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Journal of Periodontology Jan 2021The peri-implant soft tissue phenotype (PSP) encompasses the keratinized mucosa width (KMW), mucosal thickness (MT), and supracrestal tissue height (STH). Numerous... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The peri-implant soft tissue phenotype (PSP) encompasses the keratinized mucosa width (KMW), mucosal thickness (MT), and supracrestal tissue height (STH). Numerous approaches to augment soft tissue volume around endosseous dental implants have been investigated. To what extent PSP modification is beneficial for peri-implant health has been subject of debate in the field of implant dentistry. The aim of this systematic review was to analyze the evidence regarding the efficacy of soft tissue augmentation procedures aimed at modifying the PSP and their impact on peri-implant health.
METHODS
A comprehensive search was performed to identify clinical studies that involved soft tissue augmentation around dental implants and reported findings on KMW, MT, and/or STH changes. The effect of the intervention on peri-implant health was also assessed. Selected articles were classified based on the general type of surgical approach to increase PSP, either bilaminar or an apically positioned flap (APF) technique. A network meta-analysis including only randomized-controlled trials (RCTs) reporting on PSP outcomes was conducted to assess and compare different techniques.
RESULTS
A total of 52 articles were included in the qualitative analysis, and 23 RCTs were included as part of the network meta-analysis. Sixteen RCTs reported the outcomes of PSP modification therapy with bilaminar techniques, whereas 7 involved the use of APF. The analysis showed that bilaminar techniques in combination with soft tissue grafts (connective tissue graft [CTG], collagen matrix [CM], and acellular dermal matrix [ADM]) resulted in a significant increase in MT compared to non-augmented sites. In particular, CTG and ADM were associated with higher MT gain as compared to CM and non-augmented sites. However, no significant differences in KMW were observed across different bilaminar techniques. PSP modification via a bilaminar approach utilizing either CTG or CM showed beneficial effects on marginal bone level stability. APF-based approaches in combination with free gingival graft (FGG), CTG, CM, or ADM showed a significant KMW gain compared to non-augmented sites. However, compared to APF alone, only FGG exhibited a significantly higher KMW gain. APF with any evaluated soft tissue graft was associated with with reduction of probing depth, soft tissue dehiscence and plaque index compared to non-augmented sites compared to non-augmented sites. The evidence regarding the effect of PSP modification via APF-based approaches on peri-implant marginal bone loss or preservation is inconclusive.
CONCLUSIONS
Bilaminar approach involving CTG or ADM obtained the highest amount of MT gain, whereas APF in combination with FGG was the most effective technique for increasing KMW. KMW augmentation via APF was associated with a significant reduction in probing depth, soft tissue dehiscence and plaque index, regardless of the soft tissue grafting material employed, whereas bilaminar techniques with CTG or CM showed beneficial effects on marginal bone level stability.
Topics: Connective Tissue; Dental Implants; Gingiva; Network Meta-Analysis; Phenotype
PubMed: 32710810
DOI: 10.1002/JPER.19-0716 -
Medicina (Kaunas, Lithuania) Dec 2021: Tobacco is today the single most preventable cause of death, being associated with countless diseases, including cancer and neurological, cardiovascular, and... (Meta-Analysis)
Meta-Analysis Review
: Tobacco is today the single most preventable cause of death, being associated with countless diseases, including cancer and neurological, cardiovascular, and respiratory diseases. Smoking also brings negative consequences to oral health, potentially impairing treatment with dental implants. The present review aimed to evaluate the influence of smoking on dental implant failure rates and marginal bone loss (MBL). : Electronic search was undertaken in three databases, plus a manual search of journals. Meta-analyses were performed, in addition to meta-regressions, in order to verify how the odds ratio (OR) and MBL were associated with follow-up time. : The review included 292 publications. Altogether, there were 35,511 and 114,597 implants placed in smokers and in non-smokers, respectively. Pairwise meta-analysis showed that implants in smokers had a higher failure risk in comparison with non-smokers (OR 2.402, < 0.001). The difference in implant failure between the groups was statistically significant in the maxilla (OR 2.910, < 0.001), as well as in the mandible (OR 2.866, < 0.001). The MBL mean difference (MD) between the groups was 0.580 mm ( < 0.001). There was an estimated decrease of 0.001 in OR ( = 0.566) and increase of 0.004 mm ( = 0.279) in the MBL MD between groups for every additional month of follow-up, although without statistical significance. Therefore, there was no clear influence of the follow-up on the effect size (OR) and on MBL MD between groups. : Implants placed in smokers present a 140.2% higher risk of failure than implants placed in non-smokers.
Topics: Dental Implants; Humans; Mandible; Maxilla; Smokers; Smoking
PubMed: 35056347
DOI: 10.3390/medicina58010039 -
Frontiers in Cellular and Infection... 2021After insertion into the bone, implants osseointegrate, which is required for their long-term success. However, inflammation and infection around the implants may lead... (Review)
Review
INTRODUCTION
After insertion into the bone, implants osseointegrate, which is required for their long-term success. However, inflammation and infection around the implants may lead to implant failure leading to peri-implantitis and loss of supporting bone, which may eventually lead to failure of implant. Surface chemistry of the implant and lack of cleanliness on the part of the patient are related to peri-implantitis. The only way to get rid of this infection is decontamination of dental implants.
OBJECTIVE
This systematic review intended to study decontamination of microbial biofilm methods on titanium implant surfaces used in dentistry.
METHODS
The electronic databases Springer Link, Science Direct, and PubMed were explored from their inception until December 2020 to identify relevant studies. Studies included had to evaluate the efficiency of new strategies either to prevent formation of biofilm or to treat matured biofilm on dental implant surfaces.
RESULTS AND DISCUSSION
In this systematic review, 17 different groups of decontamination methods were summarized from 116 studies. The decontamination methods included coating materials, mechanical cleaning, laser treatment, photodynamic therapy, air polishing, anodizing treatment, radiation, sonication, thermal treatment, ultrasound treatment, chemical treatment, electrochemical treatment, antimicrobial drugs, argon treatment, and probiotics.
CONCLUSION
The findings suggest that most of the decontamination methods were effective in preventing the formation of biofilm and in decontaminating established biofilm on dental implants. This narrative review provides a summary of methods for future research in the development of new dental implants and decontamination techniques.
Topics: Anti-Infective Agents; Biofilms; Decontamination; Dental Implants; Humans; Peri-Implantitis
PubMed: 34692562
DOI: 10.3389/fcimb.2021.736186 -
The Cochrane Database of Systematic... Feb 2022Pit and fissure sealants are plastic materials that are used to seal deep pits and fissures on the occlusal surfaces of teeth, where decay occurs most often in children... (Review)
Review
BACKGROUND
Pit and fissure sealants are plastic materials that are used to seal deep pits and fissures on the occlusal surfaces of teeth, where decay occurs most often in children and adolescents. Deep pits and fissures can retain food debris and bacteria, making them difficult to clean, thereby causing them to be more susceptible to dental caries. The application of a pit and fissure sealant, a non-invasive preventive approach, can prevent dental caries by forming a protective barrier that reduces food entrapment and bacterial growth. Though moderate-certainty evidence shows that sealants are effective in preventing caries in permanent teeth, the effectiveness of applying pit and fissure sealants to primary teeth has yet to be established.
OBJECTIVES
To evaluate the effects of sealants compared to no sealant or a different sealant in preventing pit and fissure caries on the occlusal surfaces of primary molars in children and to report the adverse effects and the retention of different types of sealants.
SEARCH METHODS
An information specialist searched four bibliographic databases up to 11 February 2021 and used additional search methods to identify published, unpublished and ongoing studies. Review authors scanned the reference lists of included studies and relevant systematic reviews for further studies.
SELECTION CRITERIA
We included parallel-group and split-mouth randomised controlled trials (RCTs) that compared a sealant with no sealant, or different types of sealants, for the prevention of caries in primary molars, with no restriction on follow-up duration. We included studies in which co-interventions such as oral health preventive measures, oral health education or tooth brushing demonstrations were used, provided that the same adjunct was used with the intervention and comparator. We excluded studies with complex interventions for the prevention of dental caries in primary teeth such as preventive resin restorations, or studies that used sealants in cavitated carious lesions.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened search results, extracted data and assessed risk of bias of included studies. We presented outcomes for the development of new carious lesions on occlusal surfaces of primary molars as odds ratios (OR) with 95% confidence intervals (CIs). Where studies were similar in clinical and methodological characteristics, we planned to pool effect estimates using a random-effects model where appropriate. We used GRADE methodology to assess the certainty of the evidence.
MAIN RESULTS
We included nine studies that randomised 1120 children who ranged in age from 18 months to eight years at the start of the study. One study compared fluoride-releasing resin-based sealant with no sealant (139 tooth pairs in 90 children); two studies compared glass ionomer-based sealant with no sealant (619 children); two studies compared glass ionomer-based sealant with resin-based sealant (278 tooth pairs in 200 children); two studies compared fluoride-releasing resin-based sealant with resin-based sealant (113 tooth pairs in 69 children); one study compared composite with fluoride-releasing resin-based sealant (40 tooth pairs in 40 children); and one study compared autopolymerised sealant with light polymerised sealant (52 tooth pairs in 52 children). Three studies evaluated the effects of sealants versus no sealant and provided data for our primary outcome. Due to differences in study design such as age of participants and duration of follow-up, we elected not to pool the data. At 24 months, there was insufficient evidence of a difference in the development of new caries lesions for the fluoride-releasing sealants or no treatment groups (Becker Balagtas odds ratio (BB OR) 0.76, 95% CI 0.41 to 1.42; 1 study, 85 children, 255 tooth surfaces). For glass ionomer-based sealants, the evidence was equivocal; one study found insufficient evidence of a difference at follow-up between 12 and 30 months (OR 0.97, 95% CI 0.63 to 1.49; 449 children), while another with 12-month follow-up found a large, beneficial effect of sealants (OR 0.03, 95% CI 0.01 to 0.15; 107 children). We judged the certainty of the evidence to be low, downgrading two levels in total for study limitations, imprecision and inconsistency. We included six trials randomising 411 children that directly compared different sealant materials, four of which (221 children) provided data for our primary outcome. Differences in age of the participants and duration of follow-up precluded pooling of the data. The incidence of development of new caries lesions was typically low across the different sealant types evaluated. We judged the certainty of the evidence to be low or very low for the outcome of caries incidence. Only one study assessed and reported adverse events, the nature of which was gag reflex while placing the sealant material.
AUTHORS' CONCLUSIONS
The certainty of the evidence for the comparisons and outcomes in this review was low or very low, reflecting the fragility and uncertainty of the evidence base. The volume of evidence for this review was limited, which typically included small studies where the number of events was low. The majority of studies in this review were of split-mouth design, an efficient study design for this research question; however, there were often shortcomings in the analysis and reporting of results that made synthesising the evidence difficult. An important omission from the included studies was the reporting of adverse events. Given the importance of prevention for maintaining good oral health, there exists an important evidence gap pertaining to the caries-preventive effect and retention of sealants in the primary dentition, which should be addressed through robust RCTs.
Topics: Adolescent; Child; Dental Caries; Dentition, Permanent; Fluorides; Humans; Pit and Fissure Sealants; Tooth, Deciduous
PubMed: 35146744
DOI: 10.1002/14651858.CD012981.pub2 -
The Journal of Prosthetic Dentistry Feb 2023Artificial intelligence (AI) applications are growing in dental implant procedures. The current expansion and performance of AI models in implant dentistry applications...
STATEMENT OF PROBLEM
Artificial intelligence (AI) applications are growing in dental implant procedures. The current expansion and performance of AI models in implant dentistry applications have not yet been systematically documented and analyzed.
PURPOSE
The purpose of this systematic review was to assess the performance of AI models in implant dentistry for implant type recognition, implant success prediction by using patient risk factors and ontology criteria, and implant design optimization combining finite element analysis (FEA) calculations and AI models.
MATERIAL AND METHODS
An electronic systematic review was completed in 5 databases: MEDLINE/PubMed, EMBASE, World of Science, Cochrane, and Scopus. A manual search was also conducted. Peer-reviewed studies that developed AI models for implant type recognition, implant success prediction, and implant design optimization were included. The search strategy included articles published until February 21, 2021. Two investigators independently evaluated the quality of the studies by applying the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Quasi-Experimental Studies (nonrandomized experimental studies). A third investigator was consulted to resolve lack of consensus.
RESULTS
Seventeen articles were included: 7 investigations analyzed AI models for implant type recognition, 7 studies included AI prediction models for implant success forecast, and 3 studies evaluated AI models for optimization of implant designs. The AI models developed to recognize implant type by using periapical and panoramic images obtained an overall accuracy outcome ranging from 93.8% to 98%. The models to predict osteointegration success or implant success by using different input data varied among the studies, ranging from 62.4% to 80.5%. Finally, the studies that developed AI models to optimize implant designs seem to agree on the applicability of AI models to improve the design of dental implants. This improvement includes minimizing the stress at the implant-bone interface by 36.6% compared with the finite element model; optimizing the implant design porosity, length, and diameter to improve the finite element calculations; or accurately determining the elastic modulus of the implant-bone interface.
CONCLUSIONS
AI models for implant type recognition, implant success prediction, and implant design optimization have demonstrated great potential but are still in development. Additional studies are indispensable to the further development and assessment of the clinical performance of AI models for those implant dentistry applications reviewed.
Topics: Humans; Artificial Intelligence; Dental Implantation, Endosseous; Dental Implants; Porosity
PubMed: 34144789
DOI: 10.1016/j.prosdent.2021.05.008 -
The Cochrane Database of Systematic... Aug 2021Traditionally, amalgam has been used for filling cavities in posterior teeth, and it continues to be the restorative material of choice in some low- and middle-income... (Review)
Review
BACKGROUND
Traditionally, amalgam has been used for filling cavities in posterior teeth, and it continues to be the restorative material of choice in some low- and middle-income countries due to its effectiveness and relatively low cost. However, there are concerns over the use of amalgam restorations (fillings) with regard to mercury release in the body and the environmental impact of mercury disposal. Dental composite resin materials are an aesthetic alternative to amalgam, and their mechanical properties have developed sufficiently to make them suitable for restoring posterior teeth. Nevertheless, composite resin materials may have potential for toxicity to human health and the environment. The United Nations Environment Programme has established the Minamata Convention on Mercury, which is an international treaty that aims "to protect the [sic] human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds". It entered into force in August 2017, and as of February 2021 had been ratified by 127 governments. Ratification involves committing to the adoption of at least two of nine proposed measures to phase down the use of mercury, including amalgam in dentistry. In light of this, we have updated a review originally published in 2014, expanding the scope of the review by undertaking an additional search for harms outcomes. Our review synthesises the results of studies that evaluate the long-term effectiveness and safety of amalgam versus composite resin restorations, and evaluates the level of certainty we can have in that evidence.
OBJECTIVES
To examine the effects (i.e. efficacy and safety) of direct composite resin fillings versus amalgam fillings.
SEARCH METHODS
An information specialist searched five bibliographic databases up to 16 February 2021 and used additional search methods to identify published, unpublished and ongoing studies SELECTION CRITERIA: To assess efficacy, we included randomised controlled trials (RCTs) comparing dental composite resin with amalgam restorations in permanent posterior teeth that assessed restoration failure or survival at follow-up of at least three years. To assess safety, we sought non-randomised studies in addition to RCTs that directly compared composite resin and amalgam restorative materials and measured toxicity, sensitivity, allergy, or injury.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane.
MAIN RESULTS
We included a total of eight studies in this updated review, all of which were RCTs. Two studies used a parallel-group design, and six used a split-mouth design. We judged all of the included studies to be at high risk of bias due to lack of blinding and issues related to unit of analysis. We identified one new trial since the previous version of this review (2014), as well as eight additional papers that assessed safety, all of which related to the two parallel-group studies that were already included in the review. For our primary meta-analyses, we combined data from the two parallel-group trials, which involved 1645 composite restorations and 1365 amalgam restorations in 921 children. We found low-certainty evidence that composite resin restorations had almost double the risk of failure compared to amalgam restorations (risk ratio (RR) 1.89, 95% confidence interval (CI) 1.52 to 2.35; P < 0.001), and were at much higher risk of secondary caries (RR 2.14, 95% CI 1.67 to 2.74; P < 0.001). We found low-certainty evidence that composite resin restorations were not more likely to result in restoration fracture (RR 0.87, 95% CI 0.46 to 1.64; P = 0.66). Six trials used a split-mouth design. We considered these studies separately, as their reliability was compromised due to poor reporting, unit of analysis errors, and variability in methods and findings. Subgroup analysis showed that the findings were consistent with the results of the parallel-group studies. Three trials investigated possible harms of dental restorations. Higher urinary mercury levels were reported amongst children with amalgam restorations in two trials, but the levels were lower than what is known to be toxic. Some differences between amalgam and composite resin groups were observed on certain measures of renal, neuropsychological, and psychosocial function, physical development, and postoperative sensitivity; however, no consistent or clinically important harms were found. We considered that the vast number of comparisons made false-positive results likely. There was no evidence of differences between the amalgam and composite resin groups in neurological symptoms, immune function, and urinary porphyrin excretion. The evidence is of very low certainty, with most harms outcomes reported in only one trial.
AUTHORS' CONCLUSIONS
Low-certainty evidence suggests that composite resin restorations may have almost double the failure rate of amalgam restorations. The risk of restoration fracture does not seem to be higher with composite resin restorations, but there is a much higher risk of developing secondary caries. Very low-certainty evidence suggests that there may be no clinically important differences in the safety profile of amalgam compared with composite resin dental restorations. This review supports the utility of amalgam restorations, and the results may be particularly useful in parts of the world where amalgam is still the material of choice to restore posterior teeth with proximal caries. Of note, however, is that composite resin materials have undergone important improvements in the years since the trials informing the primary analyses for this review were conducted. The global phase-down of dental amalgam via the Minamata Convention on Mercury is an important consideration when deciding between amalgam and composite resin dental materials. The choice of which dental material to use will depend on shared decision-making between dental providers and patients in the clinic setting, and local directives and protocols.
Topics: Bias; Child; Composite Resins; Dental Amalgam; Dental Caries; Dentition, Permanent; Humans; Randomized Controlled Trials as Topic
PubMed: 34387873
DOI: 10.1002/14651858.CD005620.pub3 -
International Endodontic Journal Apr 2021The outcome of vital pulp treatment after carious pulp exposure is multifactorial and related to the procedure, biomaterial and pre-operative pulpal diagnosis. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The outcome of vital pulp treatment after carious pulp exposure is multifactorial and related to the procedure, biomaterial and pre-operative pulpal diagnosis.
OBJECTIVES
To conduct a systematic review and meta-analysis determining the outcome of direct pulp capping (DPC) in mature permanent teeth with a cariously exposed pulp and a clinical diagnosis of reversible pulpitis, and ascertain whether the capping material influences the outcome.
METHODS
Sources: MEDLINE Ovid-SP, Cochrane Central Register of Controlled Trials (CENTRAL), International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, Embase and Web of Science until April 2020. Inclusion: Prospective, retrospective cohort studies and randomized trials investigating DPC outcome or comparing different capping materials after carious pulp exposure. Exclusion: Primary teeth, mechanical, traumatic or not specified pulp exposure, teeth with irreversible pulpitis or no pulpal diagnosis. Risk of bias assessed using Cochrane and modified Downs and Black quality assessment checklist. Meta-analysis on combined clinical/radiographic outcome was performed using a random effect model. Success was defined as absence of signs and symptoms of irreversible pulpitis, apical periodontitis or loss of pulp vitality.
RESULTS
Quality assessment highlighted four non-randomized studies to be of fair and five of poor quality. Four randomized trials had a high risk of bias. The pooled success rate differed based on material and follow-up. Calcium hydroxide success rate was 74% at 6-months, 65% at 1-year, 59% at 2-3 years and 56% at 4-5 years. Mineral trioxide aggregate (MTA) success was 91%, 86%, 84% and 81% at the same time points. Biodentine success was 96% at 6-months, 86% at 1 year and 86% at 2-3 years. The meta-analysis revealed MTA had better success than calcium hydroxide at 1-year (OR 2.66, 95% CI; 1.46- 4.84, P = 0.001) and 2- to 3-year follow-up (OR 2.21, 95% CI; 1.42-3.44, P = 0.0004). There was no difference between MTA and Biodentine.
DISCUSSION
These results were based on poor methodological quality studies. The effect size for of MTA vs Ca(OH)2, although modest, was consistent with narrow CI.
CONCLUSIONS
Low-quality evidence suggests a high success rate for direct pulp capping in teeth with cariously exposed pulps with better long-term outcomes for MTA and Biodentine compared with calcium hydroxide.
Topics: Aluminum Compounds; Calcium Compounds; Dental Caries; Dental Pulp Capping; Dentition, Permanent; Drug Combinations; Humans; Oxides; Prospective Studies; Pulp Capping and Pulpectomy Agents; Retrospective Studies; Silicates; Treatment Outcome
PubMed: 33222178
DOI: 10.1111/iej.13449 -
The Journal of Prosthetic Dentistry Mar 2020The restoration of extensively damaged endodontically treated teeth remains a challenge. The use of post-retained restorations has been questioned because of potential...
STATEMENT OF PROBLEM
The restoration of extensively damaged endodontically treated teeth remains a challenge. The use of post-retained restorations has been questioned because of potential tooth weakening.
PURPOSE
The purpose of this systematic review was to determine whether endocrowns are a reliable alternative to post-retained restorations for extensively damaged endodontically treated teeth and to determine which preparation design is most appropriate and which materials are best adapted for fabricating endocrowns.
MATERIAL AND METHODS
The literature that was analyzed covered endocrowns from 1995 to June 2018. A search was conducted for in vitro and clinical studies in English in 3 research databases (PubMed, Cochrane, and Scopus), and this was complemented by a manual search in the bibliographies of the studies found. Case reports were excluded.
RESULTS
A total of 41 publications consisting of 8 clinical studies and 33 in vitro studies were included in this systematic review. Several analysis parameters were identified: for the clinical studies, survival rate, failure modes, and clinical criteria; for the in vitro studies, fracture resistance, stress distribution, preparation criteria, and materials used.
CONCLUSIONS
Endocrowns are a reliable alternative to post-retained restorations for molars and seem promising for premolars. A certain preparation design and a rigorous adhesion protocol must be respected. Among the available materials, lithium disilicate glass-ceramic and nanofilled composite resin stand out.
Topics: Composite Resins; Crowns; Dental Porcelain; Dental Restoration Failure; Dental Stress Analysis; Humans; Materials Testing; Tooth, Nonvital
PubMed: 31353111
DOI: 10.1016/j.prosdent.2019.04.009 -
Dental Materials : Official Publication... Jan 2023This review study provides an overview of factors that influence the longevity of all types of direct resin composite restorations. (Review)
Review
OBJECTIVES
This review study provides an overview of factors that influence the longevity of all types of direct resin composite restorations.
METHODS
A systematic search was performed in PubMed, Scopus, and Web of Science databases for articles reporting data from primary longitudinal clinical studies on composite longevity published 2011-2021. Prospective or retrospective studies with restorations in permanent dentition, with follow-up periods of at least 5 years were included.
RESULTS
In total, 33 articles were included with different study designs, practice settings, datasets, countries of origin, and sample sizes. Annual failure rates of restorations ranged from 0.08% to 6.3%. Survival rates varied between 23% and 97.7%, success rates varied between 43.4% and 98.7%. Secondary caries, fractures, and esthetic compromise were main reasons for failures. Risk factors for reduced restoration durability included patient-level factors (e.g., caries risk, parafunctional habits, number of check-ups per year, socioeconomic status), dentist factors (different operators, operator's experience), and tooth/restoration factors (endodontic treatment, type of tooth, number of restored surfaces). Patient gender and the composite used generally did not influence durability.
SIGNIFICANCE
A number of risk factors are involved in the longevity of composite restorations. Differences between composites play a minor role in durability, assuming that materials and techniques are properly applied by dentists. Patient factors play a major role in longevity. The decision-making process implemented by dentists relative to the diagnosis of aging or failed restorations may also affect the longevity of restorations. Clinicians should treat patients comprehensively and promote a healthy lifestyle to ensure longevity.
Topics: Humans; Composite Resins; Dental Caries; Dental Restoration Failure; Dental Restoration, Permanent
PubMed: 36494241
DOI: 10.1016/j.dental.2022.11.009 -
Dental Materials : Official Publication... Dec 2021The aim of this systematic review and meta-analysis was to compare the bond strength between eroded and sound permanent enamel and dentin and to assess whether bonding... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of this systematic review and meta-analysis was to compare the bond strength between eroded and sound permanent enamel and dentin and to assess whether bonding performance (immediate and after aging) differs between etch&rinse and self-etch adhesives and can be improved by surface pretreatment prior to bonding.
METHODS
Electronic databases (PubMed, Scopus, Embase, Web of Science, CENTRAL, LILACS, BBO) were searched by two reviewers. Random-effect meta-analyses were performed to compare bond strength to sound and eroded dental hard tissues without and with surface pretreatment prior to bonding, respectively. The effect of adhesive mode (etch&rinse vs. self-etch) and aging (immediate vs. aged) was compared using subgroup analyses. Statistical heterogeneity was assessed using Cochran's Q and I-statistic. Funnel plots and Egger's regression intercept tests were used to evaluate publication bias. Quality and risk of bias of included studies were also assessed.
RESULTS
Fourty-seven studies (45 in vitro, 2 in situ) were included in the systematic review and meta-analyses. Erosion impairs bond strength to dentin (p < 0.001; mean difference: -10.2 MPa [95%CI: -11.9 to -8.6 MPa]), but not to enamel (p = 0.260). Surface pretreatment measures removing or stabilizing the collagenous matrix can improve dentin bond strength (maximum mean difference: +12.4 MPa). Etch&rinse and self-etch adhesives did not perform significantly different on eroded enamel (p = 0.208) and dentin (p = 0.353). The majority of studies (32 of 47) presented a medium risk of bias.
SIGNIFICANCE
Data from in vitro and in situ studies showed that erosion impairs dentin bonding of etch&rinse and self-etch adhesives and makes surface pretreatment prior to bonding of composite restorations necessary.
Topics: Dental Bonding; Dental Cements; Dental Enamel; Dentin; Dentin-Bonding Agents; Materials Testing; Resin Cements
PubMed: 34593245
DOI: 10.1016/j.dental.2021.09.014