Adhesion of resin-based materials to eroded dentin: a systematic review and meta-analysis

Objective To determine whether bond strength to eroded dentin is similar to values found for sound dentin, before and after additional treatments. Materials and methods MeSH terms and keywords relative to the topics 'adhesion to dentin' and 'eroded dentin' were searched in the Pubmed and the Scopus databases. In vitro studies that compared the bond strength to sound and eroded dentin were selected. The following data were included: pH-cycling model, materials, treatments, bond strength tests, and failure modes. Bond strength values were compared by meta-analyses and the failure modes were analyzed for random effects. Results The bond strength data of the 23 studies included were extracted by the reviewers and assessed by meta-analyses. Low risk of bias was found most frequently. Sound x Eroded Dentin comparisons revealed higher bond strength to sound dentin. When compared with untreated eroded dentin, treatments such as NaOCl, E64, CHX and PAA acid, PPA and RI primer, showed high and durable bond strength values (p<0.0001). Mixed failures were the most frequent type (39.26%), followed by adhesive (38.21%) and cohesive failures (6.15%). Conclusions The bond strength to eroded dentin can be improved by mechanical and chemical strategies, applied before or during the adhesive protocol. Clinical significance Eroded teeth, an increasingly frequent clinical condition found, require restorations with adhesive protocols that result in favorable and durable bond strength over time.