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The Journal of Adhesive Dentistry
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J Adhes Dent 21 (2019), No. 1     28. Feb. 2019
J Adhes Dent 21 (2019), No. 1  (28.02.2019)

Page 7-26, doi:10.3290/j.jad.a41975, PubMed:30799468


Bonding Performance of Universal Adhesives: An Updated Systematic Review and Meta-Analysis
Cuevas-Suárez, Carlos Enrique / da Rosa, Wellington Luiz de Oliveira / Lund, Rafael Guerra / da Silva, Adriana Fernandes / Piva, Evandro
Purpose: To evaluate through a systematic review and meta-analysis whether the immediate and long-term bonding performance of universal adhesives would be improved by prior acid etching.
Materials and Methods: Two reviewers performed a literature search up to April 2018 in eight databases: PubMed, Web of Science, Cochrane Library, SciELO, Scopus, LILACS, IBECS, and BBO. Only studies that evaluated the dentin or enamel bond strength of universal adhesives using a self-etch or etch-and-rinse strategy were included. Analyses were carried out using RevMan 5.3.5 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). A global analysis comparing self-etch or etch-and-rinse strategies and the influence of aging on bonding performance was performed with random-effects models at a significance level of p < 0.05.
Results: A total of 59 in vitro studies were included in the meta-analysis. The enamel bond strength of universal adhesives was improved by the etch-and-rinse approach (p < 0.05). In dentin, this effect was observed for ultra-mild and intermediately strong universal adhesives (p < 0.05). Irrespective of the strategy employed, intermediately strong adhesives showed a decrease in bond strength after all types of aging. This effect was also observed for ultra--mild universal adhesives used in the etch-and-rinse approach (p < 0.05). Mild universal adhesives showed bond strength stability in both strategies (p > 0.05).
Conclusions: The in vitro evidence suggests that bonding performance of mild universal adhesives can be improved by using the selective enamel-etch strategy. Mild universal adhesives seem to be the more stable materials, in both etch-and-rinse or self-etch strategies.

Keywords: adhesive, dental bonding, dental materials, universal adhesives, systematic review