Bond Strength of Universal Adhesives to Dentin: A Systematic Review and Meta-Analysis

Abstract

Currently, the availability of a wide variety of universal adhesives makes it difficult for clinicians to choose the correct system for specific bonding situations to dentin substrate. This study aimed to determine whether there are any alternative techniques or additional strategies available to enhance the bond strength of universal adhesives to dentin through a systematic review and meta-analysis. Two reviewers executed a literature search up to September 2020 in four electronic databases: PubMed, ISI Web of Science, Scopus, and EMBASE. Only in vitro studies that reported the dentin bond strength of universal adhesives using additional strategies were included. An analysis was carried out using Review Manager Software version 5.3.5 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). The methodological quality of each in vitro study was assessed according to the parameters of a previous systematic. A total of 5671 potentially relevant studies were identified. After title and abstract examination, 74 studies remained in systematic review. From these, a total of 61 studies were included in the meta-analysis. The bond strength of universal adhesives to dentin was improved by the use of one of the following techniques: Previous application of matrix metalloproteinases (MMP) inhibitors (p < 0.001), prolonged application time (p = 0.007), scrubbing technique (p < 0.001), selective dentin etching (p < 0.001), non-atmospheric plasma (p = 0.01), ethanol-wet bonding (p < 0.01), prolonged blowing time (p = 0.02), multiple layer application (p = 0.005), prolonged curing time (p = 0.006), and hydrophobic layer coating (p < 0.001). On the other hand, the use of a shortened application time (p = 0.006), and dentin desensitizers (p = 0.01) impaired the bond strength of universal adhesives to dentin. Most of the analyses performed showed a high heterogenicity. The in vitro evidence suggests that the application of universal adhesives using some alternative techniques or additional strategies may be beneficial for improving their bonding performance to dentin. This research received no external funding. Considering that this systematic review was carried out only with in vitro studies, registration was not performed.

Antibacterial and Bonding Properties of Universal Adhesive Dental Polymers Doped with Pyrogallol

“…The incorporation of PY into universal adhesives may influence their bonding performance to dentin and ameliorate the antibacterial effects against cariogenic species, such as S. mutans . An ideal restorative material should possess some antibacterial properties, along with good mechanical properties and bonding stability over time [ 1 , 21 , 36 ]. Unfortunately, the resin adhesive systems that are currently available on the market do not completely fulfill all these requirements.…”

“…However, the bond strength and stability of resin adhesives bonded to dental tissues are important aspects to attain optimal dental restorations in an oral cavity [ 1 , 3 , 5 , 21 ]. Indeed, several studies [ 41 , 42 , 43 , 44 , 45 ] reported a severe degradation of the polymer–dentin interface over time due to a synergic hydrolytic degradation of the polymer matrix within the hybrid layer and to the enzymatic degradation of poorly infiltrated demineralized dentin collagen fibrils through activated host metalloproteinases (MMPs) and cysteine-cathepsins (CTs).…”

“…Despite novel technologies and constant developments in polymer chemistry, there is still a lack of information regarding the bonding performance of modern universal adhesive systems [ 1 ]. Currently, these types of adhesive systems represent an advanced choice for dental practitioners, as they can be used in self-etch, etch-and-rinse, or a selective enamel-etching mode [ 2 , 3 ].…”

One-Year Clinical Aging of Low Stress Bulk-Fill Flowable Composite in Class II Restorations: A Case Report and Literature Review

“…Thus, the hybrid layer is a mixture of dentin, hydroxyapatite, resin monomers and residual solvents; hence, its stability ultimately depends on the resistance of the individual components to the degradation [51]. In general, the more compact and homogeneous the hybrid layer, the more stable resin-dentin bond is created [34,52] (Figure 2b).…”

“…Interestingly, the resin-dentin interface produced by two-step etch-and-rinse adhesives, degraded with time when directly exposed to water or oral fluids [33]. When exposed to long-term water storage, an increase in the number of adhesive interface failures was demonstrated in in vitro studies [34,35].…”