Nonthermal atmospheric or low-pressure plasma (NTP) can improve the surface characteristics of dental materials without affecting their bulk properties. This study aimed to systematically review the available scientific evidence on the effectiveness of using NTP for the surface treatment of etchable, silica-based dental ceramics before cementation, and elucidate its potential to replace the hazardous and technically demanding protocol of hydrofluoric acid (HF) etching. A valid search query was developed with the help of PubMed's Medical Subject Headings (MeSH) vocabulary thesaurus and translated to three electronic databases: PubMed, Web of Science, and Scopus. The methodological quality of the studies was assessed according to an adapted version of the Methodological Index for Non-Randomized Studies (MINORS). Thirteen in vitro study reports published between 2008 and 2023 were selected for the qualitative and quantitative data synthesis. The implemented methodologies were diverse, comprising 19 different plasma treatment protocols with various device settings. Argon, helium, oxygen, or atmospheric air plasma may significantly increase the wettability and roughness of silicate ceramics by plasma cleaning, etching, and activation, but the treatment generally results in inferior bond strength values after cementation compared to those achieved with HF etching. The technically demanding protocol of plasma-enhanced chemical vapor deposition was employed more commonly, in which the surface deposition of hexamethyl disiloxane with subsequent oxygen plasma activation proved the most promising, yielding bond strengths comparable to those of the positive control. Lack of power analysis, missing adequate control, absence of examiner blinding, and non-performance of specimen aging were common methodological frailties that contributed most to the increase in bias risk (mean MINORS score 15.3 ± 1.1). NTP can potentially improve the adhesive surface characteristics of dental silicate ceramics in laboratory conditions, but the conventional protocol of HF etching still performs better in terms of the resin-ceramic bond strength and longevity. More preclinical research is needed to determine the optimal NTP treatment settings and assess the aging of plasma-treated ceramic surfaces in atmospheric conditions.

中文翻译：

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非热等离子体牙科硅酸盐陶瓷表面改性：系统评价

非热常压或低压等离子体 (NTP) 可以改善牙科材料的表面特性，而不影响其整体性能。本研究旨在系统地回顾关于在固结前使用 NTP 对可蚀刻二氧化硅基牙科陶瓷进行表面处理的有效性的现有科学证据，并阐明其取代危险且技术要求高的氢氟酸 (HF) 蚀刻方案的潜力。在 PubMed 的医学主题词 (MeSH) 词汇词库的帮助下开发了有效的搜索查询，并将其翻译为三个电子数据库：PubMed、Web of Science 和 Scopus。研究的方法学质量根据非随机研究方法学指数（MINORS）的改编版本进行评估。选择 2008 年至 2023 年间发表的 13 份体外研究报告进行定性和定量数据合成。实施的方法多种多样，包括 19 种不同的等离子体处理方案和不同的设备设置。氩气、氦气、氧气或大气等离子体可以通过等离子体清洁、蚀刻和活化显着增加硅酸盐陶瓷的润湿性和粗糙度，但与高频蚀刻相比，这种处理通常会导致胶结后的结合强度值较差。技术要求较高的等离子体增强化学气相沉积方案被更普遍地采用，其中六甲基二硅氧烷的表面沉积以及随后的氧等离子体活化被证明是最有前途的，产生的粘合强度与阳性对照相当。缺乏功效分析、缺乏足够的控制、没有检查员盲法以及不进行标本老化是常见的方法学缺陷，是导致偏倚风险增加的主要原因（平均次要分数 15.3 ± 1.1）。NTP 可以在实验室条件下改善牙科硅酸盐陶瓷的粘合表面特性，但传统的 HF 蚀刻方案在树脂-陶瓷粘合强度和寿命方面仍然表现更好。需要更多的临床前研究来确定最佳的 NTP 处理设置并评估等离子处理的陶瓷表面在大气条件下的老化情况。