Adhesive luting to hybrid ceramic and resin composite cad/cam blocks: Er:Yag laser versus chemical etching and micro-abrasion pretreatment

Purpose: To evaluate the effect of Er:YAG laser on the roughness, surface topography, and bond strength to resin luting cement based on chemical and micro-abrasion pretreatments of different computer-aided design/computer-aided manufacturing materials. Methods: A polymer-infiltrated-ceramic-network (PICN) material (Vita Enamic, VE), three indirect resin composite (Cerasmart, CS; Shofu HC, SH; Lava Ultimate, LU), and one lithium disilicate ceramic (IPS e.max CAD, EM) blocks were subjected to one of the following pretreatments: no treatment (NC ), Er:YAG etching with one of two powers (either 3 or 6 W), hydrofluoric acid (HF) etching, self-etching ceramic primer (ME), or micro-abrasion (MA). The shear bond strength (SBS) of resin luting cement to pretreated materials was tested. Surface roughness was measured via atomic force microscopy, and surface topography was analyzed via scanning electron microscopy. Two-way analysis of variance, Tukey post-hoc test, and Pearson correlation were applied. Results: Etching EM and VE with HF or the ME resulted in the highest SBS values in their groups (P < 0.05). LU, SH, VE, and CS indicated similar SBS values when treated with 3 W, 6 W, and MA. The highest surface roughness (Sa ) values were obtained for the LU, CS, and VE groups when treated with 6 W, whereas the lowest Sa values were obtained for CS when treated with the ME and EM when treated with the ME or 3 W. Only SH and CS indicated a significant correlation between surface roughness and bond strength. Conclusions: Er:YAG laser etching is comparable to micro-abrasion when treating resin composite blocks and may induce fewer surface cracks. HF etching remains the gold standard for the treatment of glass-based ceramics and PICNs.