human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To evaluate the effects of various chemical surface modifications on adhesion between zirconia and resin adhesive . MATERIAL AND METHODS Pre-sintered zirconia discs were sectioned from commercial cylindrical blocks and polished with abrasive papers under running tap water . All the discs were r and omly divided into five study groups according to the methods of surface treatment , including : the  control group ( fully sintered , without any modification ) , group S ( fully sintered and s and blasted with silica coated alumina particles ) , group HN ( fully sintered and etched with a blend of mineral acid solution at 100 ° C for 25 min ) , group HF ( fully sintered and etched with 48 % hydrofluoric acid solution at 100 ° C for 25 min )  , and group Si ( coated with silica particles and then fully sintered ) .  The mean value of surface roughness was evaluated before further treatment . Resin stubs ( 3.6 mm in diameter and 3 mm in height ) were adhered and light cured on each zirconia disc after the application of a silane coupling agent . In each group , all the sample s were further divided into three subgroups with each n=12 , one for the measurement of initial adhesion strength ( shear bond ) value and the other two were tested after thermal cycling for 10,000 and 20,000 cycles , respectively . The results were analyzed with two-way ANOVA and Turkey HSD ( p<0.05 ) . XRD technique was utilized in the examination of zirconia surface crystallinity . The morphological appearance of zirconia surface after surface treatment was observed with SEM . RESULTS The control group showed the lowest initial shear bond strength ( SBS ) value ( 16.8 ± 2.4 MPa ) and did not survive the aging treatments . All the investigated surface treatments improved resin zirconia bond strength significantly , the group S displaying the highest initial value of 25.1 ± 2.7 MPa . However , the highest resistance to the aging effects of thermal cycling was found in group Si . It was further shown in the XRD examination that only the grit-blasting caused the crystalline transformation from tetragonal phase to monoclinic phase ( T → M ) . On the other h and , such a phase transformation could not be detected in all the other four groups . SIGNIFICANCE Resin zirconia adhesion could be effectively improved by both HF etching and silica coating on zirconia surface , without leading to a T → M crystalline phase transformation This study evaluated the effect of different air-particle abrasion protocol s on the biaxial flexural strength and structural stability of zirconia ceramics . Zirconia ceramic specimens ( ISO 6872 ) ( Lava , 3 M ESPE ) were obtained ( N=336 ) . The specimens ( N=118 , n=20 per group ) were r and omly assigned to one of the air-abrasion protocol s : Gr1 : Control ( as-sintered ) ; Gr2 : 50 µm Al2O3 ( 2.5 bar ) ; Gr3 : 50 µm Al2O3 ( 3.5 bar ) ; Gr4 : 110 µm Al2O3(2.5 bar ) ; Gr5 : 110 µm Al2O3 ( 3.5 bar ) ; Gr6 : 30 µm SiO2 ( 2.5 bar ) ( CoJet ) ; Gr7 : 30 µm SiO2(3.5 bar ) ; Gr8 : 110 µm SiO2 ( 2.5 bar ) ( Rocatec Plus ) ; and Gr9 : 110 µm SiO2 ( 3.5 bar ) ( duration : 20 s , distance : 10 mm ) . While half of the specimens were tested immediately , the other half was subjected to cyclic loading in water ( 100,000 cycles ; 50 N , 4 Hz , 37 ° ° C ) prior to biaxial flexural strength test ( ISO 6872 ) . Phase transformation ( t→m ) , relative amount of transformed monoclinic zirconia ( FM ) , transformed zone depth ( TZD ) and surface roughness were measured . Particle type ( p=0.2746 ) , pressure ( p=0.5084 ) and cyclic loading ( p=0.1610 ) did not influence the flexural strength . Except for the air-abraded group with 110 µm Al2O3 at 3.5 bar , all air-abrasion protocol s increased the biaxial flexural strength ( MPa ) ( Controlnon-aged : 1,030 ± 153 , Controlaged : 1,138 ± 138 ; Experimentalnon-aged : 1,307 ± 184 - 1,554 ± 124 ; Experimentalaged : 1,308 ± 118 - 1,451 ± 135 ) in both non-aged and aged conditions , respectively . Surface roughness ( Ra ) was the highest with 110 µm Al2O3(0.84 µm . FM values ranged from 0 % to 27.21 % , higher value for the Rocatec Plus ( 110 µm SiO2 ) and 110 µm Al2O3 groups at 3.5 bar pressure . TZD ranged between 0 and 1.43 µm , with the highest values for Rocatec Plus and 110 µm Al2O3 groups at 3.5 bar pressure PURPOSE Resin bonding of In-Ceram Zirconia ( ICZ ) ceramics is still a challenge , especially for minimally invasive applications . This study evaluated the adhesion of ICZ to enamel and dentin after different surface treatments of the ceramic . MATERIAL S AND METHODS ICZ ceramic specimens ( diameter : 6 mm ; thickness : 2 mm ) ( N = 100 ) were fabricated following the manufacturer 's instructions and r and omly assigned to 5 groups ( n = 20 ) , according to the surface treatment methods applied . The groups were as follows : group C : no treatment ; group SB : s and blasting ; group SCS-S : CoJet+silane ; group SCS-P : CoJet+Alloy Primer ; group GE-S : glaze+ hydrofluoric acid etching ( 9.6 % ) for 60 s+silane . Each group was r and omly divided into two subgroups to be bonded to either enamel or dentin ( n = 10 per group ) using MDP-based resin cement ( Panavia F2.0 ) . All the specimens were subjected to thermocycling ( 5000x , 5 ° C-55 ° C ) . The specimens were mounted in a universal testing machine and tensile force was applied to the ceramic/cement interface until failure occurred ( 1 mm/min ) . After evaluating all the debonded specimens under SEM , the failure types were defined as either " adhesive " with no cement left on the ceramic surface ( score 0 ) or " mixed " with less than 1/2 of the cement left adhered to the surface with no cohesive failure of the substrate ( score 1 ) . The data were statistically evaluated using 2-way ANOVA and Tukey 's tests ( α = 0.05 ) . RESULTS The highest tensile bond strength for the enamel surfaces was obtained in group GE-S ( 18.1 ± 2 MPa ) and the lowest in group SB ( 7.1 ± 1.4 MPa ) . Regarding dentin , group CSC-P showed the highest ( 12 ± 1.3 MPa ) and SB the lowest tensile bond strength ( 5.7 ± 0.4 MPa ) . Groups SB , CSC-S , CSC-P , and GE-S did not show significant differences between the different surface treatments on either enamel or dentin surfaces ( p < 0.05 , p < 0.001 , respectively ) . Groups CSC-P and GE-S presented similar bond strength for both the enamel and dentin substrates ( p < 0.8 and p < 0.9 ) , respectively . While on enamel substrates , exclusively adhesive failures from ICZ ( score 0 ) were found , on dentin exclusively mixed failures were observed ( score 1 ) . CONCLUSION Adhesion of ICZ to both enamel and dentin can be improved when ceramics are glazed , etched , and silanized , or s and blasted , primed , and cemented with an MDP-based cement This study evaluated the effects of different adhesive strategies on the adhesion of zirconia to dentin using conventional and self-adhesive cements and their corresponding adhesive resins . The occlusal parts of human molars ( N=80 ) were sectioned , exposing the dentin . The teeth and zirconia cylinders ( N=80 ) ( diameter=3.4 mm ; height=4 mm ) were r and omly divided into eight groups according to the factors " surface conditioning " and " cement type " ( n=10 per group ) . One conventional cement ( CC : RelyX ARC , 3 M ESPE ) and one self-adhesive cement ( SA : RelyX U200 , 3 M ESPE ) and their corresponding adhesive resin ( for CC , Adper Single Bond Plus ; for SA , Scotchbond Universal Adhesive-SU ) were applied on dentin . Zirconia specimens were conditioned either using chairside ( CJ : CoJet , 30 μm , 2.5 bar , four seconds ) , laboratory silica coating ( RC : Rocatec , 110 μm , 2.5 bar , four seconds ) , or universal primer ( Single Bond Universal-UP ) . Nonconditioned groups for both cements acted as the control ( C ) . Specimens were stored in water ( 37 ° C , 30 days ) and subjected to shear bond strength ( SBS ) testing ( 1 mm/min ) . Data ( MPa ) were analyzed using two-way analysis of variance and a Tukey test ( α=0.05 ) . While surface conditioning significantly affected the SBS values ( p=0.0001 ) ( C < RC = CJ = UP ) , cement type did not ( p=0.148 ) ( CC = SA ) . The interaction terms were significant ( p=0.014 ) . Failure types were predominantly adhesive . Air-abrasion and the use of the universal primer improved the bond strength of zirconia to dentin compared to the control group , regardless of the type of resin cement used This study aim ed to evaluate the effect of different primer/resin luting agent combinations and alumina air abrasion on the adhesion to zirconia . Eighty blocks ( 4 × 4 × 3 mm ) of Lava Frame Zirconia ( 3 M ESPE ) were produced and r and omly assigned into eight groups ( n=10 ) according to two zirconia surface treatments  ( untreated or air abrasion with 50-μm alumina particles ) and four luting systems ( SU : Scotchbond Universal/RelyX Unicem 2 ; ZP : Z-Prime Plus/Duo-link Universal ; MB : Monobond Plus/Variolink II ; and AP : Alloy Primer/ED Primer II/Panavia F 2.0 ) . After the conditioning and primer applications , resin luting agents were manipulated and applied on the zirconia , using a matrix , to form a cylinder ( 2 mm in diameter × 2 mm high ) , followed by photoactivation for 40 seconds . After that , the specimens were stored in distilled water ( 37 ° C ) for 120 days and then su bmi tted to shear bond strength testing , followed by failure mode evaluation under an optical microscope ( 30 × ) . A two-way analysis of variance and Tukey test ( α=0.05 ) were used for data analysis . Alumina air abrasion ( Al ) promoted higher bond values for the three luting systems , except for SU , which showed the best results without air abrasion , while with air abrasion , Al-SU , Al-ZP , and Al-MB presented higher values compared to Al-AP . We concluded that the alumina air abrasion of zirconia surfaces seemed to be dispensable for the SU group , while air abrasion ( topographical alterations ) enhanced the adhesion of the ZP , MB , and AP groups This study compares the bond strength of resin cement and yttrium-stabilized tetragonal zirconia polycrystalline ( Y-TZP ) ceramic with different surface conditioning methods . Two hundred presintered Y-TZP ceramic specimens were prepared , sintered ( 4 × 4 × 4 mm ) , and r and omly assigned to four equal groups as control ( C , no conditioning ) ; airborne particle abraded ( APA , air abrasion with 11 μm Al2O3 ) ; tribochemical silica coating/silane coupling system ( TSC , Rocatec , air abrasion with 110 μm Al2O3 , 30 μm silica-coated Al2O3 and silane ) ; and laser ( L , Er : YAG laser irradiation treated at a power setting of 200 mJ ) . After specimen preparation , composite resin cylinders were prepared and cemented with resin cements ( Clearfil Esthetic , Panavia F 2.0 , Rely X-U100 , Super Bond C&B , and Multilink Automix ) on the ceramic surfaces and kept in an incubator at 37 ° C for 60 days . All specimens were tested for shear bond strength with a universal testing machine , and fractured surfaces were evaluated by environmental scanning electron microscopy . Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U-tests ( α=0.05 ) . The bond strengths for C and L groups were not significantly 
    Output:
    
agent
Conclusions .
Airborne-particle abrasion and tribo-chemical silica coating are the pre-treatment methods with more evidence in the literature .
Increased adhesion could be expected after physico-chemical conditioning of zirconia .
Surface contamination has a negative effect on adhesion .
There is no evidence to support a universal adhesion protocol
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To evaluate the effects of various chemical surface modifications on adhesion between zirconia and resin adhesive . MATERIAL AND METHODS Pre-sintered zirconia discs were sectioned from commercial cylindrical blocks and polished with abrasive papers under running tap water . All the discs were r and omly divided into five study groups according to the methods of surface treatment , including : the  control group ( fully sintered , without any modification ) , group S ( fully sintered and s and blasted with silica coated alumina particles ) , group HN ( fully sintered and etched with a blend of mineral acid solution at 100 ° C for 25 min ) , group HF ( fully sintered and etched with 48 % hydrofluoric acid solution at 100 ° C for 25 min )  , and group Si ( coated with silica particles and then fully sintered ) .  The mean value of surface roughness was evaluated before further treatment . Resin stubs ( 3.6 mm in diameter and 3 mm in height ) were adhered and light cured on each zirconia disc after the application of a silane coupling agent . In each group , all the sample s were further divided into three subgroups with each n=12 , one for the measurement of initial adhesion strength ( shear bond ) value and the other two were tested after thermal cycling for 10,000 and 20,000 cycles , respectively . The results were analyzed with two-way ANOVA and Turkey HSD ( p<0.05 ) . XRD technique was utilized in the examination of zirconia surface crystallinity . The morphological appearance of zirconia surface after surface treatment was observed with SEM . RESULTS The control group showed the lowest initial shear bond strength ( SBS ) value ( 16.8 ± 2.4 MPa ) and did not survive the aging treatments . All the investigated surface treatments improved resin zirconia bond strength significantly , the group S displaying the highest initial value of 25.1 ± 2.7 MPa . However , the highest resistance to the aging effects of thermal cycling was found in group Si . It was further shown in the XRD examination that only the grit-blasting caused the crystalline transformation from tetragonal phase to monoclinic phase ( T → M ) . On the other h and , such a phase transformation could not be detected in all the other four groups . SIGNIFICANCE Resin zirconia adhesion could be effectively improved by both HF etching and silica coating on zirconia surface , without leading to a T → M crystalline phase transformation This study evaluated the effect of different air-particle abrasion protocol s on the biaxial flexural strength and structural stability of zirconia ceramics . Zirconia ceramic specimens ( ISO 6872 ) ( Lava , 3 M ESPE ) were obtained ( N=336 ) . The specimens ( N=118 , n=20 per group ) were r and omly assigned to one of the air-abrasion protocol s : Gr1 : Control ( as-sintered ) ; Gr2 : 50 µm Al2O3 ( 2.5 bar ) ; Gr3 : 50 µm Al2O3 ( 3.5 bar ) ; Gr4 : 110 µm Al2O3(2.5 bar ) ; Gr5 : 110 µm Al2O3 ( 3.5 bar ) ; Gr6 : 30 µm SiO2 ( 2.5 bar ) ( CoJet ) ; Gr7 : 30 µm SiO2(3.5 bar ) ; Gr8 : 110 µm SiO2 ( 2.5 bar ) ( Rocatec Plus ) ; and Gr9 : 110 µm SiO2 ( 3.5 bar ) ( duration : 20 s , distance : 10 mm ) . While half of the specimens were tested immediately , the other half was subjected to cyclic loading in water ( 100,000 cycles ; 50 N , 4 Hz , 37 ° ° C ) prior to biaxial flexural strength test ( ISO 6872 ) . Phase transformation ( t→m ) , relative amount of transformed monoclinic zirconia ( FM ) , transformed zone depth ( TZD ) and surface roughness were measured . Particle type ( p=0.2746 ) , pressure ( p=0.5084 ) and cyclic loading ( p=0.1610 ) did not influence the flexural strength . Except for the air-abraded group with 110 µm Al2O3 at 3.5 bar , all air-abrasion protocol s increased the biaxial flexural strength ( MPa ) ( Controlnon-aged : 1,030 ± 153 , Controlaged : 1,138 ± 138 ; Experimentalnon-aged : 1,307 ± 184 - 1,554 ± 124 ; Experimentalaged : 1,308 ± 118 - 1,451 ± 135 ) in both non-aged and aged conditions , respectively . Surface roughness ( Ra ) was the highest with 110 µm Al2O3(0.84 µm . FM values ranged from 0 % to 27.21 % , higher value for the Rocatec Plus ( 110 µm SiO2 ) and 110 µm Al2O3 groups at 3.5 bar pressure . TZD ranged between 0 and 1.43 µm , with the highest values for Rocatec Plus and 110 µm Al2O3 groups at 3.5 bar pressure PURPOSE Resin bonding of In-Ceram Zirconia ( ICZ ) ceramics is still a challenge , especially for minimally invasive applications . This study evaluated the adhesion of ICZ to enamel and dentin after different surface treatments of the ceramic . MATERIAL S AND METHODS ICZ ceramic specimens ( diameter : 6 mm ; thickness : 2 mm ) ( N = 100 ) were fabricated following the manufacturer 's instructions and r and omly assigned to 5 groups ( n = 20 ) , according to the surface treatment methods applied . The groups were as follows : group C : no treatment ; group SB : s and blasting ; group SCS-S : CoJet+silane ; group SCS-P : CoJet+Alloy Primer ; group GE-S : glaze+ hydrofluoric acid etching ( 9.6 % ) for 60 s+silane . Each group was r and omly divided into two subgroups to be bonded to either enamel or dentin ( n = 10 per group ) using MDP-based resin cement ( Panavia F2.0 ) . All the specimens were subjected to thermocycling ( 5000x , 5 ° C-55 ° C ) . The specimens were mounted in a universal testing machine and tensile force was applied to the ceramic/cement interface until failure occurred ( 1 mm/min ) . After evaluating all the debonded specimens under SEM , the failure types were defined as either " adhesive " with no cement left on the ceramic surface ( score 0 ) or " mixed " with less than 1/2 of the cement left adhered to the surface with no cohesive failure of the substrate ( score 1 ) . The data were statistically evaluated using 2-way ANOVA and Tukey 's tests ( α = 0.05 ) . RESULTS The highest tensile bond strength for the enamel surfaces was obtained in group GE-S ( 18.1 ± 2 MPa ) and the lowest in group SB ( 7.1 ± 1.4 MPa ) . Regarding dentin , group CSC-P showed the highest ( 12 ± 1.3 MPa ) and SB the lowest tensile bond strength ( 5.7 ± 0.4 MPa ) . Groups SB , CSC-S , CSC-P , and GE-S did not show significant differences between the different surface treatments on either enamel or dentin surfaces ( p < 0.05 , p < 0.001 , respectively ) . Groups CSC-P and GE-S presented similar bond strength for both the enamel and dentin substrates ( p < 0.8 and p < 0.9 ) , respectively . While on enamel substrates , exclusively adhesive failures from ICZ ( score 0 ) were found , on dentin exclusively mixed failures were observed ( score 1 ) . CONCLUSION Adhesion of ICZ to both enamel and dentin can be improved when ceramics are glazed , etched , and silanized , or s and blasted , primed , and cemented with an MDP-based cement This study evaluated the effects of different adhesive strategies on the adhesion of zirconia to dentin using conventional and self-adhesive cements and their corresponding adhesive resins . The occlusal parts of human molars ( N=80 ) were sectioned , exposing the dentin . The teeth and zirconia cylinders ( N=80 ) ( diameter=3.4 mm ; height=4 mm ) were r and omly divided into eight groups according to the factors " surface conditioning " and " cement type " ( n=10 per group ) . One conventional cement ( CC : RelyX ARC , 3 M ESPE ) and one self-adhesive cement ( SA : RelyX U200 , 3 M ESPE ) and their corresponding adhesive resin ( for CC , Adper Single Bond Plus ; for SA , Scotchbond Universal Adhesive-SU ) were applied on dentin . Zirconia specimens were conditioned either using chairside ( CJ : CoJet , 30 μm , 2.5 bar , four seconds ) , laboratory silica coating ( RC : Rocatec , 110 μm , 2.5 bar , four seconds ) , or universal primer ( Single Bond Universal-UP ) . Nonconditioned groups for both cements acted as the control ( C ) . Specimens were stored in water ( 37 ° C , 30 days ) and subjected to shear bond strength ( SBS ) testing ( 1 mm/min ) . Data ( MPa ) were analyzed using two-way analysis of variance and a Tukey test ( α=0.05 ) . While surface conditioning significantly affected the SBS values ( p=0.0001 ) ( C < RC = CJ = UP ) , cement type did not ( p=0.148 ) ( CC = SA ) . The interaction terms were significant ( p=0.014 ) . Failure types were predominantly adhesive . Air-abrasion and the use of the universal primer improved the bond strength of zirconia to dentin compared to the control group , regardless of the type of resin cement used This study aim ed to evaluate the effect of different primer/resin luting agent combinations and alumina air abrasion on the adhesion to zirconia . Eighty blocks ( 4 × 4 × 3 mm ) of Lava Frame Zirconia ( 3 M ESPE ) were produced and r and omly assigned into eight groups ( n=10 ) according to two zirconia surface treatments  ( untreated or air abrasion with 50-μm alumina particles ) and four luting systems ( SU : Scotchbond Universal/RelyX Unicem 2 ; ZP : Z-Prime Plus/Duo-link Universal ; MB : Monobond Plus/Variolink II ; and AP : Alloy Primer/ED Primer II/Panavia F 2.0 ) . After the conditioning and primer applications , resin luting agents were manipulated and applied on the zirconia , using a matrix , to form a cylinder ( 2 mm in diameter × 2 mm high ) , followed by photoactivation for 40 seconds . After that , the specimens were stored in distilled water ( 37 ° C ) for 120 days and then su bmi tted to shear bond strength testing , followed by failure mode evaluation under an optical microscope ( 30 × ) . A two-way analysis of variance and Tukey test ( α=0.05 ) were used for data analysis . Alumina air abrasion ( Al ) promoted higher bond values for the three luting systems , except for SU , which showed the best results without air abrasion , while with air abrasion , Al-SU , Al-ZP , and Al-MB presented higher values compared to Al-AP . We concluded that the alumina air abrasion of zirconia surfaces seemed to be dispensable for the SU group , while air abrasion ( topographical alterations ) enhanced the adhesion of the ZP , MB , and AP groups This study compares the bond strength of resin cement and yttrium-stabilized tetragonal zirconia polycrystalline ( Y-TZP ) ceramic with different surface conditioning methods . Two hundred presintered Y-TZP ceramic specimens were prepared , sintered ( 4 × 4 × 4 mm ) , and r and omly assigned to four equal groups as control ( C , no conditioning ) ; airborne particle abraded ( APA , air abrasion with 11 μm Al2O3 ) ; tribochemical silica coating/silane coupling system ( TSC , Rocatec , air abrasion with 110 μm Al2O3 , 30 μm silica-coated Al2O3 and silane ) ; and laser ( L , Er : YAG laser irradiation treated at a power setting of 200 mJ ) . After specimen preparation , composite resin cylinders were prepared and cemented with resin cements ( Clearfil Esthetic , Panavia F 2.0 , Rely X-U100 , Super Bond C&B , and Multilink Automix ) on the ceramic surfaces and kept in an incubator at 37 ° C for 60 days . All specimens were tested for shear bond strength with a universal testing machine , and fractured surfaces were evaluated by environmental scanning electron microscopy . Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U-tests ( α=0.05 ) . The bond strengths for C and L groups were not significantly 
    Output:
    