Clinical performance of posterior restorations using a universal adhesive over moist and dry dentin: A 36-month double-blind split-mouth randomized clinical trial

Re-evaluating the role of moist dentin of adhesive systems used in the etch-and-rinse bonding strategy. A systematic review and meta-analysis

BACKGROUND

The wet-bonding protocol has been used in the etch-and-rinse (ER) mode to maintain adhesive infiltration in demineralized dentin. This study answered the research question: "Do the retention rates and other secondary outcomes of composite restorations in non-carious cervical lesions (NCCLs) differ between dry- and wet-bonding techniques?"

METHODS

The authors included randomized clinical trials in which NCCLs were restored with ER or universal adhesives applied under dry and moist dentin. Searches for eligible articles were performed in MEDLINE via PubMed, Web of Science, Cochrane Library, Brazilian Library in Dentistry, Latin American and Caribbean Health Sciences Literature, Scopus, Embase, and grey literature without language and date restrictions and updated in May 2024. The Cochrane Risk of bias 2.0 (RoB) was used. The authors conducted meta-analyses with the random-effects model and assessed heterogeneity. The certainty of the evidence was assessed by GRADE.

RESULTS

We found five split-mouth randomized clinical trials from Brazil, published between 2005 and 2023, involving 195 adult patients with up to five years of follow-up. Three had a low RoB, one had some concerns, and one had a high RoB. No significant difference was observed between groups at any recall time for the outcomes. The risk ratio and 95 % CI for retention rates were at 18-24 months 0.91 (0.45 to 1.84); at 36 months, 0.82 (0.38 to 1.78), and at 60 months, 1.0 (0.42 to 2.38). The risk difference for postoperative sensitivity was 0.00 (-0.03 to 0.03) in all follow-ups.

LIMITATIONS OF EVIDENCE

The retention rates and other secondary outcomes were not affected by dentin moisture with a moderate certainty of evidence. PROSPERO 2023 CRD42023427861.

Buonocore Memorial Lecture 2023: Changing Operative Mindsets with Universal Adhesives and Cements

Adhesive dentistry has undergone significant advancements since its inception, marked by continuous improvements in material performance and adaptability to various dental and restorative substrates. Initially, the anatomical differences between enamel and dentin made adhesive approaches challenging. Early systems were often complex and operator dependent, leading to the development of multistep protocols. However, advancements have led to the creation of more user-friendly self-etch systems and the emergence of universal adhesives (UAs). These UAs can be applied with equal effectiveness to different substrates, including enamel and dentin, simplifying the clinical workflow and enhancing reliability. The concept of universality has recently been extended to other dental materials, most notably universal resin cements. These cements offer a versatile approach as they are capable of both adhesive and self-adhesive bonding, thereby accommodating a wide range of restorative scenarios. The advent of these materials represents a significant advance toward simplifying procedures, reducing technique sensitivity and the likelihood of operator error, and achieving consistently high quality restorations. Current research focuses on further refining these universal materials to enhance their performance, making them a cornerstone of modern adhesive dentistry.