Randomized clinical trial of four adhesion strategies: A 42 month study

Update on Enamel Bonding Strategies

Optimal strategies for the application of an adhesive differ between enamel and dentin because of the differences in their composition. The development of adhesive systems has mainly focused on the bonding of dentin, rather than on the enamel, by etching with phosphoric acid (PA). Dental adhesive technologies continue to rapidly advance, and various adhesive systems have been developed since the study of Buonocore in 1955. He introduced the enamel acid-etch technique. Then, the etch-and-rinse (ER) system was developed, and subsequently, the self-etch (SE) system. Universal adhesives are a new generation of one-bottle SE adhesives that can be applied with either ER mode or SE mode, or a combined system involving selective enamel etching mode. Since the combination of PA etching and the SE system differs from conventional ER systems, the enamel bonding strategy should be carefully considered. This concise review of the literature on reliable enamel bonding strategies should prove helpful to clinicians to choose an appropriate adhesive system to achieve optimal clinical outcomes.

Adhesive strategies in cervical lesions: systematic review and a network meta-analysis of randomized controlled trials

OBJECTIVES

A network meta-analysis (NMA) was performed to assess which adhesive strategy is most clinically effective in treating non-carious cervical lesions (NCCLs).

MATERIAL AND METHODS

Studies were identified by a systematic search of electronic databases including MEDLINE via PubMed, Brazilian Library in Dentistry (BBO), Cochrane Library, EMBASE, Latin American and Caribbean Health Sciences Literature database (LILACS), Scopus, and Web of Science without restrictions on publication year or language. The grey literature was also consulted. Only randomized clinical trials that compared different adhesive strategies in NCCLs in adult patients were included. The risk of bias was evaluated by using the Cochrane Collaboration tool. A random-effects Bayesian mixed treatment comparison model was used to compare adhesive strategies (3ER, 2ER, 2SE, and 1SE) at different follow-up times. The surface under cumulative ranking curve (SUCRA) was estimated for each strategy. Heterogeneity was assessed by using the Cochran Q test and I² statistics. The quality of evidence was evaluated using the GRADE approach.

RESULTS

A total of 5058 studies were identified, 66 of which met the eligibility criteria and of these 5 were judged "low" risk of bias and 57 were meta-analyzed. We did not observe significant differences in the NMA analysis for any two pairs of adhesives, except for the shortest follow-up for 2ER vs 3ER. The material 2SE ranked highest, although it differed only slightly from the other bonding strategies.

CONCLUSIONS

No bonding strategy is better than the others.

CLINICAL RELEVANCE

Adhesive efficacy cannot be characterized by its bonding strategy.