KACD
Articles
- Page Path
- HOME > Restor Dent Endod > Volume 43(3); 2018 > Article
- Research Article Do universal adhesives promote bonding to dentin? A systematic review and meta-analysis
-
Ali A. Elkaffas1, Hamdi H. H. Hamama1,2
, Salah H. Mahmoud1 -
Restor Dent Endod 2018;43(3):e29.
DOI: https://doi.org/10.5395/rde.2018.43.e29
Published online: June 18, 2018
1Department of Operative Dentistry, Faculty of Dentistry, Mansoura University, Mansoura, Egypt. JFIF d d Ducky d qhttp://ns.adobe.com/xap/1.0/ |er˭|I|-fGK.rΛp8XV1%K6mvG+tc+qE &ǸC_Nm:l=_/m5^[dߌڇ.c<%:)tQ$Ow~-aY;UJ >=F)2[nk؆?훐 M=l6[4(O.]2#-H^n#->&mp5~Fӛ+|| S,xag% qkEUzUgæBhߕP(7]kFnq?֖Cpru Z6*rEڊtS|*tI*E}7R<,nUU֫^I7Q*mSly%rdȓd8hE<9oHhMfNSRj[i7D[Rj݊+kდq{"$$H?p \̅S?㭻;t~ R߁ )^/>Qj`yt[w ԛ;² ~+ ߔ_ YW~|o] ?x^ᯛ `ʼn;g)T@vWn]>&4l p+$D̢1l|ȨF%-} .9[}w~
ԠLM9hСablfe&QoW !s ?wjLK?s7yO>(=C~_nyǜu? v 3vyo oI@qV-jeES^[9WoSܝh"l2C1a͔CiJ@3:Pճw= /7ovuk+\V;lDgն <[A+r X~d;m!_s8ݖ;;.0llUC+?i#_crʙ1~C.\q u l8Hܶ2m`ܻM3Tov|Bs rɵ"oLS-
DКw=Tv@f '6|YlD͓Y%-#Ѯo%:&!3o%\J<02;K87>^vgƓ# ;ݝmz^Y6=PS39U%~
&f#
}o!muH; ʲŇ˷yvP+&.7e[3'vR4Yj̗IZ`e˽3o[WU{
m[sUbۋZǾۆl6~9'V*.\S2<Sd*zY[aŶ`]C$n.v^Ʌ
dng>ەZ,Mmϑ :n6nϦezW qUJ4! ۇ4R! =>>F n|Q[{pRO 17ƕ~._I ''00k=b՛o}Osðc2'o\3}ݭQ^ 2 . R1yKȣtAݿ-u ܾw!`?1Whn|gzU o[ECWwjUIן)^h#1ɭ!/Z
np;o;ΗŻkXs."6E`Z1
עӐ9Kl8qd q} 2Stt;#j>;խabONŗ=fwP1j)l6J̶|gV 2`y/0E˛6+ԫ1?
6}KW c\KoKͨ2ۅFws*TԞLיuDx .kCzWXhy۶gLu|%TnupǺl-S* P RaLnT+c+*xl.v!.U=|; !_L̎뱚U=4hm:ٯ"y)$:>%(n}X'p[ȴ
^˒4kƓmzDx
\
'Nq amP7nyN݅=
2Operative Dentistry Discipline, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China. JFIF d d Ducky d qhttp://ns.adobe.com/xap/1.0/ |er˭|I|-fGK.rΛp8XV1%K6mvG+tc+qE &ǸC_Nm:l=_/m5^[dߌڇ.c<%:)tQ$Ow~-aY;UJ >=F)2[nk؆?훐 M=l6[4(O.]2#-H^n#->&mp5~Fӛ+|| S,xag% qkEUzUgæBhߕP(7]kFnq?֖Cpru Z6*rEڊtS|*tI*E}7R<,nUU֫^I7Q*mSly%rdȓd8hE<9oHhMfNSRj[i7D[Rj݊+kდq{"$$H?p \̅S?㭻;t~ R߁ )^/>Qj`yt[w ԛ;² ~+ ߔ_ YW~|o] ?x^ᯛ `ʼn;g)T@vWn]>&4l p+$D̢1l|ȨF%-} .9[}w~
ԠLM9hСablfe&QoW !s ?wjLK?s7yO>(=C~_nyǜu? v 3vyo oI@qV-jeES^[9WoSܝh"l2C1a͔CiJ@3:Pճw= /7ovuk+\V;lDgն <[A+r X~d;m!_s8ݖ;;.0llUC+?i#_crʙ1~C.\q u l8Hܶ2m`ܻM3Tov|Bs rɵ"oLS-
DКw=Tv@f '6|YlD͓Y%-#Ѯo%:&!3o%\J<02;K87>^vgƓ# ;ݝmz^Y6=PS39U%~
&f#
}o!muH; ʲŇ˷yvP+&.7e[3'vR4Yj̗IZ`e˽3o[WU{
m[sUbۋZǾۆl6~9'V*.\S2<Sd*zY[aŶ`]C$n.v^Ʌ
dng>ەZ,Mmϑ :n6nϦezW qUJ4! ۇ4R! =>>F n|Q[{pRO 17ƕ~._I ''00k=b՛o}Osðc2'o\3}ݭQ^ 2 . R1yKȣtAݿ-u ܾw!`?1Whn|gzU o[ECWwjUIן)^h#1ɭ!/Z
np;o;ΗŻkXs."6E`Z1
עӐ9Kl8qd q} 2Stt;#j>;խabONŗ=fwP1j)l6J̶|gV 2`y/0E˛6+ԫ1?
6}KW c\KoKͨ2ۅFws*TԞLיuDx .kCzWXhy۶gLu|%TnupǺl-S* P RaLnT+c+*xl.v!.U=|; !_L̎뱚U=4hm:ٯ"y)$:>%(n}X'p[ȴ
^˒4kƓmzDx
\
'Nq amP7nyN݅=
- Correspondence to Hamdi H. H. Hamama, BDS, MDS, PhD. Clinical Assistant Professor, Room 3B-53B, Operative Dentistry Discipline, Prince Philip Dental Hospital, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong. hamdy@connect.hku.hk
• Received: February 4, 2018 • Accepted: May 8, 2018
Copyright © 2018. The Korean Academy of Conservative Dentistry
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
- 4,567 Views
- 39 Download
- 29 Crossref
Abstract
-
Objectives The aims of this study were to conduct a systematic review of the microtensile bond strength (µTBS) of multi-mode adhesives to dentin and to perform a meta-analysis to assess the significance of differences in the µTBS of one of the most commonly used universal adhesives (Scotchbond Universal, 3M ESPE) depending on whether the etch-and-rinse or self-etch mode was used.
-
Materials and Methods An electronic search was performed of MEDLINE/PubMed, ScienceDirect, and EBSCOhost. Laboratory studies that evaluated the µTBS of multi-mode adhesives to dentin using either the etch-and-rinse or self-etch mode were selected. A meta-analysis was conducted of the reviewed studies to quantify the differences in the µTBS of Scotchbond Universal adhesive.
-
Results Only 10 studies fulfilled the inclusion criteria for the systematic review. Extensive variation was found in the restorative materials, testing methodologies, and failure mode in the reviewed articles. Furthermore, variation was also observed in the dimensions of the microtensile testing beams. The meta-analysis showed no statistically significant difference between the etch-and-rinse and self-etch modes for Scotchbond Universal adhesive (p > 0.05).
-
Conclusions Multi-mode ‘universal’ adhesives can achieve substantial bonding to dentin, regardless of the used modes (either etch-and-rinse or self-etch).
INTRODUCTION
Evidence-based dentistry is an approach to oral health care requiring the judicious integration of systematic assessments of clinically relevant scientific evidence [1]. In routine dental practice, clinicians are committed to providing the best possible dental care for patients. Nowadays, clinical decision-making procedure becomes more sophisticated due to the huge amount of scientific information that is continually published on new therapies, techniques, and restorative materials, which underscores the importance of an evidence-based approach in the field of dentistry. Systematic reviews and meta-analyses are considered to be the highest level of evidence supporting evidence-based decision-making [2].
Adhesive dentistry has advanced rapidly in the past 10 years. Three main strategies are used. The first is based on the total removal of the smear layer, and is referred to as the ‘etch-and-rinse’ approach [3]. Conversely, the second strategy depends on modifying the smear layer, aiming to incorporate it into the adhesive layer; this is referred to as the ‘self-etch’ approach. Additionally, the multi-mode strategy is a combination of the etch-and-rinse and self-etch approaches [4].
In the late 1990s, the chronological ‘generation’-based classification of adhesives was widely used. In this classification, adhesives are classified into 7 generations, according to the chronology of their development. The fourth generation of adhesives was the most famous, to the point that they were referred to as the ‘gold standard’ or ‘classic’ adhesives, in addition to the more descriptive term of ‘three-step etch-and-rinse’ adhesives. Subsequent generations were introduced to simplify the clinical use of adhesives, up to the seventh generation, which comprises ‘all-in-one’ adhesives. Due to the many overlaps and unclear boundaries between the generations, this classification has almost disappeared from regular use, and a new classification was introduced by Van Meerbeek in the early 2000s [4]. According to Van Meerbeek's classification, contemporary dental adhesives are categorized into 3 main groups based on the smear layer treatment strategy: etch-and-rinse, self-etch, and the resin-modified glass-ionomer approach. Then, according to the number of clinical application steps, etch-and-rinse adhesives are further divided into 2 groups: 2- or 3-step etch-and-rinse adhesives. Similarly, self-etch adhesives are further divided into one-step (‘all-in-one’) or two-step self-etch adhesives. Recently, another group, known as universal or multi-mode adhesives, was added to the previous classification [5].
These novel multi-mode adhesives reduce the complexity of clinical application procedures. Adhesives in this category may be used as etch-and-rinse adhesives, self-etch adhesives, or as self-etch adhesives on dentin and etch-and-rinse adhesives on enamel (a technique commonly referred to as ‘selective enamel etching’) [6]. Functional monomers are the principal ingredient of recently developed multi-mode adhesives [7,8], as they play a major role in chemical adhesion to dentin. Thirty years ago, a dental manufacturer (Kuraray Noritake Dental Inc., Tokyo, Japan) incorporated 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) as a functional monomer in their dental adhesives. The phosphate group of the MDP interacts with the hydroxyapatite and significantly contributes to the long-term durability of the resin-dentin interface [9].
MDP-based adhesives can chemically bond to the hydroxyapatite crystals of dentin via the electrostatic interactions of ionic bonds formed with the calcium ions of the hydroxyapatite crystals, resulting in an insoluble MDP-calcium salt. Moreover, the phosphate groups in MDP form covalent bonds with the corresponding phosphate groups of hydroxyapatite crystals to form insoluble salts [10,11]. The continual deposition of successive coats of these salts on the outer surface of the hydroxyapatite crystal is a process known as ‘nanolayering’ [12,13]. Laboratory bond strength tests can provide important insights into the clinical performance of an adhesive under different dislodging forces [14].
The outcomes of previous studies regarding this particular point are unclear and sometimes conflicting. Wagner et al. [15] evaluated the microtensile bond strength of 3 different multi-mode adhesives applied in 2 different modes, self-etch or etch-and-rinse. Their results revealed that the separate etching step did not improve the microtensile bond strength of the multi-mode adhesives when compared to the self-etch application mode. Additionally, the study by Chen et al. [16] showed no significant difference in the bonding of multi-mode adhesive to dentin between the etch-and-rinse and self-etch application modes. Conversely, the study of Muñoz et al. [17] reported that this new category of adhesives exhibited inferior microtensile bond strength values compared to the control ‘conventional’ adhesives.
The key question of this review was “Do multi-mode adhesives provide adequate bonding to dentin when used in either the etch-and-rinse or self-etch mode?” This question cannot be answered in light of the currently available scientific evidence, which is weak. Therefore, this review was designed to assess and analyze the currently available published studies evaluating the bond strength of multi-mode adhesives to dentin. The null hypothesis tested was that there is no difference in the bond strength of multi-mode adhesives to dentin between the etch-and-rinse and self-etch modes.
MATERIALS AND METHODS
In the current review, 3 databases were searched: the National Library of Medicine (MEDLINE/PubMed), ScienceDirect, and EBSCOhost. Studies published after 2005 were included in this review. The keywords used when searching the databases were (‘multi-mode’ or ‘universal’ or ‘multi-purpose’ or ‘bonding strategies’ or ‘multi-mode adhesive’ or ‘universal adhesive’) and (‘microtensile’ or ‘bond strength’) and (‘micromorphology’ or ‘ultramorphology’).
Only laboratory studies and manuscripts written in English were included in this structured review. The following studies were excluded: non-English manuscripts, studies published before 2005 (only studies from 2005 until 2016 were included), in vitro studies using animal teeth, review articles, and clinical trials and case reports. Moreover, studies used that multi-mode adhesives for other purposes were excluded. The initial search of the PubMed database identified 542 articles, and was then followed by a subsequent search of the other 2 databases in addition to a manual search.
Eight manuscripts were excluded because they were not written in English, and 181 studies were excluded because they were published before 2005. A further 173 in vitro studies using animal teeth were excluded. Of the remaining 180 manuscripts, 57 clinical trials and 6 review articles were excluded, and 105 other studies were excluded because they utilized universal adhesives for other purposes, such as enamel bonding, bonding to primary teeth, bonding to anterior teeth, orthodontic bracket adhesion, prosthodontics, and endodontics. The detailed study selection procedures are illustrated in a flowchart (Figure 1).
Two authors of this review independently assessed the titles and abstracts of all the studies. Studies were included if they were conducted to evaluate the bonding of multi-mode adhesives to dentin using either the self-etch or etch-and-rinse mode. Studies in which the secondary outcome was the bond strength of multi-mode adhesives to enamel and dentin were also included. The full-text papers were independently assessed in duplicate by the 3 authors. In this review, a study was included if at least 2 of the reviewers (authors) agreed that it was suitable. The reviewed studies were subjected to meta-analysis to quantify the differences in the mean microtensile bond strength of Scotchbond Universal adhesive using Comprehensive Meta-Analysis software, version 2 (Biostat, Englewood, NJ, USA), with 95% confidence intervals.
RESULTS
The current review evaluated 10 studies [15,16,17,18,19,20,21,22,23,24] that were conducted to evaluate the bond strength of 6 different brands of multi-mode adhesives to dentin. Seven of them (70%) evaluated the bond strength of the Scotchbond Universal adhesive (3M ESPE, St. Paul, MN, USA) [15,16,17,18,19,20,21]. Six studies (60%) evaluated the bond strength of All-Bond Universal (Bisco, Schaumburg, IL, USA) [15,16,17,18,20,21], and 4 studies (40%) evaluated the bond strength of G-bond Plus (GC, Tokyo, Japan) [18,22,23,24]. The remaining studies evaluated other universal adhesives: Prime & Bond Elect (Dentsply Caulk, Milford, DE, USA; 20%) [16,20], Futurabond Universal (Voco, Cuxhaven, Germany; 20%) [15,16], Peak Universal Adhesive (Ultradent, South Jordan, UT, USA; 20%) [17,21], and Clearfil Universal Bond (Kuraray Noritake Dental Inc.; 10%) [16].
In addition, different types of restorative materials were used, as some studies used the nanocomposite Filtek Z350 (3M ESPE; 30%) [18,20,24], while other studies used Opallis (FGM, Joinville, SC, Brazil; 20%) [17,21]. Additionally, microhybrid composites were used in the studies, such as Filtek Z250 (3M ESPE; 10%) [19], Clearfil AP-X (Kuraray Noritake Dental Inc.; 10%) [22], Venus (Heraeus Kulzer, Hanau, Germany; 10%) [23], and TPH Spectra (Dentsply Caulk; 10%) [16]. The other restorative material used was a nanohybrid composite (GrandioSO, Voco; 10%) [15]. The geographical distribution of the reviewed manuscripts was as follows: 4 studies in South America (40%) [17,18,20,21], 3 in Europe (30%) [15,22,23], 2 in North America (20%) [19,24], and only one study in Asia (10%) [16].
Most of the reviewed articles were recently published. Four studies were published in 2014 (40%) [15,18,20,21], 2 were published in 2013 (20%) [17,24], 3 were published in 2012 (30%) [19,22,23], and only one study was published in 2015 (10%) [16]. All the reviewed studies (100%) used the microtensile bond strength testing method to determine the bond strength as the primary testing method [15,16,17,18,19,20,21,22,23,24]. However, they showed considerable variation in the secondary testing methods: 4 studies (40%) evaluated interfacial nanoleakage [17,18,20,21], 3 studies (30%) evaluated the degree of conversion [17,18,24], and the remaining studies (40%) evaluated the ultra-morphology of the resin-dentin interface using scanning electron microscopy or transmission electron microscopy [15,16,19,22]. Additionally, 2 studies (20%) evaluated the enamel microtensile bond strength [22,24] and one study (10%) evaluated the dentin microshear bond strength [23]. The summary findings, testing methods, and materials of the included studies are presented in Tables 1 and 2.
Table 1
Summary of the studies included in this systematic review
| Study | Predominant failure mode | No. of teeth (per group) | Objective | Conclusion |
|---|---|---|---|---|
| Chen et al. [16] | Mixed | 200 (10) | To examine the short-term in vitro performance of 5 universal adhesives bonded to human coronal dentin | The increase in the versatility of universal adhesives was not accompanied by technological advances for overcoming the challenges associated with previous generations of adhesives. |
| Wagner et al. [15] | Adhesive | 72 (12) | To compare the µTBS and resin penetration into dentin of 3 universal adhesives applied in 2 different etching modes | Application of an etching step prior to applying universal adhesives improved their dentin penetration, but did not affect bond strength to dentin. |
| Luque-Martinez et al. [20] | Adhesive | 140 (7) | To evaluate the µTBS and nanoleakage of 3 universal adhesives, applied with increasing solvent evaporation time | An extended solvent evaporation time may improve the bonding effectiveness for specific universal adhesives depending on the adhesive strategy used. |
| Muñoz et al. [18] | Adhesive/mixed | 60 (5) | To evaluate the effect of an additional hydrophobic resin coating on the µTBS, nanoleakage, and degree of conversion of 3 universal adhesives | The use of an additional hydrophobic resin coating improved the adhesive performance in terms of resin-dentin bond strengths of new universal adhesives when used with the self-etch strategy. The additional hydrophobic resin coating also improved the degree of conversion for both the etch-and-rinse and the self-etch strategies. |
| Muñoz et al. [21] | Adhesive/mixed | 40 (5) | To evaluate the µTBS and nanoleakage of universal adhesives that did or did not contain MDP applied in 2 different etching modes | Universal adhesives that contained MDP showed higher and more stable µTBS with reduced nanoleakage at the interfaces after 6 months of water storage. |
| Perdigão et al. [24] | Adhesive/mixed | 60 (5) | To evaluate the effect of acid etching and application of a hydrophobic resin coat on the enamel/dentin bond strengths and degree of conversion of a universal adhesive system | The use of a hydrophobic resin coat may be beneficial for the selective enamel etching technique, because it improved bond strengths to enamel when applied with the etch-and-rinse strategy and to dentin when used with the self-etch adhesion strategy. |
| Muñoz et al. [17] | Adhesive/mixed | 40 (5) | To evaluate µTBS, nanoleakage, and degree of conversion of universal simplified adhesive systems | This new category of universal adhesives used on dentin was inferior as regards at least one of the properties evaluated compared to the control adhesives. |
| Hanabusa et al. [22] | Mixed | 25 (5) | To test whether a new one-step adhesive could be applied in a multi-mode manner, either ‘full’ or ‘selective,’ self-etch, and etch-and-rinse approaches | Phosphoric-acid etching definitely improved bonding of the one-step self-etch adhesive to enamel, so one should be more careful with additional phosphoric-acid etching of dentin. Although the bond strength was not reduced, the resultant adhesive interface appeared ultra-structurally more vulnerable to biodegradation. |
| Perdigão et al. [19] | Adhesive | 36 (6) | To evaluate the laboratory dentin and enamel µTBS and ultra-morphology of a new multi-purpose adhesive | This new category of universal adhesives used on dentin was superior as regards to the properties evaluated compared to the control adhesives. |
| Eren et al. [23] | - | 75 (15-15-45) | To evaluate the microtensile, microshear, and shear bond strength test methods to assess the bond strength of 2 self-etch adhesives and one etch-and-rinse adhesive on dentin | Bond strength to dentin depended on the material and the test method used. |
Table 2
Testing methods and materials used in the included studies
| Study | Year | Country | Primary testing method | Secondary testing method | Universal adhesives used | Type of composite |
|---|---|---|---|---|---|---|
| Chen et al. [16] | 2015 | China | Dentin µTBS | TEM of resin-dentin interface | Prime&Bond Elect (Dentsply Caulk, Milford, DE, USA); Scotchbond Universal (3M ESPE, St. Paul, MN, USA), All-Bond Universal (Bisco Inc., Schaumburg, IL, USA); Futurabond U (Voco, Cuxhaven, Germany); Clearfil Universal Bond (Kuraray Noritake Dental Inc., Tokyo, Japan) | Microhybrid composite (TPH Spectra, Dentsply Caulk, Milford, DE, USA) |
| SEM of tracer-infused water rich zone | ||||||
| Wagner et al. [15] | 2014 | Germany | Dentin µTBS | Semi-quantitative analysis of penetration depth by confocal light scanning microscopy | Futurabond U (Voco, Cuxhaven, Germany); All-Bond Universal Bisco Inc., Schaumburg, IL, USA); Scotchbond Universal (3M ESPE, St. Paul, MN, USA) | Nanohybrid composite (GrandioSO, Voco, Cuxhaven, Germany) |
| Luque-Martinez et al. [20] | 2014 | Brazil | Dentin µTBS | Interfacial nanoleakage | All-Bond Universal (Bisco Inc., Schaumburg, IL, USA); Prime&Bond Elect (Dentsply Caulk, Milford, DE, USA); Scotchbond Universal (3M ESPE, St. Paul, MN, USA) | Nanocomposite (Filtek Z350, 3M ESPE, St. Paul, MN, USA) |
| Muñoz et al. [18] | 2014 | Brazil | Dentin µTBS | Interfacial nanoleakage and degree of conversion | Scotchbond Universal (3M ESPE, St. Paul, MN, USA); All-Bond Universal (Bisco Inc., Schaumburg, IL, USA); G-Bond Plus (GC, Tokyo, Japan) | Nanocomposite (Filtek Z350, 3M ESPE, St. Paul, MN, USA) |
| Muñoz et al. [21] | 2014 | Brazil | Dentin µTBS | Interfacial nanoleakage | Scotchbond Universal (3M ESPE, St. Paul, MN, USA); All-Bond Universal (Bisco Inc., Schaumburg, IL, USA); Peak Universal Adhesive (Ultradent, South Jordan, UT, USA) | Microhybrid composite (Opallis, FGM, Joinville, SC, Brazil) |
| Perdigão et al. [24] | 2013 | USA | Dentin µTBS | Enamel µSBS and degree of conversion | G-Bond Plus (GC, Tokyo, Japan) | Nanocomposite (Filtek Z350, 3M ESPE, St. Paul, MN, USA) |
| Muñoz et al. [17] | 2013 | Brazil | Dentin µTBS | Interfacial nanoleakage and degree of conversion | Scotchbond Universal (3M ESPE, St. Paul, MN, USA); All-Bond Universal (Bisco Inc., Schaumburg, IL, USA); Peak Universal Adhesive (Ultradent, South Jordan, UT, USA) | Microhybrid composite (Opallis, FGM, Joinville, SC, Brazil) |
| Hanabusa et al. [22] | 2012 | Belgium | Dentin µTBS | Enamel µSBS and ultra-structural analysis TEM | G-Bond Plus (GC, Tokyo, Japan) | Microhybrid composite (Clearfil AP-X, Kuraray Noritake Dental Inc., Tokyo, Japan) |
| Perdigão et al. [19] | 2012 | USA | Dentin μTBS | Ultra-structural analysis | Scotchbond Universal (3M ESPE, St. Paul, MN, USA) | Microhybrid composite (Filtek Z250, 3M ESPE, St. Paul, MN, USA) |
| Eren et al. [23] | 2013 | Turkey | Dentin μTBS | Dentin µSBS and shear test | G-Bond Plus (GC, Tokyo, Japan) | Microhybrid composite (Venus, Heraeus Kulzer, Hanau, Germany) |
The predominant failure mode in the reviewed studies varied widely. The predominant failure mode was adhesive/mixed in 4 studies (40%) [17,18,21,24], adhesive in 3 studies (30%) [15,17,20], and mixed in 2 studies (20%) [15,16]. Moreover, all the authors clearly stated that the teeth were randomly selected. Furthermore, all the reviewed studies included a control group and were conducted on caries-free molars. The testing cross-head speed of the universal testing machine varied among the studies, as did the microtensile beam dimension. The majority of the studies (80%) used a cross-head speed of 0.5 mm/min [15,17,18,19,20,21,22,24]; however, 2 studies (20%) used a cross-head speed of 1 mm/min [16,22]. Six studies (60%) used beam dimensions of 0.8 × 0.8 mm [17,18,19,20,21,24], 2 studies (20%) used beam dimensions of 1 × 1 mm [15,22], 1 study (10%) [16] used beam dimensions of 0.9 × 0.9 mm, and another study (10%) [23] used sample dimensions of 0.7 × 0.7 mm. The examiner was blinded in only 3 studies (30%) [17,18,21].
Regarding the quality of the studies included, 8 presented a medium risk of bias, while 2 studies showed a low risk of bias. These results are presented in Table 3 according to the parameters considered in the analysis. The studies scored particularly poorly on the following items: description of the coefficient of variation, sample size calculation, and blinding of the examiner.
Table 3
Criteria used in quality assessment and the determination of risk of bias
| Study | Teeth randomization | Control group | Teeth free of caries | Samples with similar dimension | Evaluation of failure mode | Sample size calculation | Description of coefficient of variation | Universal testing machine cross-head speed | Blinding of the examiner | Risk of bias |
|---|---|---|---|---|---|---|---|---|---|---|
| Chen et al. [16] | Yes | Yes | Yes | 0.9 × 0.9 mm | Yes | No | No | 1 mm/min | No | Medium |
| Yes | Yes | |||||||||
| Wagner et al. [15] | Yes | Yes | Yes | 1 × 1 mm | Yes | No | No | 0.5 mm/min | No | Medium |
| Yes | Yes | |||||||||
| Luque-Martinez et al. [20] | Yes | Yes | Yes | 0.8 × 0.8 mm | Yes | No | No | 0.5 mm/min | No | Medium |
| Yes | Yes | |||||||||
| Muñoz et al. [18] | Yes | Yes | Yes | 0.8 × 0.8 mm | Yes | No | No | 0.5 mm/min | Yes | Low |
| Yes | Yes | |||||||||
| Muñoz et al. [21] | Yes | Yes | Yes | 0.8 × 0.8 mm | Yes | No | No | 0.5 mm/min | Yes | Low |
| Yes | Yes | |||||||||
| Perdigão et al. [24] | Yes | Yes | Yes | 0.8 × 0.8 mm | Yes | No | No | 0.5 mm/min | No | Medium |
| Yes | Yes | |||||||||
| Muñoz et al. [17] | Yes | Yes | Yes | 0.8 × 0.8 mm | Yes | No | No | 0.5 mm/min | Yes | Low |
| Yes | Yes | |||||||||
| Hanabusa et al. [22] | Yes | Yes | Yes | 1 × 1 mm | Yes | No | No | 1 mm/min | No | Medium |
| Yes | Yes | |||||||||
| Perdigão et al. [19] | Yes | Yes | Yes | 0.8 × 0.8 mm | Yes | No | No | 0.5 mm/min | No | Medium |
| Yes | Yes | |||||||||
| Eren et al. [23] | Yes | Yes | Yes | 0.7 × 0.7 mm | Yes | No | No | 0.5 mm/min | No | Medium |
| Yes | Yes |
The outcomes of the microtensile bond strength testing of the multi-mode adhesives used in the reviewed articles are shown in Table 4. After carefully reviewing the selected articles, it was found that 70% evaluated the microtensile bond strength of Scotchbond Universal in both etching modes; therefore, a meta-analysis was conducted. The meta-analysis was performed by combining all the data concerning the microtensile bond strength of Scotchbond Universal in both etching modes with the related number of teeth per group used in the corresponding study (Table 5). The results of the meta-analysis of the microtensile bond strength for Scotchbond Universal were 37.07 ± 2.12 MPa for the etch-and-rinse mode (Figure 2) and 35.81 ± 2.64 MPa for the self-etch mode (Figure 3). According to the statistical model presented by Borenstein et al. [25], there was no significant difference between the etching modes (Table 6).
Table 4
Dentin microtensile bond strength (µTBS) of Scotchbond Universal in both etching modes with the number of teeth per group used in the corresponding studies
| Study | Adhesive system and No. of teeth (per group) | Dentin µTBS (MPa) | |
|---|---|---|---|
| Etch-and-rinse | Self-etch | ||
| Chen et al. [16] | Scotchbond Universal | 55.7 ± 10.7 | 59.9 ± 11.8 |
| 200 (10) | |||
| Wagner et al. [15] | Scotchbond Universal | 49.1 ± 11.1 | 44.0 ± 21.9 |
| 72 (12) | |||
| Luque-Martinez et al. [20] | Scotchbond Universal | 36.2 ± 3.3 | 32.3 ± 4.8 |
| 140 (7) | |||
| Muñoz et al. [18] | Scotchbond Universal | 32.3 ± 3.7 | 34.7 ± 5.8 |
| 60 (5) | |||
| Muñoz et al. [21] | Scotchbond Universal | 34.7 ± 4.6 | 33.3 ± 3.2 |
| 40 (5) | |||
| Muñoz et al. [17] | Scotchbond Universal | 35.1 ± 6.6 | 32.4 ± 4.5 |
| 40 (5) | |||
| Perdigão et al. [19] | Scotchbond Universal | 54.0 ± 18.8 | 54.4 ± 18.8 |
| 36 (6) | |||
Table 5
Dentin microtensile bond strength (µTBS) of different universal adhesives used in the included studies
| Study | Adhesive system | Dentin µTBS (MPa) | |
|---|---|---|---|
| Etch-and-rinse | Self-etch | ||
| Chen et al. [16] | Prime&Bond Elect | 57.8 ± 9.1 | 56.3 ± 10.2 |
| Scotchbond Universal | 55.7 ± 10.7 | 59.9 ± 11.8 | |
| All-Bond Universal | 54.6 ± 8.3 | 50.1 ± 6.8 | |
| Clearfil Universal Bond | 49.1 ± 4.2 | 48.0 ± 7.4 | |
| Futurabond Universal | 46.5 ± 7.2 | 48.2 ± 9.7 | |
| Wagner et al. [15] | Futurabond Universal | 41.2 ± 10.7 | 37.9 ± 14.0 |
| All-Bond Universal | 44.8 ± 10.8 | 52.6 ± 12.7 | |
| Scotchbond Universal | 49.1 ± 11.1 | 44.0 ± 21.9 | |
| Luque-Martinez et al. [20] | All-Bond Universal | 40.8 ± 5.0 | 22.0 ± 5.1 |
| Prime&Bond Elect | 16.8 ± 2.4 | 18.9 ± 2.6 | |
| Scotchbond Universal | 36.2 ± 3.3 | 32.3 ± 4.8 | |
| Muñoz et al. [18] | Scotchbond Universal | 32.3 ± 3.7 | 34.7 ± 5.8 |
| All-Bond Universal | 40.8 ± 5.0 | 22.0 ± 5.1 | |
| G-Bond Plus | 20.5 ± 3.2 | 11.5 ± 3.3 | |
| Muñoz et al. [21] | All-Bond Universal | 38.5 ± 4.0 | 20.9 ± 4.1 |
| Scotchbond Universal | 34.7 ± 4.6 | 33.3 ± 3.2 | |
| Peak Universal Adhesive | 44.3 ± 1.6 | 39.5 ± 5.1 | |
| Perdigão et al. [24] | G-Bond Plus | 19.1 ± 0.7 | 13.4 ± 1.3 |
| Muñoz et al. [17] | Peak Universal Adhesive | 43.6 ± 4.6 | 39.9 ± 4.5 |
| Scotchbond Universal | 35.1 ± 6.6 | 32.4 ± 4.5 | |
| All-Bond Universal | 39.3 ± 3.7 | 13.4 ± 1.9 | |
| Hanabusa et al. [22] | G-Bond Plus | 29.4 ± 8.2 | 30.5 ± 7.6 |
| Perdigão et al. [19] | Scotchbond Universal | 54.0 ± 18.8 | 54.4 ± 18.8 |
| Eren et al. [23] | G-Bond Plus | - | 26.4 ± 8.0 |
Figure 2
Results of the meta-analysis of microtensile bond strength for Scotchbond Universal in etch-and-rinse mode.
CI, confidence interval.
Figure 3
Results of the meta-analysis of microtensile bond strength for Scotchbond Universal in self-etch mode.
CI, confidence interval.
Table 6
Comparison of microtensile bond strength (µTBS) values obtained using the etch-and-rinse and self-etch modes
| Adhesive strategy | No. of studies | µTBS (MPa) |
|---|---|---|
| Etch-and-rinse mode | 7 | 37.07 ± 2.12 |
| Self-etch mode | 7 | 35.81 ± 2.64 |
Risk of bias was evaluated according to the following parameters: randomization, blinding of the examiner, the presence of a control group, samples with similar dimensions, cross-head speed, evaluation of the failure mode, analysis by a single observer, description of the coefficient of variation, and sample size calculation. If the authors reported the parameter, the article received a ‘Yes’ for that parameter; if it was not possible to find the information, the article received a ‘No’. Articles that reported one to 3 items were classified as having a high risk of bias, those that reported 4 or 5 items were considered to have a medium risk of bias, and those that reported 6 to 8 items were classified as having a low risk of bias (Table 3).
DISCUSSION
Systematic reviews are a useful tool for clinical practitioners, as they provide accurate evidence-based answers to relevant questions in light of the best available scientific knowledge. Furthermore, systematic reviews can recommend new standardized research protocols and methodologies [26,27].
The outcomes of laboratory studies that evaluate the bonding of multi-mode adhesives to dentin are highly dependent on the dentin surface treatment protocol. The majority of new adhesive systems exhibit the versatility of being able to be used in both the etch-and-rinse and self-etch modes; however, the variation in the results may be attributed to the difference in chemical composition among these adhesives. Perdigão et al. [19] reported the presence of MDP in the composition of the multi-mode adhesive Scotchbond Universal (3M ESPE), which can bond chemically to dentin by the formation of stable nanolayer coats around dentinal hydroxyapatites [28,29].
Scotchbond Universal also contains polyalkenoic acid copolymer (PAC; Vitrebond copolymer), which in combination with MDP enhances the bonding to dentin in comparison to corresponding PAC-free adhesives. In contrast, Muñoz et al. [17] reported that PAC might compete with the MDP monomer for calcium-binding sites in hydroxyapatite crystals, and due to its high molecular weight, could even prevent monomer approximation during polymerization, harming the chemical bond of MDP to dentin and adversely affecting bond strength. Moreover, it was demonstrated that 2-hydroxyethyl methacrylate competed with MDP by binding to the calcium of hydroxyapatite, decreasing the bond strength to dentin [30,31]. The majority of the included studies utilized the Scotchbond Universal (3M ESPE) multi-mode adhesive system. Therefore, it was beneficial to conduct a meta-analysis of these studies. The meta-analysis revealed no significant differences in the microtensile bond strength of Scotchbond multi-mode adhesive between the surface treatment modes.
Theoretically, in the etch-and-rinse mode, the phosphoric acid etching of dentin results in superficial dentin demineralization and total removal of the smear layer, consequently leading to the exposure of dentinal collagen fibrils and promoting the impregnation of monomers [32,33]. Many authors have explained the positive results that they obtained from laboratory bond testing within this theoretical framework. However, Pashley et al. [33] showed that the etching procedure reduced the amount of calcium and phosphate ions, as the hydroxyapatite crystals were nearly totally removed after the etching process, which may adversely affect the chemical bonding of MDP to hydroxyapatites.
Recently, it was found that the bonding of multi-mode adhesives to dentin in the etch-and-rinse mode relies on the infiltration of resin into exposed collagen fibril scaffolds, in a process known as ‘micro-mechanical interlocking.’ Furthermore, a true chemical bond was found to have formed due to the presence of functional monomer groups (MDP). This functional group has weak bonding affinity to hydroxyapatite-depleted collagen (etched dentin). This might explain the relatively low bond strength of multi-mode adhesives to dentin when used in the etch-and-rinse mode. Despite the presence of long funnel-shaped resin tags in the etch-and-rinse mode, recent studies showed that these resin tags did not contribute significantly to tensile bond strength [34,35].
In contrast, in the self-etch mode, the acidulated monomers simultaneously condition and prime the dentin surface by dissolving the smear layer, with a minimal adverse effect on dentinal calcium and phosphate levels. This might promote chemical interactions of hydroxyapatite crystals with the functional groups of MDP monomers, enhancing the chemical bond between the adhesive and the dentin substrate. However, the amount of resin impregnation during micro-mechanical interlocking in the self-etch mode was affected by the production of a hybrid layer that was thinner than that produced by the etch-and-rinse mode [36]. Moreover, Peumans et al. [37] reported that the thickness of the hybrid layer did not have a major influence on bonding to dentin.
Some variation was observed among the reviewed studies, particularly in the cross-head speed of the universal testing machine and the dimensions of the beams for microtensile bond strength tests. These variations in the methodological setup may have a major influence on the distribution of stresses along the resin/dentin interface. Despite these variations, the loading rate did not significantly influence the bond strength values due to the reduced dimensions of the specimens and the homogeneity of the adhesive interface. Sano et al. [14] reported that the tensile bond strength was inversely related to the surface area of the bonded interface. They attributed this phenomenon to the development of defects and/or stress raisers at the interface [14].
Evaluating the fracture pattern helps to explain the variation in bond strength across different multi-mode adhesive systems. Nevertheless, the results regarding failure patterns in the reviewed studies showed extensive variation, but the adhesive/mixed failure pattern was still the predominant failure mode in the plurality of the studies. Mixed failure was common when microtensile tests were performed under higher testing speeds. In the laboratory studies of Chen et al. [16] and Hanabusa et al. [22], increasing the cross-head speed from 0.5 to 1.0 mm/min resulted in a high frequency of mixed failure. Perdigão et al. [19] and Wagner et al. [15] concluded that adhesive failure patterns were associated with high bond strength values. It is well known that self-etch adhesives exhibit lower bond strength than etch-and-rinse adhesives; however, according the results of this evidence-based review, it seems that the MDP group enhances the bonding of self-etch adhesives to dentin.
Furthermore, most of the studies showed a medium risk of bias. Accordingly, it would be too difficult to control for all the variables that may have influenced the outcomes of the studies.
CONCLUSIONS
Although the reviewed studies showed great variability, sufficient scientific evidence was found to support the hypothesis that the bonding of multi-mode adhesives to dentin does not significantly vary depending on whether the etch-and-rinse or self-etch mode is used.
-
Conflict of Interest: No potential conflict of interest relevant to this article was reported.
-
Author Contributions:
Conceptualization: Hamama HHH, Mahmoud SH.
Data curation: Elkaffas AA, Hamama HHH, Mahmoud SH.
Funding acquisition: Elkaffas AA, Hamama HHH, Mahmoud SH.
Investigation: Elkaffas AA, Hamama HHH, Mahmoud SH.
Methodology: Elkaffas AA, Hamama HHH, Mahmoud SH.
Project administration: Hamama HHH, Mahmoud SH.
Resources: Elkaffas AA, Hamama HHH, Mahmoud SH.
Supervision: Hamama HHH, Mahmoud SH.
Validation: Hamama HHH, Mahmoud SH.
Visualization: Elkaffas AA.
Writing - original draft: Elkaffas AA.
Writing - review & editing: Hamama HHH, Mahmoud SH.
-
Conference meetings: The preliminary results of this study were presented at the International Association for Dental Research (IADR) general meeting held in South Korea (June 2016).
- 1. Richards D, Lawrence A. Evidence based dentistry. Br Dent J 1995;179:270-273.ArticlePubMedPDF
- 2. Forrest JL. Evidence-based decision making: a translational guide for dental professionals. Philadelphia (PA): Wolters Kluwer Health/Lippincott Williams & Wilkins; 2009.
- 3. Toledano M, Osorio R, Moreira MA, Cabrerizo-Vilchez MA, Gea P, Tay FR, Pashley DH. Effect of the hydration status of the smear layer on the wettability and bond strength of a self-etching primer to dentin. Am J Dent 2004;17:310-314.PubMed
- 4. Van Meerbeek B, De Munck J, Yoshida Y, Inoue S, Vargas M, Vijay P, Van Landuyt K, Lambrechts P, Vanherle G. Buonocore memorial lecture. Adhesion to enamel and dentin: current status and future challenges. Oper Dent 2003;28:215-235.PubMed
- 5. In: Hilton TJ, Ferracane JL, Broome JC, editors. Summitt's fundamentals of operative dentistry: a contemporary approach. Hanover Park (IL): Quintessence Publishing Company Incorporated; 2013.
- 6. Lopes GC, Vieira LC, Monteiro S Jr, Caldeira de Andrada MA, Baratieri CM. Dentin bonding: effect of degree of mineralization and acid etching time. Oper Dent 2003;28:429-439.PubMed
- 7. Wang T, Nikaido T, Nakabayashi N. Photocure bonding agent containing phosphoric methacrylate. Dent Mater 1991;7:59-62.PubMed
- 8. Van Landuyt KL, Yoshida Y, Hirata I, Snauwaert J, De Munck J, Okazaki M, Suzuki K, Lambrechts P, Van Meerbeek B. Influence of the chemical structure of functional monomers on their adhesive performance. J Dent Res 2008;87:757-761.ArticlePubMedPDF
- 9. Carvalho RM, Pegoraro TA, Tay FR, Pegoraro LF, Silva NR, Pashley DH. Adhesive permeability affects coupling of resin cements that utilise self-etching primers to dentine. J Dent 2004;32:55-65.ArticlePubMed
- 10. Yoshihara K, Yoshida Y, Hayakawa S, Nagaoka N, Irie M, Ogawa T, Van Landuyt KL, Osaka A, Suzuki K, Minagi S, Van Meerbeek B. Nanolayering of phosphoric acid ester monomer on enamel and dentin. Acta Biomater 2011;7:3187-3195.ArticlePubMed
- 11. Yoshida Y, Yoshihara K, Nagaoka N, Hayakawa S, Torii Y, Ogawa T, Osaka A, Meerbeek BV. Self-assembled nano-layering at the adhesive interface. J Dent Res 2012;91:376-381.ArticlePubMedPDF
- 12. Fujisawa S, Kadoma Y, Komoda Y. Hemolysis mechanism of dental adhesive monomer (methacryloyloxydecyl dihydrogen phosphate) using a phosphatidylcholine liposome system as a model for biomembranes. Dent Mater J 1990;9:136-146.ArticlePubMed
- 13. Fukegawa D, Hayakawa S, Yoshida Y, Suzuki K, Osaka A, Van Meerbeek B. Chemical interaction of phosphoric acid ester with hydroxyapatite. J Dent Res 2006;85:941-944.ArticlePubMedPDF
- 14. Sano H, Shono T, Sonoda H, Takatsu T, Ciucchi B, Carvalho R, Pashley DH. Relationship between surface area for adhesion and tensile bond strength--evaluation of a micro-tensile bond test. Dent Mater 1994;10:236-240.ArticlePubMed
- 15. Wagner A, Wendler M, Petschelt A, Belli R, Lohbauer U. Bonding performance of universal adhesives in different etching modes. J Dent 2014;42:800-807.ArticlePubMed
- 16. Chen C, Niu LN, Xie H, Zhang ZY, Zhou LQ, Jiao K, Chen JH, Pashley DH, Tay FR. Bonding of universal adhesives to dentine--old wine in new bottles? J Dent 2015;43:525-536.ArticlePubMed
- 17. Muñoz MA, Luque-Martinez I, Malaquias P, Hass V, Reis A, Campanha NH, Loguercio AD. In vitro longevity of bonding properties of universal adhesives to dentin. Oper Dent 2015;40:282-292.ArticlePubMedPDF
- 18. Muñoz MA, Sezinando A, Luque-Martinez I, Szesz AL, Reis A, Loguercio AD, Bombarda NH, Perdigão J. Influence of a hydrophobic resin coating on the bonding efficacy of three universal adhesives. J Dent 2014;42:595-602.ArticlePubMed
- 19. Perdigão J, Sezinando A, Monteiro PC. Laboratory bonding ability of a multi-purpose dentin adhesive. Am J Dent 2012;25:153-158.PubMed
- 20. Luque-Martinez IV, Perdigão J, Muñoz MA, Sezinando A, Reis A, Loguercio AD. Effects of solvent evaporation time on immediate adhesive properties of universal adhesives to dentin. Dent Mater 2014;30:1126-1135.ArticlePubMed
- 21. Muñoz MA, Luque I, Hass V, Reis A, Loguercio AD, Bombarda NH. Immediate bonding properties of universal adhesives to dentine. J Dent 2013;41:404-411.ArticlePubMed
- 22. Hanabusa M, Mine A, Kuboki T, Momoi Y, Van Ende A, Van Meerbeek B, De Munck J. Bonding effectiveness of a new ‘multi-mode’ adhesive to enamel and dentine. J Dent 2012;40:475-484.ArticlePubMed
- 23. Eren D, Bektaş ÖÖ, Siso SH. Three different adhesive systems; three different bond strength test methods. Acta Odontol Scand 2013;71:978-983.ArticlePubMed
- 24. Perdigão J, Muñoz MA, Sezinando A, Luque-Martinez IV, Staichak R, Reis A, Loguercio AD. Immediate adhesive properties to dentin and enamel of a universal adhesive associated with a hydrophobic resin coat. Oper Dent 2014;39:489-499.ArticlePubMedPDF
- 25. Borenstein M, Hedges L, Higgins J, Rothstein H. Introduction to meta-analysis. Chichester (UK): John Wiley & Sons; 2009.
- 26. Greenhalgh T. Papers that summarise other papers (systematic reviews and meta-analyses). BMJ 1997;315:672-675.ArticlePubMedPMC
- 27. Linde K, Willich SN. How objective are systematic reviews? Differences between reviews on complementary medicine. J R Soc Med 2003;96:17-22.ArticlePubMedPMC
- 28. Reis A, Leite TM, Matte K, Michels R, Amaral RC, Geraldeli S, Loguercio AD. Improving clinical retention of one-step self-etching adhesive systems with an additional hydrophobic adhesive layer. J Am Dent Assoc 2009;140:877-885.ArticlePubMed
- 29. Waidyasekera K, Nikaido T, Weerasinghe DS, Ichinose S, Tagami J. Reinforcement of dentin in self-etch adhesive technology: a new concept. J Dent 2009;37:604-609.ArticlePubMed
- 30. Yoshihara K, Yoshida Y, Nagaoka N, Fukegawa D, Hayakawa S, Mine A, Nakamura M, Minagi S, Osaka A, Suzuki K, Van Meerbeek B. Nano-controlled molecular interaction at adhesive interfaces for hard tissue reconstruction. Acta Biomater 2010;6:3573-3582.ArticlePubMed
- 31. Turp V, Sen D, Tuncelli B, Özcan M. Adhesion of 10-MDP containing resin cements to dentin with and without the etch-and-rinse technique. J Adv Prosthodont 2013;5:226-233.ArticlePubMedPMC
- 32. Van Meerbeek B, Yoshihara K, Yoshida Y, Mine A, De Munck J, Van Landuyt KL. State of the art of self-etch adhesives. Dent Mater 2011;27:17-28.ArticlePubMed
- 33. Pashley DH, Tay FR, Breschi L, Tjäderhane L, Carvalho RM, Carrilho M, Tezvergil-Mutluay A. State of the art etch-and-rinse adhesives. Dent Mater 2011;27:1-16.ArticlePubMed
- 34. De Munck J, Van Landuyt K, Peumans M, Poitevin A, Lambrechts P, Braem M, Van Meerbeek B. A critical review of the durability of adhesion to tooth tissue: methods and results. J Dent Res 2005;84:118-132.ArticlePubMedPDF
- 35. Taschner M, Nato F, Mazzoni A, Frankenberger R, Falconi M, Petschelt A, Breschi L. Influence of preliminary etching on the stability of bonds created by one-step self-etch bonding systems. Eur J Oral Sci 2012;120:239-248.ArticlePubMed
- 36. Chersoni S, Suppa P, Grandini S, Goracci C, Monticelli F, Yiu C, Huang C, Prati C, Breschi L, Ferrari M, Pashley DH, Tay FR. In vivo and in vitro permeability of one-step self-etch adhesives. J Dent Res 2004;83:459-464.ArticlePubMedPDF
- 37. Peumans M, De Munck J, Van Landuyt K, Van Meerbeek B. Thirteen-year randomized controlled clinical trial of a two-step self-etch adhesive in non-carious cervical lesions. Dent Mater 2015;31:308-314.ArticlePubMed
- 38. Hamama HH, Yiu CK, Burrow MF, King NM. Systematic review and meta-analysis of randomized clinical trials on chemomechanical caries removal. Oper Dent 2015;40:E167-E178.ArticlePubMedPDF
REFERENCES
Tables & Figures
REFERENCES
Citations
Citations to this article as recorded by 
- Influence of Proximal-Cervical Undermined Enamel Areas on Marginal Quality and Enamel Integrity of Laboratory and CAD/CAM Ceramic Inlays and Partial Crowns
Roland Frankenberger, Katharina Friedrich, Marie-Christine Dudek, Julia Winter, Norbert Krämer, Matthias J. Roggendorf
Journal of Functional Biomaterials.2025; 16(3): 82. CrossRef - Improving Bonding Protocols: The Effect of Selective Dentin Etching with Two Different Universal Adhesives—An In Vitro Study
Sandro Ferreira, Tiago Rodrigues, Mariana Nunes, Ana Mano Azul, José João Mendes, Ana Filipa Chasqueira, Joana Costa
Polymers.2025; 17(9): 1215. CrossRef - Effect of surface treatment on glass ionomers in sandwich restorations: a systematic review and meta-analysis of laboratory studies
Hoda S. Ismail, Ashraf Ibrahim Ali, Franklin Garcia-Godoy
Restorative Dentistry & Endodontics.2025; 50(2): e13. CrossRef - Wet vs. Dry Dentin Bonding: A Systematic Review and Meta-Analysis of Adhesive Performance and Hybrid Layer Integrity
Mircea Popescu, Mădălina Malița, Andrei Vorovenci, Andreea Angela Ștețiu, Viorel Ștefan Perieanu, Radu Cătălin Costea, Mihai David, Raluca Mariana Costea, Maria Antonia Ștețiu, Andi Ciprian Drăguș, Cristina Maria Șerbănescu, Andrei Burlibașa, Oana Eftene,
Oral.2025; 5(3): 63. CrossRef - The Effect of Different Multimode Adhesives On Microleakage of Class V Composite Restorations in Three Etching Modes
Fatma Yılmaz, Sevgi Kurşun, Zeliha Öztürk
ADO Klinik Bilimler Dergisi.2025; 14(3): 177. CrossRef - Tooth-composite bond failure with a universal and an etch-and-rinse adhesive depending on mode and frequency of application
Ellen Schulz-Kornas, Mathilde Tittel, Hartmut Schneider, Maximilian Bemmann, Marco Pellino, Tobias Meissner, Florian Fuchs, Christian Hannig, Florian Tetschke, Kyung-Jin Park, Michaela Strumpski, Rainer Haak
Dental Materials.2024; 40(2): 359. CrossRef - Comparison of postoperative hypersensitivity between Total-etch and Universal adhesive system: a randomized clinical trial
Kiran Javed, Nouman Noor, Muhammad Zubair Nasir, Manzoor Ahmed Manzoor
Scientific Reports.2024;[Epub] CrossRef - Adhesion and sealing of different universal adhesive systems associated with bulk‐fill resins after using endodontic irrigation solutions: An in vitro study
Érika Mayumi Omoto, Anderson Catelan, Paulo Henrique dos Santos, Luciano Tavares Angelo Cintra, Fernanda de Souza e Silva Ramos, Caio César Pavani, André Luiz Fraga Briso, Ticiane Cestari Fagundes
Australian Endodontic Journal.2024; 50(2): 309. CrossRef - Evaluation of the effects of combined application of dimethylaminohexadecyl methacrylate and MDP on dentin bonding and antimicrobial properties
Jiadi Shen, Ming Ma, Yun Huang, Haochen Miao, Xin Wei
Journal of Materials Science.2023; 58(31): 12685. CrossRef - Efficacy of adhesive strategies for restorative dentistry: A systematic review and network meta-analysis of double-blind randomized controlled trials over 12 months of follow-up
Kevin Sheng-Kai Ma, Li-Tzu Wang, Markus B. Blatz
Journal of Prosthodontic Research.2023; 67(1): 35. CrossRef - Impact of Preceded Tumor Therapeutic Irradiation on the Microtensile Bond Strength of Universal Adhesives Applied in Self-Etch Mode to Human Dentin In Vitro
Sina Broscheit, Dirk Vordermark, Reinhard Gerlach, Christian Ralf Gernhardt
Applied Sciences.2023; 13(13): 7873. CrossRef - Effect of the Adhesive Strategy on Clinical Performance and Marginal Integrity of a Universal Adhesive in Non-Carious Cervical Lesions in a Randomized 36-Month Study
Rainer Haak, Gesa Stache, Hartmut Schneider, Matthias Häfer, Gerhard Schmalz, Ellen Schulz-Kornas
Journal of Clinical Medicine.2023; 12(18): 5776. CrossRef - Universal Adhesives in Clinical Dentistry
Fusun Ozer, Shilpa Patnaikuni
Science, Art and Religion.2023; 2(1--2): 6. CrossRef - Deep proximal margin rebuilding with direct esthetic restorations: a systematic review of marginal adaptation and bond strength
Hoda S. Ismail, Ashraf I. Ali, Rabab El. Mehesen, Jelena Juloski, Franklin Garcia-Godoy, Salah H. Mahmoud
Restorative Dentistry & Endodontics.2022;[Epub] CrossRef - Improving Properties of an Experimental Universal Adhesive by Adding a Multifunctional Dendrimer (G-IEMA): Bond Strength and Nanoleakage Evaluation
Joana Vasconcelos e Cruz, António H. S. Delgado, Samuel Félix, José Brito, Luísa Gonçalves, Mário Polido
Polymers.2022; 14(7): 1462. CrossRef - Scoping review of trials evaluating adhesive strategies in pediatric dentistry: where do simplified strategies lie?
António H. S. Delgado, Hasan Jamal, Anne Young, Paul Ashley
BMC Oral Health.2021;[Epub] CrossRef - Does acid etching prior to applying universal adhesives affect the bond strength of glass fiber post to root dentin?
Helder Callegaro Velho, Eduardo Trindade Dalence, Pablo Soares Machado, Marília Pivetta Rippe, Jovito Adiel Skupien, Vinícius Felipe Wandscher
International Journal of Adhesion and Adhesives.2021; 105: 102795. CrossRef - Does Adhesive Layer Thickness and Tag Length Influence Short/Long-Term Bond Strength of Universal Adhesive Systems? An In-Vitro Study
Naji Kharouf, Tarek Ashi, Ammar Eid, Levi Maguina, Jihed Zghal, Nairy Sekayan, Rim Bourgi, Louis Hardan, Salvatore Sauro, Youssef Haikel, Davide Mancino
Applied Sciences.2021; 11(6): 2635. CrossRef - Chronological history and current advancements of dental adhesive systems development: a narrative review
Maicon Sebold, Carolina Bosso André, Beatriz Ometto Sahadi, Lorenzo Breschi, Marcelo Giannini
Journal of Adhesion Science and Technology.2021; 35(18): 1941. CrossRef - Laboratory methods for measuring adhesive bond strength between restoration materials and hard tooth tissues
I.Ya. Poyurovskaya, A.P. Polikarpova, F.S. Rusanov
Stomatologiya.2021; 100(5): 88. CrossRef - Effect of Curcumin Suspension and Vitamin C on Dentin Shear Bond Strength and Durability. A Pilot Study
Dalia A. Abuelenain, Ensanya A. Abou Neel, Tariq S. Abuhaimed, Amal M. Alamri, Hanan S. Ammar, Sahar M. N. Bukhary
The Open Dentistry Journal.2021; 15(1): 540. CrossRef - Effect of 9.3 μm CO2 and 2.94 μm Er:YAG Laser vs. Bur Preparations on Marginal Adaptation in Enamel and Dentin of Mixed Class V Cavities Restored With Different Restorative Systems
Clara Isabel Anton y Otero, Enrico Di Bella, Ivo Krejci, Tissiana Bortolotto
Frontiers in Dental Medicine.2021;[Epub] CrossRef - Adhesion strategy and curing mode of a universal adhesive influence the bonding of dual-cured core build-up resin composite to dentin
Ahmed Eid Elsayed, Mohamed Amr Kamel, Farid Sabry El-Askary
Journal of Adhesion Science and Technology.2021; 35(1): 52. CrossRef - Influence of etching mode and composite resin type on bond strength to dentin using universal adhesive system
Stefan Dačić, Milan Miljković, Aleksandar Mitić, Goran Radenković, Marija Anđelković‐Apostolović, Milica Jovanović
Microscopy Research and Technique.2021; 84(6): 1212. CrossRef - Universal adhesives - a new direction in the development of adhesive systems
A. Tichý, K. Hosaka, J. Tagami
Česká stomatologie a praktické zubní lékařství.2020; 120(1): 4. CrossRef - Effect of Over-Etching and Prolonged Application Time of a Universal Adhesive on Dentin Bond Strength
Phoebe Burrer, Hoang Dang, Matej Par, Thomas Attin, Tobias T. Tauböck
Polymers.2020; 12(12): 2902. CrossRef - Profile of a 10-MDP-based universal adhesive system associated with chlorhexidine: Dentin bond strength and in situ zymography performance
Marina Ciccone Giacomini, Polliana Mendes Candia Scaffa, Rafael Simões Gonçalves, Giovanna Speranza Zabeu, Cristina de Mattos Pimenta Vidal, Marcela Rocha de Oliveira Carrilho, Heitor Marques Honório, Linda Wang
Journal of the Mechanical Behavior of Biomedical Materials.2020; 110: 103925. CrossRef - Universal dental adhesives: Current status, laboratory testing, and clinical performance
Sanket Nagarkar, Nicole Theis‐Mahon, Jorge Perdigão
Journal of Biomedical Materials Research Part B: Applied Biomaterials.2019; 107(6): 2121. CrossRef - Modifying Adhesive Materials to Improve the Longevity of Resinous Restorations
Wen Zhou, Shiyu Liu, Xuedong Zhou, Matthias Hannig, Stefan Rupf, Jin Feng, Xian Peng, Lei Cheng
International Journal of Molecular Sciences.2019; 20(3): 723. CrossRef
ePub Link
Cite
XML DownloadDo universal adhesives promote bonding to dentin? A systematic review and meta-analysis
Figure 1 Flowchart of the study selection procedure.
Figure 2 Results of the meta-analysis of microtensile bond strength for Scotchbond Universal in etch-and-rinse mode.CI, confidence interval.
Figure 3 Results of the meta-analysis of microtensile bond strength for Scotchbond Universal in self-etch mode.CI, confidence interval.
Figure 1
Figure 2
Figure 3
Do universal adhesives promote bonding to dentin? A systematic review and meta-analysis
Summary of the studies included in this systematic review
| Study | Predominant failure mode | No. of teeth (per group) | Objective | Conclusion |
|---|---|---|---|---|
| Chen et al. [ | Mixed | 200 (10) | To examine the short-term in vitro performance of 5 universal adhesives bonded to human coronal dentin | The increase in the versatility of universal adhesives was not accompanied by technological advances for overcoming the challenges associated with previous generations of adhesives. |
| Wagner et al. [ | Adhesive | 72 (12) | To compare the µTBS and resin penetration into dentin of 3 universal adhesives applied in 2 different etching modes | Application of an etching step prior to applying universal adhesives improved their dentin penetration, but did not affect bond strength to dentin. |
| Luque-Martinez et al. [ | Adhesive | 140 (7) | To evaluate the µTBS and nanoleakage of 3 universal adhesives, applied with increasing solvent evaporation time | An extended solvent evaporation time may improve the bonding effectiveness for specific universal adhesives depending on the adhesive strategy used. |
| Muñoz et al. [ | Adhesive/mixed | 60 (5) | To evaluate the effect of an additional hydrophobic resin coating on the µTBS, nanoleakage, and degree of conversion of 3 universal adhesives | The use of an additional hydrophobic resin coating improved the adhesive performance in terms of resin-dentin bond strengths of new universal adhesives when used with the self-etch strategy. The additional hydrophobic resin coating also improved the degree of conversion for both the etch-and-rinse and the self-etch strategies. |
| Muñoz et al. [ | Adhesive/mixed | 40 (5) | To evaluate the µTBS and nanoleakage of universal adhesives that did or did not contain MDP applied in 2 different etching modes | Universal adhesives that contained MDP showed higher and more stable µTBS with reduced nanoleakage at the interfaces after 6 months of water storage. |
| Perdigão et al. [ | Adhesive/mixed | 60 (5) | To evaluate the effect of acid etching and application of a hydrophobic resin coat on the enamel/dentin bond strengths and degree of conversion of a universal adhesive system | The use of a hydrophobic resin coat may be beneficial for the selective enamel etching technique, because it improved bond strengths to enamel when applied with the etch-and-rinse strategy and to dentin when used with the self-etch adhesion strategy. |
| Muñoz et al. [ | Adhesive/mixed | 40 (5) | To evaluate µTBS, nanoleakage, and degree of conversion of universal simplified adhesive systems | This new category of universal adhesives used on dentin was inferior as regards at least one of the properties evaluated compared to the control adhesives. |
| Hanabusa et al. [ | Mixed | 25 (5) | To test whether a new one-step adhesive could be applied in a multi-mode manner, either ‘full’ or ‘selective,’ self-etch, and etch-and-rinse approaches | Phosphoric-acid etching definitely improved bonding of the one-step self-etch adhesive to enamel, so one should be more careful with additional phosphoric-acid etching of dentin. Although the bond strength was not reduced, the resultant adhesive interface appeared ultra-structurally more vulnerable to biodegradation. |
| Perdigão et al. [ | Adhesive | 36 (6) | To evaluate the laboratory dentin and enamel µTBS and ultra-morphology of a new multi-purpose adhesive | This new category of universal adhesives used on dentin was superior as regards to the properties evaluated compared to the control adhesives. |
| Eren et al. [ | - | 75 (15-15-45) | To evaluate the microtensile, microshear, and shear bond strength test methods to assess the bond strength of 2 self-etch adhesives and one etch-and-rinse adhesive on dentin | Bond strength to dentin depended on the material and the test method used. |
µTBS, microtensile bond strength; MDP, methacryloyloxydecyl dihydrogen phosphate.
Testing methods and materials used in the included studies
| Study | Year | Country | Primary testing method | Secondary testing method | Universal adhesives used | Type of composite |
|---|---|---|---|---|---|---|
| Chen et al. [ | 2015 | China | Dentin µTBS | TEM of resin-dentin interface | Prime&Bond Elect (Dentsply Caulk, Milford, DE, USA); Scotchbond Universal (3M ESPE, St. Paul, MN, USA), All-Bond Universal (Bisco Inc., Schaumburg, IL, USA); Futurabond U (Voco, Cuxhaven, Germany); Clearfil Universal Bond (Kuraray Noritake Dental Inc., Tokyo, Japan) | Microhybrid composite (TPH Spectra, Dentsply Caulk, Milford, DE, USA) |
| SEM of tracer-infused water rich zone | ||||||
| Wagner et al. [ | 2014 | Germany | Dentin µTBS | Semi-quantitative analysis of penetration depth by confocal light scanning microscopy | Futurabond U (Voco, Cuxhaven, Germany); All-Bond Universal Bisco Inc., Schaumburg, IL, USA); Scotchbond Universal (3M ESPE, St. Paul, MN, USA) | Nanohybrid composite (GrandioSO, Voco, Cuxhaven, Germany) |
| Luque-Martinez et al. [ | 2014 | Brazil | Dentin µTBS | Interfacial nanoleakage | All-Bond Universal (Bisco Inc., Schaumburg, IL, USA); Prime&Bond Elect (Dentsply Caulk, Milford, DE, USA); Scotchbond Universal (3M ESPE, St. Paul, MN, USA) | Nanocomposite (Filtek Z350, 3M ESPE, St. Paul, MN, USA) |
| Muñoz et al. [ | 2014 | Brazil | Dentin µTBS | Interfacial nanoleakage and degree of conversion | Scotchbond Universal (3M ESPE, St. Paul, MN, USA); All-Bond Universal (Bisco Inc., Schaumburg, IL, USA); G-Bond Plus (GC, Tokyo, Japan) | Nanocomposite (Filtek Z350, 3M ESPE, St. Paul, MN, USA) |
| Muñoz et al. [ | 2014 | Brazil | Dentin µTBS | Interfacial nanoleakage | Scotchbond Universal (3M ESPE, St. Paul, MN, USA); All-Bond Universal (Bisco Inc., Schaumburg, IL, USA); Peak Universal Adhesive (Ultradent, South Jordan, UT, USA) | Microhybrid composite (Opallis, FGM, Joinville, SC, Brazil) |
| Perdigão et al. [ | 2013 | USA | Dentin µTBS | Enamel µSBS and degree of conversion | G-Bond Plus (GC, Tokyo, Japan) | Nanocomposite (Filtek Z350, 3M ESPE, St. Paul, MN, USA) |
| Muñoz et al. [ | 2013 | Brazil | Dentin µTBS | Interfacial nanoleakage and degree of conversion | Scotchbond Universal (3M ESPE, St. Paul, MN, USA); All-Bond Universal (Bisco Inc., Schaumburg, IL, USA); Peak Universal Adhesive (Ultradent, South Jordan, UT, USA) | Microhybrid composite (Opallis, FGM, Joinville, SC, Brazil) |
| Hanabusa et al. [ | 2012 | Belgium | Dentin µTBS | Enamel µSBS and ultra-structural analysis TEM | G-Bond Plus (GC, Tokyo, Japan) | Microhybrid composite (Clearfil AP-X, Kuraray Noritake Dental Inc., Tokyo, Japan) |
| Perdigão et al. [ | 2012 | USA | Dentin μTBS | Ultra-structural analysis | Scotchbond Universal (3M ESPE, St. Paul, MN, USA) | Microhybrid composite (Filtek Z250, 3M ESPE, St. Paul, MN, USA) |
| Eren et al. [ | 2013 | Turkey | Dentin μTBS | Dentin µSBS and shear test | G-Bond Plus (GC, Tokyo, Japan) | Microhybrid composite (Venus, Heraeus Kulzer, Hanau, Germany) |
µTBS, microtensile bond strength; TEM, transmission electron microscopy; SEM, scanning electron microscopy.
Criteria used in quality assessment and the determination of risk of bias
| Study | Teeth randomization | Control group | Teeth free of caries | Samples with similar dimension | Evaluation of failure mode | Sample size calculation | Description of coefficient of variation | Universal testing machine cross-head speed | Blinding of the examiner | Risk of bias |
|---|---|---|---|---|---|---|---|---|---|---|
| Chen et al. [ | Yes | Yes | Yes | 0.9 × 0.9 mm | Yes | No | No | 1 mm/min | No | Medium |
| Yes | Yes | |||||||||
| Wagner et al. [ | Yes | Yes | Yes | 1 × 1 mm | Yes | No | No | 0.5 mm/min | No | Medium |
| Yes | Yes | |||||||||
| Luque-Martinez et al. [ | Yes | Yes | Yes | 0.8 × 0.8 mm | Yes | No | No | 0.5 mm/min | No | Medium |
| Yes | Yes | |||||||||
| Muñoz et al. [ | Yes | Yes | Yes | 0.8 × 0.8 mm | Yes | No | No | 0.5 mm/min | Yes | Low |
| Yes | Yes | |||||||||
| Muñoz et al. [ | Yes | Yes | Yes | 0.8 × 0.8 mm | Yes | No | No | 0.5 mm/min | Yes | Low |
| Yes | Yes | |||||||||
| Perdigão et al. [ | Yes | Yes | Yes | 0.8 × 0.8 mm | Yes | No | No | 0.5 mm/min | No | Medium |
| Yes | Yes | |||||||||
| Muñoz et al. [ | Yes | Yes | Yes | 0.8 × 0.8 mm | Yes | No | No | 0.5 mm/min | Yes | Low |
| Yes | Yes | |||||||||
| Hanabusa et al. [ | Yes | Yes | Yes | 1 × 1 mm | Yes | No | No | 1 mm/min | No | Medium |
| Yes | Yes | |||||||||
| Perdigão et al. [ | Yes | Yes | Yes | 0.8 × 0.8 mm | Yes | No | No | 0.5 mm/min | No | Medium |
| Yes | Yes | |||||||||
| Eren et al. [ | Yes | Yes | Yes | 0.7 × 0.7 mm | Yes | No | No | 0.5 mm/min | No | Medium |
| Yes | Yes |
Yes, parameter present; No, parameter not present.
Dentin microtensile bond strength (µTBS) of Scotchbond Universal in both etching modes with the number of teeth per group used in the corresponding studies
| Study | Adhesive system and No. of teeth (per group) | Dentin µTBS (MPa) | |
|---|---|---|---|
| Etch-and-rinse | Self-etch | ||
| Chen et al. [ | Scotchbond Universal | 55.7 ± 10.7 | 59.9 ± 11.8 |
| 200 (10) | |||
| Wagner et al. [ | Scotchbond Universal | 49.1 ± 11.1 | 44.0 ± 21.9 |
| 72 (12) | |||
| Luque-Martinez et al. [ | Scotchbond Universal | 36.2 ± 3.3 | 32.3 ± 4.8 |
| 140 (7) | |||
| Muñoz et al. [ | Scotchbond Universal | 32.3 ± 3.7 | 34.7 ± 5.8 |
| 60 (5) | |||
| Muñoz et al. [ | Scotchbond Universal | 34.7 ± 4.6 | 33.3 ± 3.2 |
| 40 (5) | |||
| Muñoz et al. [ | Scotchbond Universal | 35.1 ± 6.6 | 32.4 ± 4.5 |
| 40 (5) | |||
| Perdigão et al. [ | Scotchbond Universal | 54.0 ± 18.8 | 54.4 ± 18.8 |
| 36 (6) | |||
The values are shown as mean ± standard deviation.
Dentin microtensile bond strength (µTBS) of different universal adhesives used in the included studies
| Study | Adhesive system | Dentin µTBS (MPa) | |
|---|---|---|---|
| Etch-and-rinse | Self-etch | ||
| Chen et al. [ | Prime&Bond Elect | 57.8 ± 9.1 | 56.3 ± 10.2 |
| Scotchbond Universal | 55.7 ± 10.7 | 59.9 ± 11.8 | |
| All-Bond Universal | 54.6 ± 8.3 | 50.1 ± 6.8 | |
| Clearfil Universal Bond | 49.1 ± 4.2 | 48.0 ± 7.4 | |
| Futurabond Universal | 46.5 ± 7.2 | 48.2 ± 9.7 | |
| Wagner et al. [ | Futurabond Universal | 41.2 ± 10.7 | 37.9 ± 14.0 |
| All-Bond Universal | 44.8 ± 10.8 | 52.6 ± 12.7 | |
| Scotchbond Universal | 49.1 ± 11.1 | 44.0 ± 21.9 | |
| Luque-Martinez et al. [ | All-Bond Universal | 40.8 ± 5.0 | 22.0 ± 5.1 |
| Prime&Bond Elect | 16.8 ± 2.4 | 18.9 ± 2.6 | |
| Scotchbond Universal | 36.2 ± 3.3 | 32.3 ± 4.8 | |
| Muñoz et al. [ | Scotchbond Universal | 32.3 ± 3.7 | 34.7 ± 5.8 |
| All-Bond Universal | 40.8 ± 5.0 | 22.0 ± 5.1 | |
| G-Bond Plus | 20.5 ± 3.2 | 11.5 ± 3.3 | |
| Muñoz et al. [ | All-Bond Universal | 38.5 ± 4.0 | 20.9 ± 4.1 |
| Scotchbond Universal | 34.7 ± 4.6 | 33.3 ± 3.2 | |
| Peak Universal Adhesive | 44.3 ± 1.6 | 39.5 ± 5.1 | |
| Perdigão et al. [ | G-Bond Plus | 19.1 ± 0.7 | 13.4 ± 1.3 |
| Muñoz et al. [ | Peak Universal Adhesive | 43.6 ± 4.6 | 39.9 ± 4.5 |
| Scotchbond Universal | 35.1 ± 6.6 | 32.4 ± 4.5 | |
| All-Bond Universal | 39.3 ± 3.7 | 13.4 ± 1.9 | |
| Hanabusa et al. [ | G-Bond Plus | 29.4 ± 8.2 | 30.5 ± 7.6 |
| Perdigão et al. [ | Scotchbond Universal | 54.0 ± 18.8 | 54.4 ± 18.8 |
| Eren et al. [ | G-Bond Plus | - | 26.4 ± 8.0 |
The values are shown as mean ± standard deviation.
Comparison of microtensile bond strength (µTBS) values obtained using the etch-and-rinse and self-etch modes
| Adhesive strategy | No. of studies | µTBS (MPa) |
|---|---|---|
| Etch-and-rinse mode | 7 | 37.07 ± 2.12 |
| Self-etch mode | 7 | 35.81 ± 2.64 |
Results are based on the t-test of the meta-analysis data following the statistical model of Borenstein et al. [
Table 1 Summary of the studies included in this systematic review
µTBS, microtensile bond strength; MDP, methacryloyloxydecyl dihydrogen phosphate.
Table 2 Testing methods and materials used in the included studies
µTBS, microtensile bond strength; TEM, transmission electron microscopy; SEM, scanning electron microscopy.
Table 3 Criteria used in quality assessment and the determination of risk of bias
Yes, parameter present; No, parameter not present.
Table 4 Dentin microtensile bond strength (µTBS) of Scotchbond Universal in both etching modes with the number of teeth per group used in the corresponding studies
The values are shown as mean ± standard deviation.
Table 5 Dentin microtensile bond strength (µTBS) of different universal adhesives used in the included studies
The values are shown as mean ± standard deviation.
Table 6 Comparison of microtensile bond strength (µTBS) values obtained using the etch-and-rinse and self-etch modes
Results are based on the
