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PURPOSE: This systematic review evaluated the effects of simulated gastric acid (SGA) on surface and mechanical properties of dental ceramics to answer the research question: Does immersion in SGA alter the surface roughness, microhardness, fracture strength, and color of dental ceramics? METHODS: A literature search was conducted in PubMed, Scopus, Web of Science, Embase, Open Gray, and Google Scholar, in February 2025. Independent reviewers selected and analyzed in vitro studies assessing one or more outcomes-roughness, microhardness, fracture strength, or color-after acid exposure. Data were extracted independently, and risk of bias was assessed using the RoBDEMAT tool. RESULTS: Out of 2,111 studies, 22 were included. Ceramics analyzed were lithium disilicate (n = 15), polymer-infiltrated feldspathic (n = 11), zirconia (n = 11), feldspathic (n = 8), zirconia-reinforced lithium silicate (n = 7), and leucite-reinforced (n = 4). Surface roughness changes were material-dependent, with feldspathic ceramics most affected and zirconia most stable. Microhardness generally decreased across ceramics. Fracture strength remained mostly unchanged, except for occasional reductions. Polymer-infiltrated ceramics and zirconia showed the greatest color stability. Specimen shapes and dimensions varied across studies, reflecting differences in study aims and testing protocols. Most studies showed appropriate outcome reporting, statistical analysis, and test standardization (>90%). However, operator blinding, when applicable, was not reported in any of the included studies. Randomization (> 87%) and sample size calculation (50%) were also frequently missing. CONCLUSION: Surface, mechanical, and optical properties of ceramics were affected by acid exposure, varying by material. Zirconia and polymer-infiltrated ceramics show greater stability. Methodological heterogeneity limits conclusions, underscoring the need for standardized protocols and clinical validation.
Rodrigues et al. (Sat,) studied this question.