Effect of Cold Atmospheric Pressure Plasma on Wettability of Implant Prosthetic Materials: An In-Vitro Study

Effect of Cold Atmospheric Pressure Plasma on Wettability of Implant Prosthetic Materials: An In-Vitro Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Cold Atmospheric Pressure Plasma on Wettability of Implant Prosthetic Materials: An In-Vitro Study Moataz Bayadse, Leonie Grander, Lisa Steiner, Samir Abou-Ayash, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8942943/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Purpose Surface wettability is a key factor in bonding of dental materials. The aim of the present study was to investigate the influence of different exposure times of cold atmospheric pressure plasma at constant power on the surface wettability of various dental materials employed in implantology, using the “Piezo-Brush®” PZ3 cold atmospheric pressure plasma device. Methods Seventy-five standardized specimens made of titanium alloy, zirconia, lithium disilicate and polymer-infiltrated hybrid ceramic network were manufactured and polished. Specimens of each material were divided into 5 groups (each n = 15). Four groups were cold atmospheric pressure plasma treated for 5, 10, 20 or 30 seconds and compared to the untreated control group. Surface wettability was assessed by measuring the contact angle of distilled water using a goniometer. Statistical analysis was performed using one-way ANOVA. Results The mean contact angle was significantly reduced by 60–80% after 5 seconds of cold atmospheric pressure plasma treatment for all investigated materials (p < 0.001). Prolonged cold atmospheric pressure plasma exposure resulted in further reduction in mean contact angle values for titanium at each additional treatment duration (p < 0.001), whereas for lithium disilicate a reduction was observed only up to 10 seconds. For zirconia and polymer-infiltrated hybrid ceramic network, no further reduction in contact angle was observed beyond 5 seconds of cold atmospheric pressure plasma treatment. Conclusion Cold atmospheric pressure plasma treatment significantly increases surface wettability after short exposure times and may therefore improve adhesion. Under the plasma parameters applied in this study, extending treatment beyond 5 seconds for zirconia and polymer-infiltrated hybrid ceramic network or beyond 10 seconds for titanium and lithium disilicate offers no additional clinically relevant benefits. Cold atmospheric pressure plasma surface treatment titanium zirconia wettability contact angle abutment crown CAD-CAM Figures Figure 1 Figure 2 Figure 3 Figure 4 BACKGROUND Adhesive bonding between different materials is a daily necessity in every field of dentistry. Materials such as ceramics or metals need to be bonded to each other or to the tooth structure. Due to different chemical, physical and mechanical properties, each material has a specific pre-treatment protocol. These pre-treatments in combination with suitable adhesives are necessary to achieve a durable and stable bond ( 1 ). Another important factor is the elimination of contamination, which could prohibit the wetting of the luting material and reduce the bond strength ( 2 ). Wettability is a key prerequisite for effective adhesive bonding, as it determines the ability of a luting material to spread over and interact with the substrate surface. Adequate wetting enables intimate contact at the bonding interface, supporting micromechanical interlocking and chemical interactions. Wettability is commonly assessed by the contact angle, with lower values indicating improved wetting behaviour. Insufficient wettability may result in incomplete surface coverage and reduced bond strength ( 3 ). Pre-treatment steps to improve the adhesive bond are methods that promote micromechanical retention, wetting, chemical bonding or all of them ( 4 – 8 ). Common pretreatment protocols for titanium and zirconia involve sandblasting followed by the application of a phosphate primer, whereas the gold standard for lithium disilicate ceramics is etching with hydrofluoric acid (HF) before primer application ( 4 – 12 ). Due to the increasing use of digital workflows in restorative dentistry, the bonding of CAD/CAM-fabricated ceramic crowns to prefabricated titanium bases (Ti-bases) has become common clinical practice ( 6 – 8 , 13 ). Various studies have shown that bonding CAD/CAM-manufactured crowns after conditioning with the recommended protocols results in sufficient bond strength ( 14 , 15 ). However, debonding, especially of CAD/CAM hybrid crowns occurs in clinical practice. Furthermore, conventional pretreatment methods can be associated with several problems. Sandblasting with Al 2 O 3 powder can lead to microcracks in the ceramic and HF can cause health problems during processing ( 16 ). The differences of pretreatment protocols, for example regarding sandblasting pressure or exposure times of chemicals can lead to processing errors in clinical practice and may result in premature failure of the restauration ( 17 ). Cold atmospheric pressure plasma (CAP) is already established in automotive industry or aviation engineering and is intended to improve the surface characteristics for adhesive bonding ( 18 ). Several studies have investigated the influence of CAP on dental materials, ( 19 ) and its use for decontamination ( 20 , 21 ). Plasma systems applicable in dentistry differ in their generating methods, operating temperature and pressure, and process gas. Some systems operate in ambient air and do not require vacuum equipment or inert gas supply. This offers practical advantages by enabling simple and efficient integration into routine dental laboratory workflows. CAP generated with ambient air has been investigated for conditioning implant-prosthetic materials. In previous studies the expected positive effects on bond strength could not be confirmed. It was even reported that CAP treatment, whether used alone or in combination with components of conventional pretreatment protocols, not only failed to show improvement but even resulted in a decline of bond strength ( 22 , 23 ). The reasons for the lack of enhanced bond strength remain unclear. One potential explanation discussed in the literature is the insufficient specification and standardization of plasma process parameters such as exposure time and power settings for the effective conditioning of dental materials. Therefore, the aim of the present study was to investigate the effect of different CAP exposure times at constant power on the wettability of various materials commonly used in implant prosthodontics. The null hypothesis was that cold atmospheric pressure plasma treatment would not affect the wettability measured by the contact angle (CA). METHODS Preparation of specimens Seventy-five platelets (20 mm x 20 mm x 5 mm) were cut out of a titanium sheet (Ti6Al4V, Elli ASTM 136F, HWN titan GmbH, Mönchengladbach, Germany). These were manually polished in two stages using pumice powder followed by polishing brush. After polishing, the specimens were cleaned using alcohol and distilled water. In addition, 75 specimens each were fabricated from three different ceramics: zirconia 3Y-TZP (IPS e.max ZirCAD LT, Ivoclar Vivadent, Ellwangen, Germany), lithium disilicate (IPS e.max CAD, Ivoclar Vivadent, Ellwangen, Germany) and a polymer-infiltrated hybrid ceramic network (PICN) (ENAMIC®, VITA-Zahnfabrik, Bad Säckingen, Germany) using subtractive CAD/CAM milling. The samples were designed as cubes (10 mm x 10 mm x 10 mm). The zirconia samples were sintered in the Programat S1 furnace and the lithium disilicate samples were crystallized in the Programat EP 5010 furnace according to the manufacturer's instructions. All samples were then polished using diamond grinding pads with grit sizes of 50, 100, 200, 400 and 800 grit under water cooling and cleaned with alcohol and distilled water. The surface roughness was evaluated using a perthometer (Pethen Perthometer PRK) calibrated to the manufacturer’s instructions. The measurement followed a standard protocol. For each surface, ten measurements were performed over a length of 1.75 mm with a distance of 1.75 mm between them. Mean roughness value (Ra value) was calculated for each surface to document the initial conditions within the groups and to examine the influence of the standardized surface polishing. All specimen preparation steps were carried out by a single experienced operator. CAP treatment The specimens of each material were divided into 5 groups (each n = 15) according to the CAP exposure time. The 5groups included a control group (no CAP treatment) and groups with 5-, 10-, 20- and 30-seconds CAP treatment with maximum power (max. plasma and substrate temperature 50°C; input voltage 230 V; operating power 18.0 W). The “Piezo-Brush®” PZ3 hand-held device (Relyon Plasma GmbH, Regensburg, Germany) was used as the CAP source. The CAP-device uses ambient air as process gas. To ensure a constant distance between the material and the nozzle, the device was attached to a holder. For the CAP treatment of the titanium specimens, the nearfield nozzle for conductive materials and for the ceramic specimens needle nozzle for non-conductive materials was selected with a working distance of 0.5 mm for titanium and 2 mm for ceramic materials (Fig. 1 ). Contact angle measurement The CA measurements were carried out at the Max Planck Institute for Polymer Research (Mainz, Germany). A goniometer (Drop Shape Analyzer DSA100E, KRÜSS GmbH, Hamburg, Germany) was used to determine the CA of the materials. Distilled water was drawn into a 0.1 ml syringe and a 3 µl drop of water was applied to the surface at a rate of 1 µl/sec. The CA measurements were carried out immediately after the CAP treatment (Fig. 2 ). The goniometer provides CA measurement for each drop at the left and right side. With the goniometer, the values were generated by evaluating a series of images using the system-software (KRÜSS ADVANCE 1.9.2.2, KRÜSS GmbH, Hamburg, Germany). All measurements were performed under constant parameter settings. Statistical analysis Data processing and statistical analyses were performed using Microsoft Excel (version 16.82) and IBM SPSS Statistics (version 23; IBM Corp., Armonk, NY, USA). To compare mean CA at different CAP exposure times, one-way analysis of variance (ANOVA) was applied when the assumption of normality was met, as assessed by the Shapiro–Wilk test. If not, the Kruskal–Wallis test was used as a non-parametric alternative. To control the cumulative type I error associated with multiple pairwise comparisons, a Bonferroni-corrected post hoc test was applied, with the significance level adjusted to p = 0.005. RESULTS Table 1 presents the surface roughness measurements (Ra) of the investigated materials. PICN showed the highest mean surface roughness (1.85 ± 0.18 µm), followed by zirconia (0.60 ± 0.05 µm) and titanium (0.45 ± 0.12 µm), while lithium disilicate exhibited the lowest mean roughness (0.25 ± 0.05 µm). Table 1 Mean surface roughness values (Ra) for each material in µm. Material n Minimum (µm) Maximum (µm) Mean (µm) Standard deviation Titanium 75 0.23 0.71 0.45 ± 0.12 Zirconia 75 0.53 0.75 0.60 ± 0.05 Lithium disilicate 75 0.14 0.38 0.25 ± 0.05 PICN 75 1.60 2.30 1.85 ± 0.18 Contact angle All investigated materials exhibited a significant decrease in CA after 5 sec of CAP exposure (Fig. 3 , Tables 2 , 3 ; p < 0.001). Significant reduction of CA beyond 5 sec of CAP treatment was only observed for titanium and lithium disilicate. In both materials the 10 sec CAP treatment achieved a significant reduction in CA compared to 5 sec treatment (titanium p < 0.001, lithium disilicate p = 0.003). For lithium disilicate, no further significant reduction of CA was observed with extended CAP treatment beyond 10 sec (p = 1.000), whereas for titanium, an additional reduction compared to 10 sec was achieved when the exposure time was increased to 30 sec (p < 0.001). For zirconia and PICN surfaces, prolonging the CAP exposure beyond 5 sec did not result in any additional significant reduction in CA (Tables 2 , 3 ; p = 1). Table 2 Contact angle values (°) of different materials after CAP treatment. Values are presented as mean ± standard deviation (minimum–maximum). Material 0 sec 5 sec 10 sec 20 sec 30 sec Titanium N = 15 68° ± 4° (64°–75°) 21° ± 3° (17°–26°) 15° ± 3° (9°–19°) 12° ± 2° (10°–16°) 9° ± 1° (7°–11°) Zirconia N = 15 82° ± 10° (61°–95°) 26° ± 3° (22°–33°) 24° ± 3° (19°–29°) 24° ± 3° (20°–29°) 24° ± 3° (19°–30°) Lithium disilicate N = 15 47° ± 7° (35°–58°) 19° ± 3° (16°–25°) 14° ± 2° (12°–18°) 14° ± 2° (9°–17°) 13° ± 2° (10°–17°) PICN N = 15 82° ± 10° (61°–93°) 18° ± 3° (14°–24°) 17° ± 3° (13°–24°) 17° ± 3° (12°–23°) 17° ± 3° (10°–21°) Table 3 Bonferroni-adjusted p-values for pairwise comparisons of CAP exposure times (significance level adjusted p = 0.005). Comparison (s) Titanium Zirconia Lithium disilicate PICN 0 vs 5 < 0.001 < 0.001 < 0.001 < 0.001 5 vs 10 < 0.001 1.000 0.003 1.000 5 vs 20 < 0.001 1.000 < 0.001 1.000 5 vs 30 < 0.001 1.000 < 0.001 1.000 10 vs 20 0.072 1.000 1.000 1.000 10 vs 30 < 0.001 1.000 1.000 1.000 20 vs 30 0.015 1.000 1.000 1.000 DISCUSSION The aim of this study was to investigate the influence of CAP on the wettability of the dental materials titanium, zirconia, lithium disilicate ceramic and polymer-infiltrated hybrid ceramic network material measured by CA. For all materials, a significant drop in CA was detected after 5 seconds of CAP treatment with the device used in the present investigation. Therefore, the null hypothesis, that CAP treatment would not affect the wettability, was rejected. In the titanium and lithium disilicate specimens, the CA was further reduced by prolonged CAP treatment at 30 sec for titanium and 10 sec for lithium disilicate. Zirconia and PICN showed no further reduction in CA, increasing CAP exposure time to more than 5 sec. In the present study, common materials for single implant crowns were selected. In comparable studies, primarily zirconia and titanium were examined ( 24 – 28 ). Furthermore, there are studies that have focused on alternative materials such as feldspar ceramics, polymethyl methacrylate (PMMA), or leucite ceramics, which have reported an improvement in bond strength after plasma treatment ( 29 – 31 ). Jassim et al. used the same CAP device (PiezoBrush® PZ3, Relyon Plasma) as in the present study. However, CAP exposure time and nozzle–surface distance differed ( 32 ). In their study, CAP treatment for 80 sec at a greater distance resulted in CA of 7° for zirconia. The present study achieved CA of 24° with no further reduction after 10 sec at a reduced distance. These findings indicate that plasma efficiency is strongly influenced by its application parameters, even when the same device is used. Jassim et al. also investigated the relationship between plasma treatment and bond strength, finding an improvement of adhesion without altering the surface as it occurs while sandblasting with aluminum oxide ( 32 ). In another study by Silva et al. , the CA of titanium and zirconia specimens were examined after 5, 10 and 20 seconds of pretreatment with non-thermal plasma and atmospheric pressure. They demonstrated that a 10 sec plasma exposure resulted in a decrease of CA from15° to 0°. In contrast to the present study, an MDP primer was used for specimen preparation instead of distilled water ( 28 ). Therefore, the smaller CA could also be attributed to the MDP primer. In a study by Akram et al ., titanium got pretreated with atmospheric pressure plasma after sandblasting. The CA of water decreased with the duration of the sandblasting treatment to a minimum of 25° after 120 seconds and the surface energy increased with prolonged CAP exposure time. CA decreased to a minimum of 8.1° after 15 minutes of plasma exposure with a distance of 10 mm ( 25 ). In the present study, standardized polishing and cleaning procedures resulted in reproducible Ra values within each material group. This was performed to prevent that the surface roughness has a substantial influence on the CA measurements.Other studies investigating the influence of plasma treatment on CA are not directly comparable to the present study because different polishing and cleaning methods were performed ( 33 ). Another difference occurs in studies that used cylindrical shaped specimens instead of flat ones ( 34 , 35 ). The cylindrical design is more comparable to the actual geometry of an abutment or an implant, but it does not allow a direct comparison with the flat surfaces of other parts. In addition, the round surface can have an influence on the CA of the liquid droplet. In the present study, a holder was used to ensure a constant distance between the plasma device and the surface of the specimens. Korzec et al. were able to prove that the size of the effectively activated area depends on the distance between the plasma nozzle and the material ( 36 ). Jassim et al. , who also conducted their investigation using a “Piezo-Brush®” PZ3 and employed a plasma activation time of 80 seconds, worked at a distance of 5 mm. This differs from the distance used in the present study and from the recommendations of Korzec et al. ( 33 , 35 ). In some other studies investigating the influence of plasma on wettability, other process gases such as pure oxygen, argon or mixtures of these two, were used. In these studies, no greater differences in the reduction of the CA were observed compared to the present study working with ambient air ( 24 , 28 ). The use of ambient air does not appear to be a disadvantage of the method used here, especially given that this procedure is easier to carry out and requires less technical equipment. Several limitations of the present study should be acknowledged. First, only surface wettability, assessed by CA measurements, was evaluated. Although wettability is an important parameter for bonding, adhesive performance is multifactorial and influenced by factors such as surface chemistry, surface energy, roughness, and interactions with primer or bonding systems. Second, the results are limited to the specific experimental setup, including the plasma device, treatment parameters, nozzle–surface distance, and ambient conditions, which may affect plasma efficacy and limit comparability with other studies. Third, flat, standardized specimens were used, which do not fully reflect clinical geometries. Finally, only a limited range of dental materials was investigated, restricting the generalizability of the findings. One factor that may potentially influence the bond strength of an adhesive system could be the humidity. Variations in ambient temperature and humidity may affect the consistency of CAP application and should be evaluated in further studies. Although CAP treatment successfully reduced the CA, its clinical relevance and potential to enhance bond strength remain questionable. Previous studies using the same CAP showed no improvement in the bond strength of zirconia crowns to titanium bases after application to zirconia for 15 sec and titanium bases for ≥ 30 sec ( 18 ), nor after 30 sec application to PICN crowns compared with conventional conditioning ( 19 ). In both cases, bond strength was reduced. Successful adhesive bonding requires intimate interfacial contact, which is strongly influenced by surface wettability. Based on the CA, wetting is classified as non-wetting (CA > 90°), wetting (CA < 90°) and spreading (CA ∼ 0°). Optimal conditions promote spreading without excessively reducing liquid surface tension and thereby impairing cohesive forces ( 3 ). The reduced pull-off values observed after CAP treatment in previous studies ( 22 , 23 ) may be attributed to excessive CAP exposure, leading to an over-reduction of surface tension and weakened cohesive forces within composite system. Further studies are required to evaluate alternative primer/bonder systems, different ceramics materials, and the influence of humidity. CONCLUSION Cold atmospheric pressure plasma treatment effectively improves the surface wettability of titanium, zirconia, lithium disilicate ceramics and polymer infiltrated hybrid ceramic commonly used in dentistry. A reduction in the contact angle was observed for all materials after 5 seconds of treatment, indicating that prolonged cold atmospheric pressure plasma exposure offers no additional benefit. Further studies are required to determine the cold atmospheric pressure plasma application duration that optimally enhances bond strength. Abbreviations CA Contact angle CAD Computer-Aided-Design CAM Computer-Aided-Manufacturing CAP Cold Atmospheric-Pressure Plasma sec Seconds µm Micromillimeters µSBS Microshear bond strength Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding The authors would like to thank relyon Plasma GmbH (Regensburg, Germany) for providing the plasma device PZ3. No further funding has taken place. Acknowledgements The authors would like to thank the Max Planck Institute for Polymer Research (Mainz, Germany) for their support. Authors' contributions M.B. and S.W. conceptualized the study and developed the methodology. Data curation, analysis, and interpretation were performed by M.B. and S.W. M.B. and S.W. drafted the original manuscript. S.W., L.G., S.A.-A., and L.S. critically reviewed and edited the manuscript. Figures and tables were prepared by M.B., L.G., and L.S. The study was supervised by S.W. All authors read and approved the final manuscript. References Rosentritt M, Lohbauer U, Ilie N, Wie. befestigen? ZWR-Das Dtsch Zahnärzteblatt. 2016;125(05):224–7. Aguilar-Mendoza JA, Rosales-Leal JI, Rodríguez-Valverde MA, González-López S, Cabrerizo-Vílchez MA. Wettability and bonding of self-etching dental adhesives: Influence of the smear layer. Dent Mater. 2008;24(7):994–1000. Marshall SJ, Bayne SC, Baier R, Tomsia AP, Marshall GW. 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Bayadse","email":"data:image/png;base64,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","orcid":"","institution":"University Medical Center of the Johannes Gutenberg University Mainz","correspondingAuthor":true,"prefix":"","firstName":"Moataz","middleName":"","lastName":"Bayadse","suffix":""},{"id":597088314,"identity":"0907804d-f79a-45d0-bdad-e31284b2a755","order_by":1,"name":"Leonie Grander","email":"","orcid":"","institution":"University Medical Center of the Johannes Gutenberg University Mainz","correspondingAuthor":false,"prefix":"","firstName":"Leonie","middleName":"","lastName":"Grander","suffix":""},{"id":597088315,"identity":"f5d7f504-8f2e-487c-a067-5f255a18c092","order_by":2,"name":"Lisa Steiner","email":"","orcid":"","institution":"University Medical Center of the Johannes Gutenberg University Mainz","correspondingAuthor":false,"prefix":"","firstName":"Lisa","middleName":"","lastName":"Steiner","suffix":""},{"id":597088316,"identity":"1d192427-f8d0-4c22-8546-ade75003e0da","order_by":3,"name":"Samir Abou-Ayash","email":"","orcid":"","institution":"University Medical Center of the Johannes Gutenberg University Mainz","correspondingAuthor":false,"prefix":"","firstName":"Samir","middleName":"","lastName":"Abou-Ayash","suffix":""},{"id":597088317,"identity":"c893b3fb-fed0-49ad-8d2b-70c8465b84dd","order_by":4,"name":"Stefan Wentaschek","email":"","orcid":"","institution":"University Medical Center of the Johannes Gutenberg University Mainz","correspondingAuthor":false,"prefix":"","firstName":"Stefan","middleName":"","lastName":"Wentaschek","suffix":""}],"badges":[],"createdAt":"2026-02-23 04:54:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8942943/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8942943/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103622253,"identity":"4af99f31-62b4-4eec-b2fd-0623989ce38f","added_by":"auto","created_at":"2026-02-27 18:40:01","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":399468,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCold atmospheric-pressure plasma (CAP) treatment:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(A) PZ3 plasma device mounted in the holder, (B) CAP treatment of the titanium surface, (C) CAP treatment of the zirconia surface (distance increased for illustrative purposes).\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8942943/v1/c6ff84197218ab6c2e3fadaf.jpeg"},{"id":103622259,"identity":"8b96e78d-e99a-47ea-bd85-a361eecd43e8","added_by":"auto","created_at":"2026-02-27 18:40:03","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":31617,"visible":true,"origin":"","legend":"\u003cp\u003eGoniometer used for CA measurement.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8942943/v1/b07c7f6a5270bdc5e0aff577.jpeg"},{"id":103622251,"identity":"b31e3a8f-27aa-4adc-8d37-a21a7f397f8a","added_by":"auto","created_at":"2026-02-27 18:40:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":116371,"visible":true,"origin":"","legend":"\u003cp\u003eContact angle (CA) of a 3-µL water droplet on a titanium surface after CAP exposure for (A) 0 sec, (B) 5 sec, (C) 10 sec, (D) 20 sec, and (E) 30 sec.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8942943/v1/a18553702bd942724bbf681b.png"},{"id":103622261,"identity":"ad5cf990-a23b-4b44-b2da-9d6327c3bdb3","added_by":"auto","created_at":"2026-02-27 18:40:03","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":7105,"visible":true,"origin":"","legend":"\u003cp\u003eCA measurements on all samples at different CAP exposure times.\u003c/p\u003e","description":"","filename":"Onlinefloatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-8942943/v1/191ee7e8473fe35388323027.png"},{"id":104399386,"identity":"70143329-dd70-4eda-ae41-a444df1ac24c","added_by":"auto","created_at":"2026-03-11 12:05:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1154105,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8942943/v1/7503d3cb-8947-430f-8d71-59561f5058f4.pdf"},{"id":103622250,"identity":"154f44f0-0a99-4fc8-a8a7-773efcaba80e","added_by":"auto","created_at":"2026-02-27 18:39:59","extension":"jpeg","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":146347,"visible":true,"origin":"","legend":"\u003cp\u003eGraphical Abstract\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8942943/v1/6faa55deba67f55744006011.jpeg"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of Cold Atmospheric Pressure Plasma on Wettability of Implant Prosthetic Materials: An In-Vitro Study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eAdhesive bonding between different materials is a daily necessity in every field of dentistry. Materials such as ceramics or metals need to be bonded to each other or to the tooth structure. Due to different chemical, physical and mechanical properties, each material has a specific pre-treatment protocol. These pre-treatments in combination with suitable adhesives are necessary to achieve a durable and stable bond (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Another important factor is the elimination of contamination, which could prohibit the wetting of the luting material and reduce the bond strength (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWettability is a key prerequisite for effective adhesive bonding, as it determines the ability of a luting material to spread over and interact with the substrate surface. Adequate wetting enables intimate contact at the bonding interface, supporting micromechanical interlocking and chemical interactions. Wettability is commonly assessed by the contact angle, with lower values indicating improved wetting behaviour. Insufficient wettability may result in incomplete surface coverage and reduced bond strength (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePre-treatment steps to improve the adhesive bond are methods that promote micromechanical retention, wetting, chemical bonding or all of them (\u003cspan additionalcitationids=\"CR5 CR6 CR7\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Common pretreatment protocols for titanium and zirconia involve sandblasting followed by the application of a phosphate primer, whereas the gold standard for lithium disilicate ceramics is etching with hydrofluoric acid (HF) before primer application (\u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8 CR9 CR10 CR11\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Due to the increasing use of digital workflows in restorative dentistry, the bonding of CAD/CAM-fabricated ceramic crowns to prefabricated titanium bases (Ti-bases) has become common clinical practice (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Various studies have shown that bonding CAD/CAM-manufactured crowns after conditioning with the recommended protocols results in sufficient bond strength (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, debonding, especially of CAD/CAM hybrid crowns occurs in clinical practice. Furthermore, conventional pretreatment methods can be associated with several problems. Sandblasting with Al\u003csub\u003e2\u003c/sub\u003eO\u003csub\u003e3\u003c/sub\u003e powder can lead to microcracks in the ceramic and HF can cause health problems during processing (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The differences of pretreatment protocols, for example regarding sandblasting pressure or exposure times of chemicals can lead to processing errors in clinical practice and may result in premature failure of the restauration (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCold atmospheric pressure plasma (CAP) is already established in automotive industry or aviation engineering and is intended to improve the surface characteristics for adhesive bonding (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Several studies have investigated the influence of CAP on dental materials, (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and its use for decontamination (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Plasma systems applicable in dentistry differ in their generating methods, operating temperature and pressure, and process gas. Some systems operate in ambient air and do not require vacuum equipment or inert gas supply. This offers practical advantages by enabling simple and efficient integration into routine dental laboratory workflows.\u003c/p\u003e \u003cp\u003eCAP generated with ambient air has been investigated for conditioning implant-prosthetic materials. In previous studies the expected positive effects on bond strength could not be confirmed. It was even reported that CAP treatment, whether used alone or in combination with components of conventional pretreatment protocols, not only failed to show improvement but even resulted in a decline of bond strength (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The reasons for the lack of enhanced bond strength remain unclear. One potential explanation discussed in the literature is the insufficient specification and standardization of plasma process parameters such as exposure time and power settings for the effective conditioning of dental materials.\u003c/p\u003e \u003cp\u003eTherefore, the aim of the present study was to investigate the effect of different CAP exposure times at constant power on the wettability of various materials commonly used in implant prosthodontics. The null hypothesis was that cold atmospheric pressure plasma treatment would not affect the wettability measured by the contact angle (CA).\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003ePreparation of specimens\u003c/p\u003e \u003cp\u003eSeventy-five platelets (20 mm x 20 mm x 5 mm) were cut out of a titanium sheet (Ti6Al4V, Elli ASTM 136F, HWN titan GmbH, M\u0026ouml;nchengladbach, Germany). These were manually polished in two stages using pumice powder followed by polishing brush. After polishing, the specimens were cleaned using alcohol and distilled water. In addition, 75 specimens each were fabricated from three different ceramics: zirconia 3Y-TZP (IPS e.max ZirCAD LT, Ivoclar Vivadent, Ellwangen, Germany), lithium disilicate (IPS e.max CAD, Ivoclar Vivadent, Ellwangen, Germany) and a polymer-infiltrated hybrid ceramic network (PICN) (ENAMIC\u0026reg;, VITA-Zahnfabrik, Bad S\u0026auml;ckingen, Germany) using subtractive CAD/CAM milling. The samples were designed as cubes (10 mm x 10 mm x 10 mm). The zirconia samples were sintered in the Programat S1 furnace and the lithium disilicate samples were crystallized in the Programat EP 5010 furnace according to the manufacturer's instructions. All samples were then polished using diamond grinding pads with grit sizes of 50, 100, 200, 400 and 800 grit under water cooling and cleaned with alcohol and distilled water. The surface roughness was evaluated using a perthometer (Pethen Perthometer PRK) calibrated to the manufacturer\u0026rsquo;s instructions. The measurement followed a standard protocol. For each surface, ten measurements were performed over a length of 1.75 mm with a distance of 1.75 mm between them. Mean roughness value (Ra value) was calculated for each surface to document the initial conditions within the groups and to examine the influence of the standardized surface polishing. All specimen preparation steps were carried out by a single experienced operator.\u003c/p\u003e \u003cp\u003eCAP treatment\u003c/p\u003e \u003cp\u003eThe specimens of each material were divided into 5 groups (each n\u0026thinsp;=\u0026thinsp;15) according to the CAP exposure time. The 5groups included a control group (no CAP treatment) and groups with 5-, 10-, 20- and 30-seconds CAP treatment with maximum power (max. plasma and substrate temperature 50\u0026deg;C; input voltage 230 V; operating power 18.0 W). The \u0026ldquo;Piezo-Brush\u0026reg;\u0026rdquo; PZ3 hand-held device (Relyon Plasma GmbH, Regensburg, Germany) was used as the CAP source. The CAP-device uses ambient air as process gas. To ensure a constant distance between the material and the nozzle, the device was attached to a holder. For the CAP treatment of the titanium specimens, the nearfield nozzle for conductive materials and for the ceramic specimens needle nozzle for non-conductive materials was selected with a working distance of 0.5 mm for titanium and 2 mm for ceramic materials (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eContact angle measurement\u003c/p\u003e \u003cp\u003eThe CA measurements were carried out at the Max Planck Institute for Polymer Research (Mainz, Germany). A goniometer (Drop Shape Analyzer DSA100E, KR\u0026Uuml;SS GmbH, Hamburg, Germany) was used to determine the CA of the materials. Distilled water was drawn into a 0.1 ml syringe and a 3 \u0026micro;l drop of water was applied to the surface at a rate of 1 \u0026micro;l/sec. The CA measurements were carried out immediately after the CAP treatment (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The goniometer provides CA measurement for each drop at the left and right side. With the goniometer, the values were generated by evaluating a series of images using the system-software (KR\u0026Uuml;SS ADVANCE 1.9.2.2, KR\u0026Uuml;SS GmbH, Hamburg, Germany). All measurements were performed under constant parameter settings.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData processing and statistical analyses were performed using Microsoft Excel (version 16.82) and IBM SPSS Statistics (version 23; IBM Corp., Armonk, NY, USA). To compare mean CA at different CAP exposure times, one-way analysis of variance (ANOVA) was applied when the assumption of normality was met, as assessed by the Shapiro\u0026ndash;Wilk test. If not, the Kruskal\u0026ndash;Wallis test was used as a non-parametric alternative. To control the cumulative type I error associated with multiple pairwise comparisons, a Bonferroni-corrected post hoc test was applied, with the significance level adjusted to p\u0026thinsp;=\u0026thinsp;0.005.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the surface roughness measurements (Ra) of the investigated materials. PICN showed the highest mean surface roughness (1.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18 \u0026micro;m), followed by zirconia (0.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05 \u0026micro;m) and titanium (0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12 \u0026micro;m), while lithium disilicate exhibited the lowest mean roughness (0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05 \u0026micro;m).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean surface roughness values (Ra) for each material in \u0026micro;m.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaterial\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMinimum (\u0026micro;m)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaximum (\u0026micro;m)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean (\u0026micro;m)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStandard deviation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTitanium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZirconia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLithium disilicate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePICN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eContact angle\u003c/p\u003e \u003cp\u003eAll investigated materials exhibited a significant decrease in CA after 5 sec of CAP exposure (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Significant reduction of CA beyond 5 sec of CAP treatment was only observed for titanium and lithium disilicate. In both materials the 10 sec CAP treatment achieved a significant reduction in CA compared to 5 sec treatment (titanium p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, lithium disilicate p\u0026thinsp;=\u0026thinsp;0.003). For lithium disilicate, no further significant reduction of CA was observed with extended CAP treatment beyond 10 sec (p\u0026thinsp;=\u0026thinsp;1.000), whereas for titanium, an additional reduction compared to 10 sec was achieved when the exposure time was increased to 30 sec (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eFor zirconia and PICN surfaces, prolonging the CAP exposure beyond 5 sec did not result in any additional significant reduction in CA (Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e; p\u0026thinsp;=\u0026thinsp;1).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eContact angle values (\u0026deg;) of different materials after CAP treatment. Values are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (minimum\u0026ndash;maximum).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaterial\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 sec\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 sec\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 sec\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 sec\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30 sec\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTitanium\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e68\u0026deg; \u0026plusmn; 4\u0026deg; (64\u0026deg;\u0026ndash;75\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e21\u0026deg; \u0026plusmn; 3\u0026deg; (17\u0026deg;\u0026ndash;26\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e15\u0026deg; \u0026plusmn; 3\u0026deg; (9\u0026deg;\u0026ndash;19\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e12\u0026deg; \u0026plusmn; 2\u0026deg; (10\u0026deg;\u0026ndash;16\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9\u0026deg; \u0026plusmn; 1\u0026deg;\u003c/p\u003e \u003cp\u003e(7\u0026deg;\u0026ndash;11\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZirconia\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e82\u0026deg; \u0026plusmn; 10\u0026deg; (61\u0026deg;\u0026ndash;95\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e26\u0026deg; \u0026plusmn; 3\u0026deg; (22\u0026deg;\u0026ndash;33\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e24\u0026deg; \u0026plusmn; 3\u0026deg; (19\u0026deg;\u0026ndash;29\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e24\u0026deg; \u0026plusmn; 3\u0026deg; (20\u0026deg;\u0026ndash;29\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24\u0026deg; \u0026plusmn; 3\u0026deg; (19\u0026deg;\u0026ndash;30\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLithium disilicate\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e47\u0026deg; \u0026plusmn; 7\u0026deg; (35\u0026deg;\u0026ndash;58\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e19\u0026deg; \u0026plusmn; 3\u0026deg; (16\u0026deg;\u0026ndash;25\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14\u0026deg; \u0026plusmn; 2\u0026deg; (12\u0026deg;\u0026ndash;18\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e14\u0026deg; \u0026plusmn; 2\u0026deg; (9\u0026deg;\u0026ndash;17\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13\u0026deg; \u0026plusmn; 2\u0026deg; (10\u0026deg;\u0026ndash;17\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePICN\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e82\u0026deg; \u0026plusmn; 10\u0026deg; (61\u0026deg;\u0026ndash;93\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e18\u0026deg; \u0026plusmn; 3\u0026deg; (14\u0026deg;\u0026ndash;24\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e17\u0026deg; \u0026plusmn; 3\u0026deg; (13\u0026deg;\u0026ndash;24\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e17\u0026deg; \u0026plusmn; 3\u0026deg; (12\u0026deg;\u0026ndash;23\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17\u0026deg; \u0026plusmn; 3\u0026deg; (10\u0026deg;\u0026ndash;21\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBonferroni-adjusted p-values for pairwise comparisons of CAP exposure times (significance level adjusted p\u0026thinsp;=\u0026thinsp;0.005).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComparison (s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTitanium\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eZirconia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLithium disilicate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePICN\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0 vs 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 vs 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 vs 20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 vs 30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10 vs 20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10 vs 30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20 vs 30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe aim of this study was to investigate the influence of CAP on the wettability of the dental materials titanium, zirconia, lithium disilicate ceramic and polymer-infiltrated hybrid ceramic network material measured by CA. For all materials, a significant drop in CA was detected after 5 seconds of CAP treatment with the device used in the present investigation. Therefore, the null hypothesis, that CAP treatment would not affect the wettability, was rejected. In the titanium and lithium disilicate specimens, the CA was further reduced by prolonged CAP treatment at 30 sec for titanium and 10 sec for lithium disilicate. Zirconia and PICN showed no further reduction in CA, increasing CAP exposure time to more than 5 sec.\u003c/p\u003e \u003cp\u003eIn the present study, common materials for single implant crowns were selected. In comparable studies, primarily zirconia and titanium were examined (\u003cspan additionalcitationids=\"CR25 CR26 CR27\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Furthermore, there are studies that have focused on alternative materials such as feldspar ceramics, polymethyl methacrylate (PMMA), or leucite ceramics, which have reported an improvement in bond strength after plasma treatment (\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Jassim et al. used the same CAP device (PiezoBrush\u0026reg; PZ3, Relyon Plasma) as in the present study. However, CAP exposure time and nozzle\u0026ndash;surface distance differed (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). In their study, CAP treatment for 80 sec at a greater distance resulted in CA of 7\u0026deg; for zirconia. The present study achieved CA of 24\u0026deg; with no further reduction after 10 sec at a reduced distance. These findings indicate that plasma efficiency is strongly influenced by its application parameters, even when the same device is used. Jassim et al. also investigated the relationship between plasma treatment and bond strength, finding an improvement of adhesion without altering the surface as it occurs while sandblasting with aluminum oxide (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). In another study by Silva \u003cem\u003eet al.\u003c/em\u003e, the CA of titanium and zirconia specimens were examined after 5, 10 and 20 seconds of pretreatment with non-thermal plasma and atmospheric pressure. They demonstrated that a 10 sec plasma exposure resulted in a decrease of CA from15\u0026deg; to 0\u0026deg;. In contrast to the present study, an MDP primer was used for specimen preparation instead of distilled water (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Therefore, the smaller CA could also be attributed to the MDP primer. In a study by Akram \u003cem\u003eet al\u003c/em\u003e., titanium got pretreated with atmospheric pressure plasma after sandblasting. The CA of water decreased with the duration of the sandblasting treatment to a minimum of 25\u0026deg; after 120 seconds and the surface energy increased with prolonged CAP exposure time. CA decreased to a minimum of 8.1\u0026deg; after 15 minutes of plasma exposure with a distance of 10 mm (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the present study, standardized polishing and cleaning procedures resulted in reproducible Ra values within each material group. This was performed to prevent that the surface roughness has a substantial influence on the CA measurements.Other studies investigating the influence of plasma treatment on CA are not directly comparable to the present study because different polishing and cleaning methods were performed (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Another difference occurs in studies that used cylindrical shaped specimens instead of flat ones (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). The cylindrical design is more comparable to the actual geometry of an abutment or an implant, but it does not allow a direct comparison with the flat surfaces of other parts. In addition, the round surface can have an influence on the CA of the liquid droplet.\u003c/p\u003e \u003cp\u003eIn the present study, a holder was used to ensure a constant distance between the plasma device and the surface of the specimens. Korzec \u003cem\u003eet al.\u003c/em\u003e were able to prove that the size of the effectively activated area depends on the distance between the plasma nozzle and the material (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Jassim \u003cem\u003eet al.\u003c/em\u003e, who also conducted their investigation using a \u0026ldquo;Piezo-Brush\u0026reg;\u0026rdquo; PZ3 and employed a plasma activation time of 80 seconds, worked at a distance of 5 mm. This differs from the distance used in the present study and from the recommendations of Korzec \u003cem\u003eet al.\u003c/em\u003e (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn some other studies investigating the influence of plasma on wettability, other process gases such as pure oxygen, argon or mixtures of these two, were used. In these studies, no greater differences in the reduction of the CA were observed compared to the present study working with ambient air (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The use of ambient air does not appear to be a disadvantage of the method used here, especially given that this procedure is easier to carry out and requires less technical equipment.\u003c/p\u003e \u003cp\u003eSeveral limitations of the present study should be acknowledged. First, only surface wettability, assessed by CA measurements, was evaluated. Although wettability is an important parameter for bonding, adhesive performance is multifactorial and influenced by factors such as surface chemistry, surface energy, roughness, and interactions with primer or bonding systems. Second, the results are limited to the specific experimental setup, including the plasma device, treatment parameters, nozzle\u0026ndash;surface distance, and ambient conditions, which may affect plasma efficacy and limit comparability with other studies. Third, flat, standardized specimens were used, which do not fully reflect clinical geometries. Finally, only a limited range of dental materials was investigated, restricting the generalizability of the findings.\u003c/p\u003e \u003cp\u003eOne factor that may potentially influence the bond strength of an adhesive system could be the humidity. Variations in ambient temperature and humidity may affect the consistency of CAP application and should be evaluated in further studies. Although CAP treatment successfully reduced the CA, its clinical relevance and potential to enhance bond strength remain questionable. Previous studies using the same CAP showed no improvement in the bond strength of zirconia crowns to titanium bases after application to zirconia for 15 sec and titanium bases for \u0026ge;\u0026thinsp;30 sec (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), nor after 30 sec application to PICN crowns compared with conventional conditioning (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In both cases, bond strength was reduced. Successful adhesive bonding requires intimate interfacial contact, which is strongly influenced by surface wettability. Based on the CA, wetting is classified as non-wetting (CA\u0026thinsp;\u0026gt;\u0026thinsp;90\u0026deg;), wetting (CA\u0026thinsp;\u0026lt;\u0026thinsp;90\u0026deg;) and spreading (CA \u0026sim; 0\u0026deg;). Optimal conditions promote spreading without excessively reducing liquid surface tension and thereby impairing cohesive forces (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The reduced pull-off values observed after CAP treatment in previous studies (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) may be attributed to excessive CAP exposure, leading to an over-reduction of surface tension and weakened cohesive forces within composite system. Further studies are required to evaluate alternative primer/bonder systems, different ceramics materials, and the influence of humidity.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eCold atmospheric pressure plasma treatment effectively improves the surface wettability of titanium, zirconia, lithium disilicate ceramics and polymer infiltrated hybrid ceramic commonly used in dentistry. A reduction in the contact angle was observed for all materials after 5 seconds of treatment, indicating that prolonged cold atmospheric pressure plasma exposure offers no additional benefit. Further studies are required to determine the cold atmospheric pressure plasma application duration that optimally enhances bond strength.\u003c/p\u003e"},{"header":"Abbreviations","content":" \u003cp\u003eCA Contact angle\u003c/p\u003e \u003cp\u003eCAD Computer-Aided-Design\u003c/p\u003e \u003cp\u003eCAM Computer-Aided-Manufacturing\u003c/p\u003e \u003cp\u003eCAP Cold Atmospheric-Pressure Plasma\u003c/p\u003e \u003cp\u003esec Seconds\u003c/p\u003e \u003cp\u003e\u0026micro;m Micromillimeters\u003c/p\u003e \u003cp\u003e\u0026micro;SBS Microshear bond strength\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank relyon Plasma GmbH (Regensburg, Germany) for providing the plasma device PZ3. No further funding has taken place.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the Max Planck Institute for Polymer Research (Mainz, Germany) for their support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eM.B. and S.W. conceptualized the study and developed the methodology. Data curation, analysis, and interpretation were performed by M.B. and S.W. M.B. and S.W. drafted the original manuscript. S.W., L.G., S.A.-A., and L.S. critically reviewed and edited the manuscript. Figures and tables were prepared by M.B., L.G., and L.S. The study was supervised by S.W. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRosentritt M, Lohbauer U, Ilie N, Wie. befestigen? 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Open access Macedonian J Med Sci. 2018;6(11):2257.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCaravaca C, Flamant Q, Anglada M, Gremillard L, Chevalier J. Impact of sandblasting on the mechanical properties and aging resistance of alumina and zirconia based ceramics. J Eur Ceram Soc. 2017;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarshilia H. Surface Modification Technologies for Aerospace and Engineering Applications: Current Trends, Challenges and Future Prospects. Trans Indian Natl Acad Eng. 2021;6:1\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDong X, Li H, Chen M, Wang Y, Yu Q. Plasma treatment of dentin surfaces for improving self-etching adhesive/dentin interface bonding. Clin plasma Med. 2015;3(1):10\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRupf S, Idlibi AN, Marrawi FA, Hannig M, Schubert A, von Mueller L, et al. 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Influence of surface pretreatment using cold-active atmospheric pressure plasma on bond strength of CAD-CAM-fabricated hybrid ceramic crowns: an in-vitro study. Int J Implant Dentistry. 2024;10(1):67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTabari K, Hosseinpour S, Mohammad-Rahimi H. The Impact of Plasma Treatment of Cercon\u0026reg; Zirconia Ceramics on Adhesion to Resin Composite Cements and Surface Properties. J Lasers Med Sci. 2017;8(Suppl 1):S56\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkram M, Jansen K, Ernst L, Bhowmik S. Atmospheric pressure plasma surface modification of titanium for high temperature adhesive bonding. Int J Adhes Adhes. 2011;31(7):598\u0026ndash;604.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLopes BB, Ayres APA, Lopes LB, Negreiros WM, Giannini M. The effect of atmospheric plasma treatment of dental zirconia ceramics on the contact angle of water. 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Int J Mol Sci. 2023;24(8):7663.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Yang T, Li B, Li J. Surface modifications of zirconia with plasma pretreatment and polydopamine coating to enhance the bond strength and durability between zirconia and titanium. Dent Mater J. 2023;42(3):449\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu C, Yang M, Ma K, Zhang Q, Bai N, Liu Y. Improvement implant osseointegration through nonthermal Ar/O\u0026thinsp;\u0026lt;\u0026thinsp;sub\u0026gt;2 plasma. Dent Mater J. 2023;42(4):461\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKorzec D, Hoppenthaler F, Burger D, Andres T, Nettesheim S. Atmospheric pressure plasma jet powered by piezoelectric direct discharge. Plasma Processes Polym. 2020;17(11):2000053.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-implant-dentistry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"IJID","sideBox":"Learn more about [International Journal of Implant Dentistry](https://journalimplantdent.springeropen.com/)","snPcode":"40729","submissionUrl":"https://submission.nature.com/new-submission/40729/3","title":"International Journal of Implant Dentistry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cold atmospheric pressure plasma, surface treatment, titanium, zirconia, wettability, contact angle, abutment crown, CAD-CAM","lastPublishedDoi":"10.21203/rs.3.rs-8942943/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8942943/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eSurface wettability is a key factor in bonding of dental materials. The aim of the present study was to investigate the influence of different exposure times of cold atmospheric pressure plasma at constant power on the surface wettability of various dental materials employed in implantology, using the \u0026ldquo;Piezo-Brush\u0026reg;\u0026rdquo; PZ3 cold atmospheric pressure plasma device.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eSeventy-five standardized specimens made of titanium alloy, zirconia, lithium disilicate and polymer-infiltrated hybrid ceramic network were manufactured and polished. Specimens of each material were divided into 5 groups (each n\u0026thinsp;=\u0026thinsp;15). Four groups were cold atmospheric pressure plasma treated for 5, 10, 20 or 30 seconds and compared to the untreated control group. Surface wettability was assessed by measuring the contact angle of distilled water using a goniometer. Statistical analysis was performed using one-way ANOVA.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean contact angle was significantly reduced by 60\u0026ndash;80% after 5 seconds of cold atmospheric pressure plasma treatment for all investigated materials (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Prolonged cold atmospheric pressure plasma exposure resulted in further reduction in mean contact angle values for titanium at each additional treatment duration (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereas for lithium disilicate a reduction was observed only up to 10 seconds. For zirconia and polymer-infiltrated hybrid ceramic network, no further reduction in contact angle was observed beyond 5 seconds of cold atmospheric pressure plasma treatment.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eCold atmospheric pressure plasma treatment significantly increases surface wettability after short exposure times and may therefore improve adhesion. Under the plasma parameters applied in this study, extending treatment beyond 5 seconds for zirconia and polymer-infiltrated hybrid ceramic network or beyond 10 seconds for titanium and lithium disilicate offers no additional clinically relevant benefits.\u003c/p\u003e","manuscriptTitle":"Effect of Cold Atmospheric Pressure Plasma on Wettability of Implant Prosthetic Materials: An In-Vitro Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-27 18:39:47","doi":"10.21203/rs.3.rs-8942943/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-27T11:31:06+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-28T12:43:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-27T13:14:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"71742091252865681846922522076275587022","date":"2026-02-27T13:11:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"176476092576445388574450062099082149848","date":"2026-02-25T17:30:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-25T12:43:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-25T12:42:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-23T12:09:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Implant Dentistry","date":"2026-02-23T04:45:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-implant-dentistry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"IJID","sideBox":"Learn more about [International Journal of Implant Dentistry](https://journalimplantdent.springeropen.com/)","snPcode":"40729","submissionUrl":"https://submission.nature.com/new-submission/40729/3","title":"International Journal of Implant Dentistry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a828adc4-76d9-4fed-8673-f23ab83d219e","owner":[],"postedDate":"February 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-13T20:08:50+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-27 18:39:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8942943","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8942943","identity":"rs-8942943","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}