Effect of Different Application Modalities on the Bonding Performance of Adhesive Systems to Dentin: A Systematic Review and Meta-Analysis

Abstract

Diverse types of dental adhesives exhibit different cytotoxic outcomes on cells in vitro. Currently, no standard adhesive application technique has so far been decisive for clinicians for better durability of resin–dentin bonds of adhesive systems. The purpose of this study was to systematically review the literature to evaluate the bonding performance of adhesive systems to dentin by using different application modalities. The systematic research strategy was conducted by two reviewers among multiple databases: PubMed, Scopus, Web of Science, Embase, and Scielo. In vitro studies reporting the effects of additional steps for the application of adhesive systems on the bond strength to dentin were selected. Meta-analysis was performed using Review Manager Software version 5.3.5 using the random effects model. The methodological quality of each in vitro study was assessed according to the parameters of a previous systematic review. The electronic research through different databases generated a total of 8318 references. After the examination of titles and abstracts, a total of 106 potentially relevant studies accessed the full-text evaluation phase. After full-text examination, 78 publications were included for the qualitative analysis, and 68 studies were included in the meta-analysis. Regarding the etch-and-rinse adhesive systems, the application modalities that improved the overall bond strength were the application of a hydrophobic resin layer (p = 0.005), an extended application time (p < 0.001), an application assisted by an electric current (p < 0.001), a double-layer application (p = 0.05), the agitation technique (p = 0.02), and the active application of the adhesive (p < 0.001). For self-etch adhesive systems, the techniques that improved the overall bond strength were the application of a hydrophobic resin layer (p < 0.001), an extended application time (p = 0.001), an application assisted by an electric current (p < 0.001), a double-layer application (p < 0.001), the agitation technique (p = 0.01), and the active application of the adhesive (p < 0.001). The in vitro evidence suggests that the application of adhesive systems using alternative techniques or additional strategies may be beneficial for improving their bond strength to dentin. The application modalities that favored the overall bond strength to dentin were an extended application time, a double-layer application, an application assisted by an electric current, the active application of the adhesive, and the application of a hydrophobic resin layer. Worth mentioning is that some techniques are intended to increase the degree of the conversion of the materials, and therefore, improvements in the biocompatibility of the materials can be expected.

Bond Strength of Low-Viscosity Bulk-Fill Composite and Adhesives Using 10-Methacryloyloxydecyl Dihydrogen Phosphate (10-Mdp)

“…Unreacted monomers give the intermediate agent the C=C needed to generate C-C covalent bonds. Furthermore, functional monomers join with the fillers to raise the cohesive strength of the composite substrate by strengthening the bonds between them [3,18].…”

“…[1,2] There are two types of BFRCs: flowable (low viscosity) and full-body (high viscosity), each having a unique therapeutic application process. Yet, since universal resin composites must be employed as a cap on top of the restoration because low-viscosity BFRCs are mostly used as dentinreplacement materials [1,3] Some clinical circumstances lead to the loss or contamination of the oil and it may affect how a fresh composite layer is applied. To promote adhesion between both the composite layers in these specific situations, the damaged composite surface must be reactivated by roughening and/or wetting the surface.…”

“…As a quick fix, this technique can be applied. [3,4] The strength and longevity of adhesion are crucial for achieving interface stability. Programmes emphasize the value of physical surface treatments and support the effectiveness of chemical conditioning techniques [3.4], but they come to different findings on the best regimen.…”

“…Several or more acidic functional molecules are present in universal and self-etch adhesives, which improve conditioning and chemical interaction. One of the most adaptable functional monomers is 10-MDP; it has a very high potential for adhesion to a wide range of substrates, including metals, lithium disilicate, zirconia ceramics, and dental hard tissues, and it appears to be essential for self-etch adhesives to reach a stable bond strength [3,5].…”

Comparative Cell Viability of Dentin-Bonding Adhesive Systems on Human Dental Pulp Stem Cells: Time-Dependent Analysis

“…Dentin bonding adhesive systems (DBASs) serve as intermediary materials that establish a connection between dentin tissue and composite resin. They are designed to facilitate the bonding of dentin tissue to composite resin surfaces, thereby ensuring the retention of dental restorations and preventing issues like microleakage and dentin sensitivity [11]. Throughout the years, dentin adhesive systems have undergone several classi cations.…”