PEEK surface treatments for resin bonding: A systematic review and network meta-analysis of in vitro studies
Abstract
OBJECTIVES
To evaluate and rank surface treatments for bonding resin composites to polyetheretherketone (PEEK) in dental applications using network meta-analysis.
DATA
Following PRISMA 2020 guidelines and the PRISMA extension for network meta-analyses (registered: OSF https://doi.org/10.17605/OSF.IO/JGRDE), the research question was structured using the PICOS framework. Eligible studies were in vitro, published in English, Portuguese, or Spanish, with no date restriction. Exclusion criteria included non-dental use of PEEK, absence of surface treatment, lack of control group, use of cleaning methods affecting adhesion, bond strength assessed only after aging, bond strength not tested between PEEK and resin composite, and results not expressed in MPa. Risk of bias was assessed using the RoBDEMAT tool. Data were pooled from studies using comparable surface treatments with different parameters.
SOURCES
Nine databases (MEDLINE, Embase, LILACS, BBO, Google Scholar, ProQuest, and institutional repositories) were searched up to February 2025.
STUDY SELECTION
A total of 1809 records were screened, leading to 14 included studies published between 2013 and 2024, evaluating 18 surface treatment protocols comprising 1186 observations.
CONCLUSIONS
Sulfuric acid combined with manufacturer-recommended bonding agents (P-score: 0.97) was the most effective protocol for enhancing bond strength between PEEK and resin composites, followed by laser treatment with adhesive. Most studies presented…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in cell cultures (in vitro), not in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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