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. 2018 Mar 6;43(2):e14.
doi: 10.5395/rde.2018.43.e14. eCollection 2018 May.

Effect of smear layer deproteinization on bonding of self-etch adhesives to dentin: a systematic review and meta-analysis

Khaldoan H Alshaikh  1 , Hamdi H H Hamama  1   2 , Salah H Mahmoud  1
Affiliations

Effect of smear layer deproteinization on bonding of self-etch adhesives to dentin: a systematic review and meta-analysis

Khaldoan H Alshaikh et al. Restor Dent Endod. .

Abstract

Objectives: The aim of this systematic review was to critically analyze previously published studies of the effects of dentin surface pretreatment with deproteinizing agents on the bonding of self-etch (SE) adhesives to dentin. Additionally, a meta-analysis was conducted to quantify the effects of the above-mentioned surface pretreatment methods on the bonding of SE adhesives to dentin.

Materials and methods: An electronic search was performed using the following databases: Scopus, PubMed and ScienceDirect. The online search was performed using the following keywords: 'dentin' or 'hypochlorous acid' or 'sodium hypochlorite' and 'self-etch adhesive.' The following categories were excluded during the assessment process: non-English articles, randomized clinical trials, case reports, animal studies, and review articles. The reviewed studies were subjected to meta-analysis to quantify the effect of the application time and concentration of sodium hypochlorite (NaOCl) and hypochlorous acid (HOCl) deproteinizing agents on bonding to dentin.

Results: Only 9 laboratory studies fit the inclusion criteria of this systematic review. The results of the meta-analysis revealed that the pooled average microtensile bond strength values to dentin pre-treated with deproteinizing agents (15.71 MPa) was significantly lower than those of the non-treated control group (20.94 MPa).

Conclusions: In light of the currently available scientific evidence, dentin surface pretreatment with deproteinizing agents does not enhance the bonding of SE adhesives to dentin. The HOCl deproteinizing agent exhibited minimal adverse effects on bonding to dentin in comparison with NaOCl solutions.

Keywords: Deproteinizing agents; Hypochlorous acid; Self-etch adhesives; Smear layer; Sodium hypochlorite.

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Conflict of interest statement

Conflict of Interest: No potential conflict of interest was reported by the authors.

Figures

Figure 1
Figure 1
Flow chart of the study selection procedure. GIC, glass ionomer cement; EDTA, ethylenediaminetetraacetic acid; NaOCl, sodium hypochlorite; μTBS, microtensile bond strength.
Figure 2
Figure 2
Overall meta-analysis results of the mean μTBS of SE adhesives bonded to NaOCl/HOCl-treated dentin. μTBS, microtensile bond strength; SE, self-etch; NaOCl, sodium hypochlorite; HOCl, hypochlorous acid; CI, confidence interval; A, 6% NaOCl; B, 50 ppm HOCl; C, 1% NaOCl; D, 5% NaOCl; E, 806.02 mM NaOCl; F, 0.95 mM HOCl; G, 1.91 mM HOCl; H, 0.5% NaOCl.
Figure 3
Figure 3
Meta-analysis results of μTBS for control groups. μTBS, microtensile bond strength; SE, self-etch; C, no dentin surface treatment was performed; CI, confidence interval.
Figure 4
Figure 4
Meta-analysis results of the mean μTBS for SE adhesive bonded to NaOCl-treated dentin. μTBS, microtensile bond strength; SE, self-etch; NaOCl, sodium hypochlorite; CI, confidence interval; A, 6% NaOCl; B, 1% NaOCl; C, 1% NaOCl; D, 806.02 mM NaOCl; E, 0.5% NaOCl.
Figure 5
Figure 5
Meta-analysis results of the mean μTBS for SE adhesive bonded to HOCl-treated dentin. μTBS, microtensile bond strength; SE, self-etch; HOCl, hypochlorous acid; CI, confidence interval; A, 50 ppm HOCl; B, 0.95 mM HOCl; C, 1.91 mM HOCl.
Figure 6
Figure 6
Meta-analysis results of the mean μTBS for 5 second dentin surface treatment with a deproteinizing agent. μTBS, microtensile bond strength; CI, confidence interval; A, 6% NaOCl; B, 50 ppm HOCl; C, 806.02 mM NaOCl; D, 0.95 mM HOCl; E, 1.91mM HOCl.
Figure 7
Figure 7
Meta-analysis results of the mean μTBS for 30 second dentin surface treatment with a deproteinizing agent. μTBS, microtensile bond strength; SE, self-etch; CI, confidence interval; A, 6% NaOCl; B, 50 ppm HOCl.
Figure 8
Figure 8
Meta-analysis results of the mean μTBS for one-step SE adhesive bonded to deproteinized dentin. μTBS, microtensile bond strength; SE, self-etch; CI, confidence interval; A, 6% NaOCl.
Figure 9
Figure 9
Meta-analysis results of the mean μTBS for two-step SE adhesive bonded to deproteinized dentin. μTBS, microtensile bond strength; SE, self-etch; CI, confidence interval; A, 6% NaOCl.
See this image and copyright information in PMC

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