Effect of Collagen Crosslinkers on Dentin Bond Strength of Adhesive Systems: A Systematic Review and Meta-Analysis

Abstract

This study aimed to identify the role of crosslinking agents in the resin–dentin bond strength (BS) when used as modifiers in adhesives or pretreatments to the dentin surface through a systematic review and meta-analysis. This paper was conducted according to the directions of the PRISMA 2020 statement. The research question of this review was: “Would the use of crosslinkers agents improve the BS of resin-based materials to dentin?” The literature search was conducted in the following databases: Embase, PubMed, Scielo, Scopus, and Web of Science. Manuscripts that reported the effect on the BS after the use of crosslinking agents were included. The meta-analyses were performed using Review Manager v5.4.1. The comparisons were performed by comparing the standardized mean difference between the BS values obtained using the crosslinker agent or the control group. The subgroup comparisons were performed based on the adhesive strategy used (total-etch or self-etch). The immediate and long-term data were analyzed separately. A total of 50 articles were included in the qualitative analysis, while 45 articles were considered for the quantitative analysis. The meta-analysis suggested that pretreatment with epigallocatechin-3-gallate (EGCG), carbodiimide, ethylenediaminetetraacetic acid (EDTA), glutaraldehyde, and riboflavin crosslinking agents improved the long-term BS of resin composites to dentin (p £ 0.02). On the other hand, the use of proanthocyanidins as a pretreatment improved both the immediate and long-term BS values (p ≤ 0.02). When incorporated within the adhesive formulation, only glutaraldehyde, riboflavin, and EGCG improved the long-term BS to dentin. It could be concluded that the application of different crosslinking agents such as carbodiimide, EDTA, glutaraldehyde, riboflavin, and EGCG improved the long-term BS of adhesive systems to dentin. This effect was observed when these crosslinkers were used as a separate step and when incorporated within the formulation of the adhesive system.

Effects of carbodiimide combined with ethanol–wet bonding pretreatment on dentin bonding properties: an in vitro study

“…In addition, although the bonding strength of all groups decreased after 10,000 thermocycling, the EDC-treated samples (EDCw, EDCw + EWB, and EDCe) maintained higher bonding strengths compared with the control group, which is consistent with the results of other studies ( Hardan et al, 2022 ; Maravic et al, 2021 ; Mazzoni et al, 2018 ). The reason is speculated to be that covalent cross-links produced with EDC inactivate the active sites of dentin matrix metalloproteinases ( Maravic et al, 2021 ; Tjaderhane, 2015 ), causing EDC-treated samples to undergo less hydrolysis and enzymatic hydrolysis, and maintain the integrity of the hybrid layer to a greater extent.…”

“…Several studies that pretreated demineralized dentin with 0.3M EDC in water for 1 min have demonstrated the improved bonding strength of the resin–dentin interface ( Comba et al, 2019 ; Hardan et al, 2022 ; Maravic et al, 2021 ; Mazzoni et al, 2013 ; Mazzoni et al, 2014 ). However, studies have shown that nearly half of the demineralized dentin the adhesive should infiltrate is still infiltrated by residual water during the process of dentin bonding ( Tjaderhane et al, 2013 ).…”

Effect of collagen cross-linkers on dentin bond strength: A systematic review and network meta-analysis

“…Notably, these cross-linked collagen matrices also possess antibacterial and anti-biofilm activities (Daood et al, 2018;Fonseca et al, 2019) The incorporation of chitosan into dentin adhesives increases long-term bond strength and creates an interface with antibacterial properties (Elsaka and Elnaghy, 2012;Diolosà et al, 2014) The usage of the chitosan-riboflavin combination enhanced the mechanical properties of dentin and synergistically reduced the degradation of the resin-dentin interface (Daood et al, 2018). The study results, in contrast to previous results (Hardan et al, 2022), refute the finding that chitosan is a weak crosslinker and does not have a significant effect when used alone.…”

Natural Bioactive Epigallocatechin-Gallate Promote Bond Strength and Differentiation of Odontoblast-like Cells

“…This hybrid-layer degradation is caused by enzymes from the zymogen protease family in the extracellular matrix, specifically matrix metalloproteinases (MMPs) and cysteine cathepsins (CCs). These enzymes are activated in an acidic environment, such as acid-etching conditioning (phosphoric acid) or adhesive itself [ 25 ]. Pretreatment with chlorhexidine after acid conditioning can reduce the activity of the zymogen protease family.…”