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Regarding universal adhesives, Passia and colleagues evaluated in their study the tensile strength of different systems of universal adhesives used for cementation of ceramics reinforced with lithium disilicate. Their samples were divided into 4 groups consisting of different universal adhesives and resin cements. After the study it was concluded that Monobond Plus showed greater strength of union to the ceramic even after 150 days of storage in water, which suggests that not all the universal systems are applicable for the adhesion of ceramics. . Likewise, Yoshiara and colleagues studied the effectiveness of coupling agents such as silane as a component of universal adhesive systems. A universal Scotchbond silane adhesive system (9.4 MPa) and a universal silane-free adhesive system such as Clearfil S3 Bond ND Quick (9.9 MPa) were used. Significantly higher bond strength was recorded when the Clearfil Porcelain bond activator was freshly mixed with the universal silane-free adhesive (27.3 MPa). Clinically, the separated silane or silane freshly mixed with the adhesive is recommended for the adhesion of ceramic restorations . Nikolaus and colleagues conducted a study in which the influence of various surface treatment methods on the adhesion effectiveness of universal adhesives was evaluated. It was observed that the silane included in the universal adhesive may not be effective in the resin ceramic bond, since the protocol that included one more step (silanization) presented a better behavior with respect to the adhesion strength (independently of the acid etching). In addition, it was determined that acid etching is considered an effective method to eliminate contaminants present and favor the formation of an effective surface for the application of a universal adhesive . On the other hand, Park and colleagues evaluated the influence of different surface treatments on the bond strength to nano-ceramic resin restorations, using a universal adhesive. It was found that the resin cement can be affected by the surface treatment and also by the application of the adhesive material. It was proved that air abrasion and the Rocatec system were very effective in increasing the bond strength of the cement to the ceramics processed in the laboratory (7.64 MPa and 7.41 MPa, respectively), when it was associated with the application of an adhesive system universal. However, these methods can generate a large loss of material so its use must be controlled. Etching with hydrofluoric acid forms a rough and superficial texture creating a honeycomb topography on the surface of the ceramic, ideal for a micro mechanical bond. However, its effect is less compared to the methods mentioned above. Another point of interest was that the need for the use of an adhesive system was confirmed to further increase the strength of the union of nano-ceramic resins and cement . Even Stawarczyk reported the effectiveness of repairing a nano ceramic resin with a universal adhesive system plus a direct resin, although the phosphoric acid monomers work better than an adhesive based exclusively on methacrylic monomers. This behavior is explained by the presence of dihydrogen phosphate (MDP), present in the universal adhesive (Single Bond Universal) . In this sense, it could be concluded that the ability of the adhesive monomers to intertwine with the collagen fibrils depends on several factors: The conditioning of the tissue, the priming steps of the same and the wetting characteristics, the chemical composition of the adhesive systems, the hydrophobic or hydrophilic behavior and the properties of the monomers.
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