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 I²-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.

中文翻译：

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对侵蚀的牙釉质和牙本质的粘附：系统评价和荟萃分析

客观的

本系统评价和荟萃分析的目的是比较腐蚀和完好的永久性牙釉质与牙本质之​​间的粘合强度，并评估蚀刻和冲洗粘合剂和自酸蚀粘合剂之间的粘合性能（即刻和老化后）是否不同，是否可以通过表面改善粘接前的预处理。

方法

两名审稿人检索了电子数据库（PubMed、Scopus、Embase、Web of Science、CENTRAL、LILACS、BBO）。进行了随机效应荟萃分析，以分别比较在粘接前没有和有表面预处理的健全和侵蚀的牙齿硬组织的粘接强度。使用亚组分析比较了粘合模式（蚀刻和冲洗与自蚀刻）和老化（立即与老化）的影响。使用 Cochran 的 Q 和I ²统计量评估统计异质性。漏斗图和 Egger 回归截距检验用于评估发表偏倚。还评估了纳入研究的质量和偏倚风险。

结果

47 项研究（45 项体外研究，2 项原位研究）被纳入系统评价和荟萃分析。侵蚀会削弱与牙本质的粘合强度（p < 0.001；平均差：-10.2 MPa [95% CI：-11.9 至 -8.6 MPa]），但不会损害牙釉质（p = 0.260）。去除或稳定胶原基质的表面预处理措施可以提高牙本质粘合强度（最大平均差：+12.4 MPa）。Etch&rinse 和自酸蚀粘合剂在侵蚀牙釉质 (p = 0.208) 和牙本质 (p = 0.353) 上的表现没有显着差异。大多数研究（47 项中的 32 项）存在中等偏倚风险。

意义

来自体外和原位研究的数据表明，侵蚀会削弱蚀刻和冲洗和自酸蚀粘合剂的牙本质粘合，并使得在复合修复体粘合之前必须进行表面预处理。