sandblasting and silane application, to achieve reliable and durable bonding to 3D-printed resins.

1. Introduction

Digital dentistry has significantly advanced with the integration of computer-aided design and computer-aided manufacturing (CAD/CAM) technologies, streamlining restorative procedures through precise, efficient, and cost-effective workflows [1]. While subtractive manufacturing (milling) remains widely used, additive manufacturing (three-dimensional (3D) printing) has emerged as a promising option due to efficiency, affordability, and capacity for complex geometries, also allowing the possibility of permanent frameworks [2,3].
According to the EN ISO/ASTM 52900 standard [3], additive manufacturing refers to the technique of constructing objects by successively layering materials based on digital 3D models, allowing precise and useful fabrication. This technique enables rapid production while minimizing material waste, making it suitable for fabricating complex geometries. Vat-polymerization (VPP), which includes stereolithography (SLA), digital light processing (DLP), and continuous liquid interface production (CLIP); material extrusion (MEX), including fused deposition modeling (FDM); binder jetting (BJT); powder bed fusion (PBF); material jetting (MJT); sheet lamination (SHL); and directed energy deposition (DED) are the seven categories into which additive manufacturing is divided [3,4]. DLP, in particular, offers high-resolution fabrication with reduced material waste, making it popular for producing temporary and permanent dental restorations, including crowns, bridges, inlays, onlays, dentures, and surgical guides [5,6].
Despite its advantages, 3D-printed resins face limitations in mechanical properties such as strength, wear resistance, and fracture toughness, which hinder their use in long-term restorations. To address these issues, recent developments have introduced highly filled 3D-printed resins, incorporating over 50% ceramic fillers like lithium disilicate and zirconia [7]. These materials improve mechanical performance, including strength, hardness, shrinkage resistance, and water absorption. However, achieving durable and reliable bonding between 3D-printed restorations and tooth substrates remains a clinical challenge. Additionally, factors inherent to the additive manufacturing process such as layer-by-layer polymerization, incomplete monomer conversion, surface irregularities, and oxygen inhibition layers, may negatively influence surface energy and compromise bonding potential [3,6]. Inadequate bonding can result in marginal leakage, secondary caries, and fractures, ultimately compromising the longevity of restorations [8].
To optimize adhesion to 3D-printed resins, various surface treatments have been explored, including mechanical surface roughening (e.g., alumina air abrasion, acid etching, laser treatment), chemical modification (e.g., silane coupling agents), and application of universal adhesives [9,10,11]. These treatments aim to improve bonding by augmenting surface texture, thereby facilitating micromechanical interlocking and strengthening chemical adhesion. Shear bond strength (SBS) and tensile bond strength tests are commonly used for assessing bonding performance among studies [1,6,7,11]. Additionally, mechanical surface treatments and chemical agents are commonly evaluated through advanced imaging techniques such as scanning electron microscopy (SEM) and atomic force microscopy (AFM), which provide detailed insights into surface morphology and the quality of adhesion [8]. However, no consensus exists regarding the optimal protocol for improving bond strength to 3D-printed resins, especially given the diversity in filler types and contents.
The degree of conversion (DC) and material composition also significantly influence bond strength. Milled resin composites, cured under elevated pressure and temperature conditions, typically achieve a high DC (up to 94.3%) [12], which may limit available free monomers for bonding [13]. In contrast, 3D-printed resins exhibit variable DCs (ranging from 45% to over 95%), potentially offering more reactive sites for adhesive bonding [12,14,15]. Differences in filler content also affect bonding performance. Milled composites usually contain around 70% ceramic fillers, while 3D-printed resins range from 0–50% [16]. These ceramic fillers, commonly silica glass or barium aluminosilicate glass, are often bonded using silane primers [16]. However, silane coupling agents may be less effective in low-filler resins, where adhesive systems play a more significant role [17].
Studies on the bond strength of 3D-printed resins have produced mixed results. Although some research supports the effectiveness of alumina air abrasion in improving surface roughness and bond strength [1,18,19], a study reported limited benefits for crown retention [20]. Similarly, the role of silane primers remains debated, while some studies highlighting their advantages, particularly when combined with adhesives [7,17], some question their standalone effectiveness [1].
Given the growing use of 3D-printed resins in dental applications, significant knowledge gaps remain, particularly concerning how different surface treatments affect bonding performance across diverse resin compositions. This article aims to assess the effectiveness of various surface treatments in improving the bonding of 3D-printed dental resins. The goal is to establish evidence-based guidelines to optimize the bonding performance of 3D-printed dental materials, thereby enhancing their clinical longevity and success in permanent restorations. The null hypothesis was that no significant differences would be observed in the immediate and aged bond strength of 3D-printed resins among the various surface treatments evaluated.

2. Materials and Methods

2.1. Study Design

This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions [21]. The study protocol was registered with Open Science Framework (OSF) under the following DOI identifier DOI 10.17605/OSF.IO/U4ASM. The research question was developed based on the PICO framework: Population, 3D-printed resin specimens used in restorative dentistry; Intervention: Surface treatments; Control: Untreated surfaces; Outcome: bond strength. The research question guiding this study was: “What is the best treatment for improving the bond strength to 3D-printed resin?”.

2.2. Literature Search

A comprehensive electronic search was used to identify relevant in vitro studies across major scientific databases, including PubMed, Web of Science, Scielo, Scopus, and EMBASE. The search encompassed studies published up to January 2025 and incorporated the terms depicted in Table 1.

2.3. Study Selection

Two independent reviewers (R.B. and N.K.) assessed titles and abstracts based on these inclusion criteria: 1. In vitro studies evaluating bonding to 3D-printed resins in restorative dentistry; 2. Studies assessing mechanical or chemical surface treatments against a control group; and 3. Studies reporting quantitative bond strength values (mean ± Standard Deviation (SD)) using standardized testing methods (e.g., SBS, micro-tensile bond strength). Studies were excluded if they were case reports, case series, pilot studies, reviews; did not focus on bonding to 3D-printed resins; lacked quantitative data; or used non-standardized testing protocols. Full-text articles were retrieved for studies that met the inclusion criteria or if eligibility was unclear. Any discrepancies between reviewers were addressed through discussion or consultation with a third reviewer (C.E.C.-S.).

2.4. Data Extraction

Data extraction was performed using a standardized form, including first author and year of publication, type of 3D-printed resin and printing technology (SLA, DLP, etc.), surface treatments applied (e.g., sandblasting, silane application, universal adhesive, etc.), bond strength testing method (e.g., shear or microtensile), storage conditions, and the main results.

2.5. Quality Assessment

The risk of bias in the included studies was assessed using the Quality Assessment Tool for In Vitro Studies (ROBDEMat tool) [22], which evaluates four domains: D1—planning and allocation; D2—sample/specimen preparation; D3—outcome assessment; and D4—data analysis and reporting. Domain D1 comprises three criteria, including the use of appropriate control or reference groups, randomization of samples, and justification of sample size. Domains D2, D3, and D4 each consist of two criteria: D2 examines the standardization of methods and experimental conditions; D3 assesses study reproducibility and whether operator blinding was implemented; and D4 evaluates the appropriateness of statistical methods and the transparency of outcome reporting. Each criterion was rated as: ‘sufficiently reported’, ‘insufficiently reported’, ‘not reported’ or ‘not applicable’. The evaluation was independently performed by two reviewers (R.B. and A.H.), and any discrepancies were resolved through discussion or with the involvement of a third reviewer (C.E.C.-S.) until consensus was reached [22].

2.6. Data Synthesis and Statistical Analysis

Meta-analyses were performed using Review Manager Software (version 5.4, The Cochrane Collaboration, Copenhagen, Denmark). A random-effects model was employed to account for potential variability across studies, and pooled-effect estimates were calculated by comparing the standardized mean differences in the bond strength where a surface protocol was used against untreated surfaces. Subgroups were formed according to the surface protocol tested (sandblasting, adhesive system, silane, and hydrofluoric (HF) acid). Separate meta-analyses were carried out for both immediate and aged bond strength outcomes. Statistical significance was set at p < 0.05. Heterogeneity among the included studies was assessed using the Cochran Q test and quantified with the I2 statistic to evaluate the degree of inconsistency across results.

3. Results

3.1. Search Strategy

A comprehensive search across all databases initially identified 10,060 records. Following the removal of duplicates, 7976 unique publications were retained for preliminary screening. After evaluating titles and abstracts, 7956 studies were excluded for not meeting the inclusion criteria. This left 20 articles for full-text assessment. Of these, 11 were excluded based on specific criteria detailed in the flowchart, resulting in 9 studies being included in the qualitative synthesis. Among these, 1 study was excluded from quantitative analysis, and the remaining 8 studies were ultimately included in the meta-analysis. A detailed overview of the selection process is illustrated in the PRISMA flowchart (Figure 1).

3.2. Main Findings

The qualitative synthesis of the studies included in this systematic review is presented in Table 2. These studies investigated a range of 3D-printed resin materials in combination with diverse surface treatment techniques aimed at enhancing bonding strength. Mechanical surface treatments commonly explored include grinding with silicon carbide (SiC) paper, diamond burs, and sandblasting. On the other hand, chemical treatments encompass the use of etchants such as HF acid, 95% ethanol, as well as the application of adhesive primers, silane coupling agents, or universal adhesive systems.

3.3. Quality Assessment and Risk of Bias

The risk of bias assessment results for the included studies are detailed in Table 3. In domain D1, while all studies clearly reported the inclusion of a control group (100%), randomization of samples was less consistently addressed, being insufficiently reported or not reported in some studies. Sample size calculation and justification (Item 1.3) were frequently insufficiently reported or absent across most studies. With regard to domain D2, most studies adequately described the standardization of samples and experimental conditions (Items 2.1 and 2.2). In domain D3, although testing procedures and outcomes were generally well described (Item 3.1), blinding of the test operator (Item 3.2) was not reported in any of the studies except for one study [26], raising concerns about outcome assessment bias. As for domain D4, both statistical analysis and outcome reporting (Items 4.1 and 4.2) were adequately addressed in most of the included studies. Overall, two studies [24,26] were rated as having a low risk of bias, fulfilling almost all assessment criteria. In contrast, the study by Jeong et al. [29] exhibited the highest risk of bias according to the ROBDEMat tool.

3.4. Meta-Analyses

Figure 2 presents the meta-analysis results on the immediate bond strength of resin-based materials to 3D-printed resins. The data show that using a surface treatment protocol significantly improved bond strength to 3D-printed resins (p = 0.01). Among the tested protocols, sandblasting and silane treatments resulted in a notable bond strength enhancement (p < 0.007). In contrast, the use of adhesive systems or HF acid did not lead to improved bond strength compared to the control group (p > 0.46).
Figure 3 shows the results from the meta-analysis of the aged bond strength of resin-based materials to 3D-printed resins. Once again, the overall bond strength to 3D-printed resins was improved when a surface protocol was used (p = 0.01). From the protocols tested, sandblasting and HF acid resulted in a significant increase of the bond strength values (p < 0.001), while the use of an adhesive system did not result in any improvement of the bond strength (p = 0.55).

4. Discussion

Surface treatment is an essential step in the bonding procedure and plays a major role in determining the bonding quality between a substrate and a restorative material. This systematic review and meta-analysis were conducted to determine the effect of different surface treatment protocols (sandblasting, silane, adhesive systems, and HF acid) on the bond strength of resin-based materials to 3D-printed resins, either immediately or after aging. Due to limited data, silane was evaluated only for aged bond strength. The results showed that immediate bond strength to 3D-printed resins was significantly improved by sandblasting or silane application, indicating the effectiveness of mechanical and chemical surface modifications. In contrast, adhesive systems and HF acid did not significantly enhance immediate bond strength compared to the control. For aged bond strength, sandblasting and HF acid had a positive effect, whereas adhesive systems alone showed no improvement. Consequently, the null hypothesis of this systematic review and meta-analysis was partially rejected.
For the immediate bond strength, the analysis revealed that surface treatment protocols significantly enhanced the bond strength to 3D-printed resins. Among the tested methods, sandblasting or silane application demonstrated a notable improvement (p ≤ 0.007) when compared to the control, indicating that specific mechanical or chemical modifications play a key role in optimizing adhesion at the initial bonding stage. On the other hand, the application of an adhesive system or HF etching did not lead to any statistically significant increase in bond strength when compared to the control (p ≥ 0.46). This suggests that these treatments alone may not be sufficient to alter the surface characteristics of 3D-printed resins in a way that promotes stronger immediate adhesion.
Sandblasting, especially with 50 µm alumina particles, notably enhances the immediate bond strength of 3D-printed resins by generating micro-retentive ridge and groove patterns on the surface of the material. This increase in surface roughness improves the mechanical retention between the resin and the resin cement, resulting in stronger bonds [30,31,32]. Studies included in the meta-analysis consistently found that sandblasting produced higher surface roughness values, which in turn resulted in improved bond strength. The improvement is attributed to sandblasting’s ability to roughen the resin surface, increasing the surface contact area and enhancing wettability, which in turn promotes a more efficient bonding process [1,20]. Furthermore, airborne-particle abrasion (APA) with alumina particles aids in removing surface contaminants and enhancing the surface texture, thereby fostering a stronger bond. APA also increases the surface energy, allowing the cement to penetrate the material and establish a stronger mechanical bond [29]. The ideal conditions for sandblasting include using 50 µm alumina particles, which have been shown to offer an optimal balance of surface roughening without damaging the resin [29]. An air pressure range of 2 to 2.5 bars is typically ideal, although higher pressures (up to 4 bars) have been shown to further enhance bond strength [1,17]. The duration of sandblasting, typically around 10 s, should be controlled to avoid over-treatment, which could damage the material’s surface or excessively roughen it, potentially compromising the bond [17]. Additionally, ensuring that the surface is free from contaminants before sandblasting is crucial; cleaning the surface with an alcohol wipe after sandblasting helps remove any residual debris or impurities that may interfere with bonding of 3D-printed resin [17].
Overall, sandblasting improves the immediate bond strength of 3D-printed resins by enhancing surface roughness and micromechanical retention, with the optimal parameters being 50 µm alumina particles, air pressure around 2–2.5 bar, and a treatment duration of about 10 s.
Silane application has been found to significantly enhance the immediate bond strength of 3D-printed resin materials, showing a marked improvement (p < 0.007) compared to the control group. This effect is likely due to silane’s ability to create a strong chemical bond between the resin and the ceramic filler particles in the material. Milled resin composites, which typically contain about 70% ceramic filler, benefit particularly from silane application, given its proven efficacy in bonding with ceramic materials like silica glass or barium aluminosilicate glass. In contrast, 3D-printed resins, particularly those used for crowns, often contain a percentage of ceramic fillers, typically ranging from 0% to 50%. This difference in filler content suggests that 3D-printed resins with lower filler content may not gain as much benefit from silane treatment as their milled counterparts. Instead, these resins might benefit more from adhesive systems, which can help improve bonding to the organic polymer matrix [16,17].
However, for 3D-printed materials with higher ceramic filler content (as mentioned by the manufacturer instructions), such as VarseoSmile Crown Plus (BEGO, Bremen, Germany), which contains between 30–50% ceramic filler, silane application becomes crucial for achieving strong bonding. The presence of a significant amount of ceramic fillers in such materials requires silane primers to promote better adhesion between the resin and the filler particles. Therefore, the effectiveness of silane in improving bonding is heavily influenced by the filler composition of the 3D-printed material. Materials with higher filler content, like VarseoSmile Crown Plus, will benefit more from silane application, which facilitates better bonding to the ceramic particles, while lower filler content may not see the same improvement [1].
It has also been noted that the silane coupling agent is a bifunctional molecule, containing two reactive groups that enable bonding with both inorganic and organic materials. One of these groups is capable of binding with inorganic materials, such as silicon oxide present in ceramic fillers, while the other binds with organic substances, such as the methacrylate group found in resin cement. When silane is applied to a silica-containing surface, the alkoxy groups undergo hydrolysis in the presence of moisture, forming silanol groups (Si–OH). These silanol groups then react with hydroxyl groups on the ceramic surface, leading to the formation of siloxane bonds (Si–O–Si), which provide a strong covalent link to the inorganic filler. Simultaneously, the organofunctional group of the silane molecule co-polymerizes with methacrylate-based resin monomers during curing, resulting in a robust chemical bridge between the filler and the resin matrix. This dual reactivity allows silane to form a strong interface between the 3D-printed resin and the resin cement, ensuring improved adhesion and bond strength. By facilitating chemical bonding between the filler particles and the resin matrix, silane coupling agents are essential in enhancing the overall durability and bonding performance, especially in materials with high ceramic content [27,33,34].
These findings align with the meta-analysis, which highlights the importance of considering the filler composition when determining the optimal surface treatment for 3D-printed resin crowns.
However, in this meta-analysis, adhesive systems alone did not significantly improve the bond strength of 3D-printed resins compared to the control. This may be due to the inherently smooth, low-roughness surface of 3D-printed materials, which limits the adhesive’s ability to achieve effective mechanical interlocking [27]. Although functional monomers like 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) can chemically bond with inorganic fillers (such as silica) or methacrylate groups [33,35,36], sufficient surface roughness is needed to optimize their performance. Without micro-retentive features, the adhesive lacks the mechanical retention needed for strong bonding [25]. It was shown that combined adhesive systems with mechanical treatments, such as APA, reported significantly higher bond strengths [25]. Mechanical treatments enhance surface area and roughness, improving both chemical bonding and mechanical interlocking. Therefore, while adhesives can enhance bond strength [37,38], their effectiveness is importantly amplified when used in conjunction with mechanical surface treatments. These findings underscore the need for combined chemical and mechanical protocols to achieve optimal bonding with 3D-printed resins.
Moreover, in this meta-analysis, those that included mechanical surface treatments such as APA in combination with adhesive systems reported significantly higher bond strength [25]. Mechanical treatments create micro-retentive patterns that increase the surface area and allow the adhesive system to penetrate more effectively. This enhances both the chemical bonding and mechanical interlocking between the resin and the cement, leading to a significantly stronger bond compared to when adhesive systems are used independently.
Thus, while adhesive systems can improve bond strength [37,38], their effect is substantially enhanced when combined with mechanical surface treatments. This highlights why, in the studies analyzed, the application of an adhesive system alone, without mechanical treatment, did not significantly improve bond strength compared to the control group. Consequently, achieving optimal bond strength in 3D-printed resins necessitates the integration of both chemical and mechanical surface treatments.
In the context of the meta-analysis, it was found that HF etching did not result in a significant enhancement of the immediate bond strength. This aligns with findings from previous studies [1,18]. HF etching showed enhanced wettability by increasing surface free energy, but bond strength remained lower. This suggests that while surface free energy is an important factor in adhesive bonding, it alone does not guarantee stronger bond strength, particularly in 3D-printed resins. The discrepancy between the high surface free energy values and lower bond strength observed with HF etching can be explained by the fact that surface free energy is primarily influenced by the material’s chemical composition rather than its surface roughness [1,39]. Acid etching typically introduces functional groups, such as hydroxyl groups, to the surface, enhancing the interaction between the surface and adhesives. However, this effect can vary depending on factors like the polymer type, acid concentration and etching timing. Notably, in materials with higher resin polymer content, like VarseoSmile Crown plus (BEGO, Bremen, Germany), the bond strength obtained through acid etching was lower, indicating that the polymer matrix might resist acid etching more effectively than mechanical roughening. This resistance could prevent acid from achieving the necessary micro-mechanical retention required for stronger bonds [1].
Additionally, it was noted that HF etching, which functions by etching the glass particles in the matrix to create porous surfaces and enhance micromechanical retention [40], did not improve bond strength in 3D-printed polymethyl methacrylate (PMMA). This could be due to PMMA’s low glass particle content and high hydrophobic monomer, which prevents effective bonding. Additionally, HF etching softened the PMMA surface, reducing surface roughness [41,42]. In contrast, HF etching markedly enhanced bond strength in bisacrylic resins, such as Luxatemp and Protemp 4, which contain more than 24% filler. These materials exhibited the highest bond strength when treated with HF acid. Therefore, the efficacy of HF etching is influenced by the type and quantity of filler present in the resin [29,40,41,42].
Furthermore, a previous study demonstrated that the use of HF acid on 3D-printed permanent resins, such as Crowntec (Saremco Dental AG, Thun, Switzerland) and Permanent Crown (Formlabs, Somerville, MA, USA), did not result in bond strength levels comparable to those achieved with sandblasting. This is due to the less rough surface created by the dissolution of filler particles during HF etching. This finding supports the results of the meta-analysis, which indicate that HF acid alone is insufficient for effective surface treatment of 3D-printed resins [18].
The evidence from the meta-analysis supports the conclusion that improving surface roughness through mechanical pretreatment is more critical than chemical etching with HF acid to achieve adequate bond strength in 3D-printed materials. Therefore, for immediate bond strength, mechanical pretreatment should be prioritized over chemical etching. Accordingly, routine use of HF acid should be avoided unless the resin components are well understood.
According to ISO 11405, in vitro aging of dental materials can be simulated using thermocycling, typically involving 500 cycles between 5 °C and 55 °C with each cycle lasting 5 s [43,44]. However, evidence suggests that such limited cycling may not adequately replicate the long-term thermal and mechanical stresses experienced intraorally [45,46]. In the studies included in this systematic review, thermocycling was performed using different protocols, with cycles ranging from 500, 1000, to 5000, reflecting variations in simulating clinical aging. These variations aim to mimic the thermal fatigue and water sorption stresses that materials endure in the oral environment over time, potentially impacting the durability of the adhesive interface. Teeth experience approximately 20–50 thermal cycles daily due to activities like eating and drinking [44], with treatment durations varying from weeks to months, necessitating extended thermocycling in some studies. Aging can degrade the adhesive interface through hydrolytic breakdown of resin components, erosion of fillers, or loss of silane coupling integrity, thus influencing the long-term effectiveness of surface treatments. Consequently, evaluating the bond strength after prolonged aging protocols helps identify treatments that maintain durability under clinically relevant conditions [43,44,45,46].
For the aged bond strength, the use of surface treatment protocols compared to the control group resulted in a statistically noteworthy improvement (p = 0.01). Though the efficiency of specific treatments varied from the immediate bond strength results. In this case, sandblasting or HF acid etching provided the highest bond improvement (p < 0.001), signifying that mechanical surface roughening or acid etching contributes to long-term adhesion stability. In contrast, silane application, effective in immediate bonding, was less influential after aging. Similarly, adhesive systems alone did not yield significant long-term benefits, suggesting their limited reliability for durable bonding with 3D-printed resins. Furthermore, the use of an adhesive system did not provide any significant improvement over time (p = 0.55), reinforcing the idea that simple adhesive application may not be a reliable approach for long-term bonding performance with 3D-printed resins.
After aging, sandblasting remains effective for maintaining high bond strength in 3D-printed resin materials due to its ability to create micro-retentive features that endure over time. Sandblasting increases the surface roughness of 3D-printed resins, which enhances mechanical interlocking with the adhesive and resin cement. These micro-retentive features provide a stronger mechanical bond compared to chemical treatments alone, which can degrade more easily under stress. The increased surface area from sandblasting allows for better resin infiltration, ensuring a more durable bond even after aging or thermocycling [27]. This is particularly important for 3D-printed materials, which often have lower surface energy than traditionally milled resins, making them more reliant on mechanical retention for bond strength [47,48]. Aging can lead to the breakdown of adhesive bonds, but sandblasted surfaces on 3D-printed resins continue to benefit from the mechanical interlock [23,24]. This interlock helps maintain the bond’s integrity despite exposure to thermal cycling or long-term use. Therefore, sandblasting with 50 µm aluminum oxide ensures sustained bond durability in 3D-printed materials, making it an essential treatment for enhancing bond strength over time.
HF etching does not immediately improve the bond strength of 3D-printed resin materials, as its primary mechanism relies on selective dissolution of glassy phases rather than significant surface roughening. Many 3D-printed resins contain lower amounts of glass fillers compared to milled composites, which limits HF aicd’s ability to create the micro-mechanical retention necessary for an immediate bond strength increase. Additionally, 3D-printed resins often have a more hydrophobic polymer matrix, which can reduce the penetration and effectiveness of HF treatment in the short-term [23,24].
However, after aging, HF etching demonstrates a notable improvement in bonding compared to the untreated group. This delayed effect may be due to the chemical changes caused by HF acid at the polymer-filler interface, which enhances the surface wettability over time [49,50,51]. By enhancing the surface energy and allowing better adaptation of the adhesive, HF etching enhances long-term bond durability. Furthermore, the mild dissolution of filler particles by HF acid can create a more reactive surface that facilitates stronger adhesion as the adhesive layer matures, particularly after thermocycling or prolonged water storage. This aligns with findings from Ozcan et al. [52], who reported that HF-treated surfaces demonstrated superior bond strength after aging compared to untreated surfaces. Therefore, while HF etching alone is not sufficient for immediate bond improvement in 3D-printed resins, its effects become more pronounced over time, contributing to enhanced adhesive stability after aging. The delayed effectiveness of HF etching observed in aged specimens can be attributed to its ability to increase the surface energy of the resin, facilitating better adhesion over time. While HF selectively dissolves glassy phases, 3D-printed resins typically contain lower amounts of these fillers, which may explain the lack of immediate improvement. However, after aging, HF-treated surfaces exhibit enhanced wettability and chemical interactions, leading to improved bond strength compared to untreated groups.
The application of an adhesive system alone did not result in any notable enhancement in bond strength over time (p = 0.55), reinforcing the notion that simple adhesive application is insufficient for long-term bonding performance with 3D-printed resins. Mechanical surface treatments, such as APA, are essential to create micro-retentive features that enhance adhesion. This method increases surface roughness, which promotes resin infiltration and enhances both mechanical and chemical adhesion. The findings align with previous research demonstrating that APA significantly improves bond strength by forming a porous structure, thereby increasing the surface area available for resin penetration [53,54].
Chemical bonding alone, particularly through the application of universal adhesives containing functional monomers like 10-MDP, does not generate sufficient bond strength, as it lacks the mechanical interlocking required for durable adhesion. Studies have reported that while adhesives containing 10-MDP improve bonding by chemically interacting with inorganic fillers, their effect is significantly enhanced when combined with APA [33,35,36]. Kömürcüoğlu et al. [55] highlighted that sandblasting, followed by the application of universal adhesives, results in superior bond strength in CAD/CAM materials. This is because APA removes the resin-rich superficial layer, exposing filler particles and improving the interaction between the adhesive and the substrate.
Moreover, thermocycling revealed that APA-treated groups maintained bond strength over time, while adhesive-only groups showed a decline, emphasizing the importance of micromechanical retention for long-term stability. The highest bond strength was observed in groups treated with both APA and universal adhesives, confirming that combining mechanical and chemical treatments optimizes bonding [27]. Universal adhesives containing Bisphenol A-Glycidyl Methacrylate (Bis-GMA) and silane enhance bonding by stabilizing the interface between the adhesive and resin cement [56,57]. However, the effectiveness of silane is more pronounced in materials with higher filler content, potentially limiting its impact in 3D-printed resins [16,17].
Taken together, these results emphasize that mechanical surface treatments, particularly sandblasting, are crucial for achieving durable adhesion in 3D-printed resins. While chemical treatments such as adhesive application and HF etching contribute to bond strength, their effectiveness is significantly enhanced when preceded by mechanical preparation. The optimal strategy for bonding 3D-printed resins appears to be a combination of sandblasting followed by silane and a universal adhesive containing functional monomers as this approach maximizes both micromechanical interlocking and chemical bonding potential.
Overall, these findings highlight the essential role of surface treatments in improving the bond strength between resin-based materials and 3D-printed resins. The immediate bond strength improvement observed with sandblasting and silane application suggests that micromechanical interlocking and chemical bonding play essential roles in adhesion. Conversely, the lack of significant improvement with adhesive application alone indicates that simple chemical interactions may not be sufficient without prior surface modification. For aged bond strength, the continued effectiveness of sandblasting highlights its ability to maintain adhesion even after thermocycling, likely due to the increased surface roughness and micro-retentive features it provides. The delayed effectiveness of HF acid suggests that it may introduce gradual chemical modifications that improve wettability and bond durability over time. However, the failure of the adhesive system to enhance aged bond strength further confirms that both mechanical and chemical surface treatments are necessary to ensure long-term stability in clinical applications. These results underscore the importance of selecting appropriate surface treatments when bonding to 3D-printed resins to optimize both immediate and long-term adhesive performance. The meta-analysis has several limitations that should be considered when interpreting the results. First, variability in the composition of 3D-printed resins across studies may have influenced the outcomes, as different materials have varying filler content and surface properties, which can affect bonding performance. Second, differences in experimental protocols, including variations in surface treatment methods (e.g., air pressure during sandblasting, concentration and application time of silane or HF acid), may have contributed to heterogeneity in the results. Third, the lack of standardized aging protocols among studies complicates the evaluation of the long-term clinical durability of the bonding techniques tested. The in vitro nature of the included studies is another limitation, as these studies do not fully replicate the complexity of the oral environment, including factors such as salivary contamination, occlusal forces, and intraoral pH variations, which can alter bonding performance. Additionally, the variability in thermocycling procedures, including differences in cycle number and temperature ranges, could impact the consistency and clinical relevance of the results. Finally, publication bias may be a concern, as studies with statistically significant results are more likely to be published, which could lead to an overestimation of the effectiveness of certain surface treatment methods. Moreover, while the ROBDEMat tool was appropriately employed to assess the risk of bias, the high variability in reporting standards across the included studies limits the strength of the pooled evidence, and this limitation should be explicitly emphasized when interpreting the overall findings. However, sensitivity analyses and publication bias assessments (such as funnel plot analysis or Egger’s regression test) were not included in this meta-analysis. These should be considered in future analyses to further evaluate the robustness of the findings and detect potential biases related to study size or selective publication. Future studies should include standardized aging protocols, explore the effects of salivary contamination or intraoral pH variations, and consider randomized controlled trials to establish clinical relevance. To validate these findings and provide more definitive recommendations for bonding to 3D-printed resins, future clinical trials and standardized in vitro studies are essential. Additionally, future research should explore the bonding of 3D-printed resins to different restorative materials beyond resin-based cements, as well as investigate long-term degradation pathways under simulated oral conditions. Clinically, these findings support the routine use of combined surface treatments when bonding 3D-printed restorations to ensure predictable adhesion and long-term success.

5. Conclusions

Based on the existing literature, this meta-analysis highlights the necessity of both mechanical and chemical surface treatments for effective bonding to 3D-printed resins. Mechanical treatments, such as sandblasting with aluminum oxide particles (50 µm), significantly enhance bond strength by increasing surface roughness and promoting micromechanical interlocking. Chemical treatments, including the application of silane coupling agents, further improve adhesion, particularly in resins with higher filler content. HF etching has demonstrated long-term benefits, enhancing bond strength for silica-based resins. However, adhesive application alone does not provide a significant improvement compared to combined treatments. For achieving optimal and long-lasting bonding, it is crucial to integrate both mechanical and chemical surface treatments, rather than relying solely on dual-cure resin cement.

Author Contributions

Conceptualization, R.B.; methodology, R.B., A.A.H., C.E.C.-S. and N.K.; software, Y.H., O.E., T.R., L.H. and A.F.-L.; validation, Y.H., L.H., M.Q. and A.F.-L.; formal analysis, R.B., A.A.H., C.E.C.-S. and N.K.; investigation, R.B., O.E., A.A.H., C.E.C.-S. and N.K.; resources, R.B., O.E., A.A.H., C.E.C.-S., L.H. and N.K.; data curation, R.B., A.A.H., C.E.C.-S. and N.K.; writing—original draft preparation, R.B., A.A.H., C.E.C.-S. and N.K.; writing—review and editing, Y.H., R.B., C.E.C.-S. and N.K.; visualization, R.B., A.A.H., O.E., Y.H., M.Q., C.E.C.-S. and N.K.; supervision, N.K.; project administration, R.B., C.E.C.-S. and N.K.; funding acquisition, N.K. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Conflicts of Interest

The authors declare no conflicts of interest.

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Prosthesis 07 00056 g001
Figure 1. Flowchart summarizing the screening process.
Figure 1. Flowchart summarizing the screening process.
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Figure 2. Results of the meta-analysis from the immediate bond strength of resin-based cements to 3D-printed resin materials.
Figure 2. Results of the meta-analysis from the immediate bond strength of resin-based cements to 3D-printed resin materials.
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Figure 3. Results of the meta-analysis from the aged bond strength of resin-based cements to 3D-printed resin materials.
Figure 3. Results of the meta-analysis from the aged bond strength of resin-based cements to 3D-printed resin materials.
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Table 1. Search strategy performed at PubMed and adapted to the other databases.
Table 1. Search strategy performed at PubMed and adapted to the other databases.
SearchTerms
#1 (Bonding Treatments)Universal adhesives OR Universal simplified adhesive systems OR Universal Dental Adhesives OR Multipurpose adhesives OR multi-purpose adhesives OR multimode adhesives OR multi-mode adhesives OR universal bonding agent OR silane OR surface treatment OR sandblasting
#2 (Bond Strength)Bond OR Bonding OR Dental bonding OR Bondng efficacy OR bond strength OR Bonding performance OR bonding effectiveness OR Bond performance OR adhesive properties OR microtensile strength OR Micro-tensile strength OR bonding properties OR Microtensile bond strength OR shear bond strength OR microshear bond strength
#3 (3D-Printed Materials)3D printing OR 3D printing manufacturing OR 3D printing resin OR 3D print resin OR additive manufacturing OR 3D-printed materials
# 4#1 AND #2 AND #3
Table 2. Characteristics of the studies included in the review.
Table 2. Characteristics of the studies included in the review.
Study and Year3D-Printed Resin Tested and Manufacturer3D PrinterSurface Treatments AppliedBond Strength TestStorageMain Results
Sutuven EO and Yildirim NC, 2025 [23]VarseoSmile Crown Plus (BEGO, Bremen, Germany)Digital Light Processing (DLP) printer Varseo XS (BEGO, Bremen, Germany)Sandblasting (SB)
Hydrofluoric (HF) acid etching
Multi-primer (MP)
SB + HF
SB + MP
SB + HF + MP		Shear 24 h water storage + 5000 thermal cycles (5–55 °C)SB-HF-MP, SB-MP, and HF groups have revealed the highest bond strength values.
Aldosari, 2024 [24]Crowntec™ (Saremco Dental AG, Rebstein, Switzerland)
C&B Per-
manent™ (ODS, Seoul, Republic of Korea)		Liquid Crystal Display (LCD) printer Sonic Mighty 4K (Phrozen Tech. Co., Ltd., Hsinchu, Taiwan)HF acid
Diamond bur
SB		ShearDistilled
water at 37 °C for 24 h		HF etching and SB improve bond strength.
Boonpitak, 2024 [25]P Pro crown and bridge (Straumann, Basel, Switzerland) DLP printer
P30 Rapid-
Shape (Straumann, Basel, Switzerland)		95% ethanol
Universal adhesive
SB		ShearStored in dry for 24 h at room temperatureHighest bond strength was achieved with the combined application of SB and an adhesive system.
Ersöz B, 2024 [18]Crowntec (Saremco Dental AG, Zwitserland), Permanent Crown (Formlabs, MA, USA)Stereolithography (SLA) printer (Formlabs 3B+, Formlabs, MA, USA), DLP printer (Asiga MAX UV, Asiga, Sydney, Australia)SB
HF acid		Shear 37 °C distilled water for 24 hSB resulted in higher bond strength values.
Mao, 2024 [1]VarseoSmile Crown plus (BEGO, Bremen, Germany)DLP printer Varseo XS (BEGO, Bremen, Germany).Silane
SB
SB + silane
HF acid
HF + silane		Shear37 °C distilled water for 24 h and 5000 thermal cycles in 5 and 55 °CEtching showed the lowest mean bond strength values. Sandblasting and silane resulted in higher values.
Soto-Montero, 2023 [26]Cosmos Temp 3D (Yller, Pelotas, RS, Brazil), Smart Print Bio Temp (MM Tech, São Carlos, SP, Brazil), Resilab 3D Temp (Wilcos, Petrópolis, RJ, Brazil)Photon, Anycubic Technology Co., Shenzen, China (DLP technology)SBMicrotensile24 h at 37 °C in distilled water, followed by thermal cycling (5000 cycles, 5 °C to 55 °C)Airborne-particle abrasion did not improve the bond strength of 3D-printed resins.
Kang, 2023 [27]TeraHarz TC-80 (Graphy, Seoul, Republic of Korea), Permanent Crown Resin (Formlabs, Somerville, MA, USA)DLP printer Sprint Ray Pro 95 (Sprint Ray, Los Angeles, CA, USA), SLA printer Form 3 (Formlabs, Somerville, MA, USA)SB
Single bond universal adhesive (SBU) 		Shear 24 h in distilled water at 37 °C, followed by 10,000 thermocycles between 5–55 °C (70 s per cycle).Combining SB and adhesive resulted in higher bond strength.
Lim, 2020 [28]Nextdent C&B (Vertex-Dental B. V., Soesterberg, Netherlands)DLP printer cara Print 4.0 (Kulzer, Hanau, Germany)SB
Primer		ShearDistilled
water at 37 °C for 24 h		Adhesion without additional surface treatment is recommended.
Jeong, 2019 [29]Nextdent C&B
ZMD-1000B Temporary (Vertex-Dental B. V., Soesterberg, The Netherlands)		DLP printer W11, Bio3D, Seoul, Korea
Zenith U, Dentis, Daegu,
Korea		Silicon Carbide (SiC) paper
SiC paper+ sandblasting
SiC paper+ HF acid
SiC paper+ adhesive (Adper Scotchbond Multi-Purpose)
SiC paper+ Single bond universal adhesive		ShearDistilled
water at 37 °C for 24 h		SiC paper and SB achieved the highest bond strength values.
Table 3. Quality analysis of studies included in the systematic review, separated by their risk of bias in different domains. R—sufficiently reported/adequate; NR—not reported; IR—insufficiently reported; and NA—not applicable.
Table 3. Quality analysis of studies included in the systematic review, separated by their risk of bias in different domains. R—sufficiently reported/adequate; NR—not reported; IR—insufficiently reported; and NA—not applicable.
StudyD1. Bias in Planning and
Allocation		D2. Bias in Sample/Specimen
Preparation		D3. Bias in Outcome
Assessment		D4. Bias in Data Treatment and
Outcome Reporting
1.11.21.32.12.23.13.24.14.2
Sutuven EO and Yildirim NC, 2025 [23]RRIRRRRNRRR
Aldosari 2024 [24]RRRRRRNRRR
Boonpitak 2024 [25]RIRRRRRNRRR
Ersöz, 2024 [18]RNRIRRRRNRRR
Mao, 2024 [1]RRNRRRRNRRR
Soto-Montero, 2023 [26]RRNRRRRRRR
Kang, 2023 [27]RNRNRRR RNRRR
Lim, 2020 [28]RRIRRRRNRRR
Jeong, 2019 [29]RNRNRRRIRNRRIR
Bias sources within each domain: 1.1—use of control group; 1.2—sample randomization; 1.3—justification of sample size; 2.1—standardization of materials/samples; 2.2—uniformity of experimental conditions; 3.1—consistency in testing procedures/outcomes; 3.2—blinding of the operator; 4.1—statistical evaluation; 4.2—reporting of results.
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MDPI and ACS Style

Bourgi, R.; Etienne, O.; Holiel, A.A.; Cuevas-Suárez, C.E.; Hardan, L.; Roman, T.; Flores-Ledesma, A.; Qaddomi, M.; Haikel, Y.; Kharouf, N. Effectiveness of Surface Treatments on the Bond Strength to 3D-Printed Resins: A Systematic Review and Meta-Analysis. Prosthesis 2025, 7, 56. https://doi.org/10.3390/prosthesis7030056

AMA Style

Bourgi R, Etienne O, Holiel AA, Cuevas-Suárez CE, Hardan L, Roman T, Flores-Ledesma A, Qaddomi M, Haikel Y, Kharouf N. Effectiveness of Surface Treatments on the Bond Strength to 3D-Printed Resins: A Systematic Review and Meta-Analysis. Prosthesis. 2025; 7(3):56. https://doi.org/10.3390/prosthesis7030056

Chicago/Turabian Style

Bourgi, Rim, Olivier Etienne, Ahmed A. Holiel, Carlos Enrique Cuevas-Suárez, Louis Hardan, Tatiana Roman, Abigailt Flores-Ledesma, Mohammad Qaddomi, Youssef Haikel, and Naji Kharouf. 2025. "Effectiveness of Surface Treatments on the Bond Strength to 3D-Printed Resins: A Systematic Review and Meta-Analysis" Prosthesis 7, no. 3: 56. https://doi.org/10.3390/prosthesis7030056

APA Style

Bourgi, R., Etienne, O., Holiel, A. A., Cuevas-Suárez, C. E., Hardan, L., Roman, T., Flores-Ledesma, A., Qaddomi, M., Haikel, Y., & Kharouf, N. (2025). Effectiveness of Surface Treatments on the Bond Strength to 3D-Printed Resins: A Systematic Review and Meta-Analysis. Prosthesis, 7(3), 56. https://doi.org/10.3390/prosthesis7030056

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