Non-Cochrane · intervention · PM42464084
The effect of surface treatment on the bonding properties of Polyetherketoneketone (PEKK) polymer to veneering materials: a systematic review and meta-analysis.
AlResayes Saad Saleh, Sayed Mohammed E, Qadi Khawla Ahmed, et al. · BMC oral health · 2026 · PubMed · doi:10.1186/s12903-026-09199-1
Findings
26 findings
| Population | ||||
|---|---|---|---|---|
| PEKK (Pekkton) specimens bonded to veneering composite resin | Air abrasion with alumina (GAB) | No surface pretreatment (control) | Shear bond strength (MPa; some tensile or unspecified bond strength) In vitro laboratory · Air abrasion with alumina (GAB) | SMD 4.79 [2.24, 7.34] Moderate Downgraded: risk of bias 7 studies · 274 participants |
| PEKK (polyetherketoneketone) specimens veneered with composite resin | Diamond abrasion | No surface pre-treatment (control) | Bond strength (shear, SMD) Not specified · Laboratory (in vitro) · GDA | SMD -3.32 [-4.76, -1.87] Moderate Downgraded: risk of bias 1 study · 20 participants |
| PEKK (Pekkton) specimens bonded to veneering composite resin | Sulfuric acid etching (GAE) | No surface pretreatment (control) | Shear bond strength (MPa; some tensile or unspecified bond strength) In vitro laboratory · Sulfuric acid etching (GAE) | SMD 2.92 [0.4, 5.44] Moderate Downgraded: risk of bias 4 studies · 218 participants |
| PEKK (Pekkton) specimens bonded to veneering composite resin | Non-thermal air plasma (GNTP) | No surface pretreatment (control) | Shear bond strength (MPa; some tensile or unspecified bond strength) In vitro laboratory · Non-thermal plasma (GNTP) | SMD 0.51 [-2.15, 3.18] Moderate Downgraded: risk of bias 2 studies · 62 participants |
| PEKK (Pekkton) specimens bonded to veneering composite resin | Tribochemical silica coating (GTCS) | No surface pretreatment (control) | Shear bond strength (MPa; some tensile or unspecified bond strength) In vitro laboratory · Tribochemical silica coating (GTCS) | SMD 1.74 [0.06, 3.42] Moderate Downgraded: risk of bias 3 studies · 162 participants |
| PEKK (polyetherketoneketone) specimens veneered with composite resin | Air abrasion plus sulfuric acid etching | No surface pre-treatment (control) | Bond strength (shear, SMD) Not specified · Laboratory (in vitro) · GABAE | SMD 2.45 [1.63, 3.27] Moderate Downgraded: risk of bias 1 study · 42 participants |
| PEKK (Pekkton) specimens bonded to veneering composite resin | Tribochemical silica coating plus sulfuric acid etching (GTCSAE) | No surface pretreatment (control) | Shear bond strength (MPa; some tensile or unspecified bond strength) In vitro laboratory · Tribochemical silica coating + acid etching (GTCSAE) | SMD -0.39 [-0.72, -0.05] Moderate Downgraded: risk of bias 2 studies · 142 participants |
| PEKK (polyetherketoneketone) specimens veneered with composite resin | Diamond abrasion plus non-thermal plasma | No surface pre-treatment (control) | Bond strength (shear, SMD) Not specified · Laboratory (in vitro) · GDANTP | SMD -3.85 [-5.44, -2.25] Moderate Downgraded: risk of bias 1 study · 20 participants |
| PEKK (Pekkton) specimens bonded to veneering composite resin | Any surface pretreatment (all pretreatment subgroups combined) | No surface pretreatment (control) | Shear bond strength (MPa; some tensile or unspecified bond strength) In vitro laboratory · All pretreatments combined | SMD 1.08 [0.37, 1.8] Moderate Downgraded: risk of bias 10 studies · 1236 participants |
| PEKK (Pekkton) specimens bonded to veneering lithium disilicate ceramic | Air abrasion with alumina (GAB) | No surface pretreatment (control) | Shear bond strength (MPa; some tensile or unspecified bond strength) In vitro laboratory · Air abrasion with alumina (GAB) | SMD 2.7 [1.16, 4.24] Moderate Downgraded: risk of bias 2 studies · 86 participants |
| PEKK (Pekkton) specimens bonded to veneering lithium disilicate ceramic | Sulfuric acid etching (GAE) | No surface pretreatment (control) | Shear bond strength (MPa; some tensile or unspecified bond strength) In vitro laboratory · Sulfuric acid etching (GAE) | SMD 1.75 [0.22, 3.27] Moderate Downgraded: risk of bias 2 studies · 86 participants |
| PEKK (polyetherketoneketone) specimens veneered with composite resin | Tribochemical silica coating plus non-thermal plasma | No surface pre-treatment (control) | Bond strength (shear, SMD) Not specified · Laboratory (in vitro) · GTCSNTP | SMD 2.01 [0.89, 3.12] Moderate Downgraded: risk of bias 1 study · 20 participants |
| PEKK (Pekkton) specimens bonded to veneering lithium disilicate ceramic | Air abrasion plus sulfuric acid etching (GABAE) | No surface pretreatment (control) | Shear bond strength (MPa; some tensile or unspecified bond strength) In vitro laboratory · Air abrasion + sulfuric acid etching (GABAE) | SMD 1.37 [-1.71, 4.45] Moderate Downgraded: risk of bias 2 studies · 86 participants |
| PEKK (Pekkton) specimens bonded to veneering lithium disilicate ceramic | Any surface pretreatment (all pretreatment subgroups combined) | No surface pretreatment (control) | Shear bond strength (MPa; some tensile or unspecified bond strength) In vitro laboratory · All pretreatments combined | SMD 1.85 [0.96, 2.75] Moderate Downgraded: risk of bias 2 studies · 384 participants |
| PEKK (polyetherketoneketone) specimens veneered with composite resin | Cold plasma (argon) | No surface pre-treatment (control) | Bond strength (shear, SMD) Not specified · Laboratory (in vitro) · GCPA | SMD 1.81 [1.07, 2.56] Moderate Downgraded: risk of bias 1 study · 40 participants |
| PEKK (polyetherketoneketone) specimens veneered with composite resin | Cold plasma (oxygen) | No surface pre-treatment (control) | Bond strength (shear, SMD) Not specified · Laboratory (in vitro) · GCPO | SMD 0.56 [-0.08, 1.19] Moderate Downgraded: risk of bias 1 study · 40 participants |
| PEKK (polyetherketoneketone) specimens veneered with composite resin | Cold plasma (nitrogen) | No surface pre-treatment (control) | Bond strength (shear, SMD) Not specified · Laboratory (in vitro) · GCPN | SMD 1.51 [0.80, 2.22] Moderate Downgraded: risk of bias 1 study · 40 participants |
| PEKK (polyetherketoneketone) specimens veneered with composite resin | Cold plasma (acetylene) | No surface pre-treatment (control) | Bond strength (shear, SMD) Not specified · Laboratory (in vitro) · GCPAc | SMD 2.09 [1.30, 2.87] Moderate Downgraded: risk of bias 1 study · 40 participants |
| PEKK (polyetherketoneketone) specimens veneered with composite resin | Hydroxyapatite coating (5%) | No surface pre-treatment (control) | Bond strength (shear, SMD) Not specified · Laboratory (in vitro) · HAP (5%) | SMD 19.04 [12.40, 25.68] Moderate Downgraded: risk of bias 1 study · 20 participants |
| PEKK (polyetherketoneketone) specimens veneered with composite resin | Er:YAG laser irradiation | No surface pre-treatment (control) | Bond strength (shear, SMD) Not specified · Laboratory (in vitro) · GEL | SMD -1.10 [-1.98, -0.23] Moderate Downgraded: risk of bias 1 study · 24 participants |
| PEKK (polyetherketoneketone) specimens veneered with composite resin | Nd:YAG laser irradiation | No surface pre-treatment (control) | Bond strength (shear, SMD) Not specified · Laboratory (in vitro) · GNL | SMD -6.32 [-8.43, -4.21] Moderate Downgraded: risk of bias 1 study · 24 participants |
| PEKK (polyetherketoneketone) specimens veneered with composite resin | Diode laser irradiation | No surface pre-treatment (control) | Bond strength (shear, SMD) Not specified · Laboratory (in vitro) · GDL | SMD -5.41 [-7.27, -3.55] Moderate Downgraded: risk of bias 1 study · 24 participants |
| PEKK (polyetherketoneketone) specimens veneered with composite resin | Femtosecond laser irradiation | No surface pre-treatment (control) | Bond strength (shear, SMD) Not specified · Laboratory (in vitro) · GFL | SMD -11.07 [-14.59, -7.55] Moderate Downgraded: risk of bias 1 study · 24 participants |
| PEKK (polyetherketoneketone) specimens veneered with lithium disilicate ceramic | Non-thermal plasma | No surface pre-treatment (control) | Bond strength (shear, SMD) Not specified · Laboratory (in vitro) · GNTP | SMD 0.00 [-0.60, 0.60] Moderate Downgraded: risk of bias 1 study · 42 participants |
| PEKK (polyetherketoneketone) specimens veneered with lithium disilicate ceramic | Tribochemical silica coating | No surface pre-treatment (control) | Bond strength (shear, SMD) Not specified · Laboratory (in vitro) · GTCS | SMD 2.79 [1.92, 3.66] Moderate Downgraded: risk of bias 1 study · 42 participants |
| PEKK (polyetherketoneketone) specimens veneered with lithium disilicate ceramic | Tribochemical silica coating plus sulfuric acid etching | No surface pre-treatment (control) | Bond strength (shear, SMD) Not specified · Laboratory (in vitro) · GTCSAE | SMD 2.42 [1.60, 3.23] Moderate Downgraded: risk of bias 1 study · 42 participants |
Included primary studies 24
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Asik 2024 Effects of various laser applications on surface roughness and bond strength to veneering composites of polyether ether ketone (PEEK) and… DOI:10.1007/s10103-024-04213-w | 2024 | this review only | not stated | not extracted yet |
| Asik 2024 Effects of various laser applications on surface roughness and bond strength to veneering composites of polyether ether ketone (PEEK) and… PMID:39500765 | 2024 | this review only | not stated | not extracted yet |
| Chopra 2023 To Evaluate and Compare the Effect of Various Surface Treatment Modalities on Shear Bond Strength of Composite to Polyetherketoneketone… PMID:38075544 | 2023 | this review only | not stated | not extracted yet |
| Dede 2021 Influence of chairside surface treatments on the shear bond strength of PEKK polymer to veneering resin materials: An in vitro study. PMID:33551138 | 2021 | this review only | not stated | not extracted yet |
| Demirci 2023 The effects of HAp coating layer on mechanical and optical properties at bonding interface of high-performance polymers DOI:10.1016/j.jmbbm.2022.105539 | 2023 | this review only | not stated | not extracted yet |
| Demirci 2023 The effects of HAp coating layer on mechanical and optical properties at bonding interface of high-performance polymers. PMID:36343522 | 2023 | this review only | not stated | not extracted yet |
| Fokas 2019 The effects of surface treatments on tensile bond strength of polyether-ketone-ketone (PEKK) to veneering resin DOI:10.1016/j.jmbbm.2019.01.015 | 2019 | this review only | not stated | not extracted yet |
| Fokas 2019 The effects of surface treatments on tensile bond strength of polyether-ketone-ketone (PEKK) to veneering resin. PMID:30738326 | 2019 | this review only | not stated | not extracted yet |
| Fuhrmann 2014 Resin bonding to three types of polyaryletherketones (PAEKs)—Durability and influence of surface conditioning DOI:10.1016/j.dental.2013.12.008 | 2014 | this review only | not stated | not extracted yet |
| Fuhrmann 2014 Resin bonding to three types of polyaryletherketones (PAEKs)-durability and influence of surface conditioning. PMID:24461250 | 2014 | this review only | not stated | not extracted yet |
| Goncalves 2025 Effect of Adhesive System on Bond Strength of Polyetheretherketone (PEEK) and Polyetherketoneketone (PEKK) DOI:10.3390/jcs9040165 | 2025 | this review only | not stated | not extracted yet |
| Gouveia 2022 Effect of surface treatment and manufacturing process on the shear bond strength of veneering composite resin to polyetherketoneketone… DOI:10.1016/j.prosdent.2021.02.003 | 2022 | this review only | not stated | not extracted yet |
| Gouveia 2022 Effect of surface treatment and manufacturing process on the shear bond strength of veneering composite resin to polyetherketoneketone… PMID:33678435 | 2022 | this review only | not stated | not extracted yet |
| Kilic 2023 Comparing the shear bond strength of veneering materials to the PAEKs after surface treatments DOI:10.1186/s12903-023-02879-2 | 2023 | this review only | not stated | not extracted yet |
| Kilic 2023 Comparing the shear bond strength of veneering materials to the PAEKs after surface treatments. PMID:36997970 | 2023 | this review only | not stated | not extracted yet |
| Kocer 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Lee 2017 Shear bond strength of composite resin to high performance polymer PEKK according to surface treatments and bonding materials. PMID:29142642 | 2017 | this review only | not stated | not extracted yet |
| M 2020 The impact of non-thermal plasma on the adhesion of polyetherketoneketone (PEKK) to a veneering composite system DOI:10.1016/j.jmbbm.2020.104065 | 2020 | this review only | not stated | not extracted yet |
| M 2020 The impact of non-thermal plasma on the adhesion of polyetherketoneketone (PEKK) to a veneering composite system. PMID:32919258 | 2020 | this review only | not stated | not extracted yet |
| Ruse 2021 Strength and flexibility of lithium disilicate bonded to polyetherketoneketone DOI:10.1016/j.prosdent.2021.10.008 | 2023 | this review only | not stated | not extracted yet |
| Ruse 2021 Strength and flexibility of lithium disilicate bonded to polyetherketoneketone. PMID:34863577 | 2023 | this review only | not stated | not extracted yet |
| Sakihara 2018 Effects of sulfuric and vinyl sulfonic acid etchants on bond strength of resin composite to polyetherketoneketone DOI:10.1007/s10266-018-0375-0 | 2018 | this review only | not stated | not extracted yet |
| Sakihara 2018 Effects of sulfuric and vinyl sulfonic acid etchants on bond strength of resin composite to polyetherketoneketone. PMID:29978283 | 2019 | this review only | not stated | not extracted yet |
| Tekli 2022 Evaluation of the Bond Strength of Polyetherketoneketone to Dental Ceramic. PMID:36562250 | 2022 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | PEKK specimens | PEKK (Pekkton Ivory, milled or pressed) specimens (n=15 in vitro studies) |
| Intervention | Surface pre-treatment | Diamond abrasion, air abrasion with alumina, tribochemical silica coating, sulfuric acid, vinyl sulfonic acid, acetone, piranha solution, non-thermal plasma, cold plasmas, lasers, hydroxyapatite coating and combinations |
| Comparison | Specimens with no surface treatment | No surface pre-treatment |
| Outcomes | Shear bond strength; tensile bond strength | Shear bond strength (14 studies); tensile bond strength (1 study) |
| Study designs | Human clinical studies and in vitro laboratory studies; English language original research | In vitro studies only (n=15); 11 in meta-analysis |
| Timing | Not specified | Aging from none to thermocycling up to 37,500 cycles |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | No | No | yes |
| 7List of excluded studies with reasonscritical | Yes | Partial Yes | no |
| 8Included studies described in detail | Yes | Partial Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: N/A · NRSI: No | NRSI: Partial Yes · RCT: Partial Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: N/A · NRSI: No | NRSI: No · RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |