Cleaning methods of contaminated lithium disilicate ceramics: A systematic review and network meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Higher bond strengths with phosphoric acid etching and HF acid etching compared to water/alcohol cleaning

• Primary Outcome: Bond strength between lithium disilicate ceramics and resin cement

• Nnt Or Sensitivity: Phosphoric acid etching consistently effective across short-term and long-term aging conditions

• Confidence Interval: Not reported in abstract

Clinical Application

Highly feasible - cleaning protocols easily implemented in clinical practice with readily available materials Relevant to Australian prosthodontic practice; phosphoric acid and HF acid readily available through dental suppliers; aligns with evidence-based approaches promoted by Australian Dental Association Patients receiving lithium disilicate ceramic restorations (crowns, veneers, inlays/onlays)

Abstract

PURPOSE: To evaluate the effects of various cleaning methods on the bond strength between lithium disilicate (LS2) ceramics and resin cement under short- and long-term aging conditions using network meta-analysis (NMA) and pairwise meta-analysis (PMA). STUDY SELECTION: An electronic search of seven databases (PubMed, Scopus, Embase, Web of Science, Google Scholar, Defense Technical Information Center, and LILACS) with a manual search of the reference lists was conducted for articles published up to March 10, 2025. Eligible studies included those that assessed the bond strength of LS2, either uncontaminated or contaminated with human saliva, fit-checking materials, try-in paste, or their combinations, using different cleaning methods. Risk of bias was evaluated using the RoBDEMAT tool. A frequentist multivariable random-effects model was used to calculate the effect sizes. RESULTS: Fifteen studies met the inclusion criteria. Under short-term aging conditions, NMA showed higher bond strengths in the uncontaminated LS2 group and the contaminated groups cleaned with hydrofluoric acid etching, commercial ceramic cleaning agents, or phosphoric acid etching than those uncleaned or cleaned with water or alcohol. In long-term aging, PMA and NMA exhibited higher bond strengths in the uncontaminated LS2 group and contaminated group cleaned with phosphoric acid etching than those contaminated groups cleaned with water or alcohol. CONCLUSIONS: Phosphoric acid etching effectively eliminates contaminants, whereas the application of water or alcohol is ineffective. Although ceramic cleaning agents effectively decontaminate surfaces under short-term aging conditions, their performance deteriorates over time, potentially compromising long-term bond durability.

References

1. 1.Thongkaemkaew, W., Thammajaruk, P., & Guazzato, M. (2026). Cleaning methods of contaminated lithium disilicate ceramics: A systematic review and network meta-analysis. Journal of Prosthodontic Research. https://doi.org/10.2186/jpr.JPR_D_24_00344