Title Selective Enamel Etching Optimizes The Bond Strength of Mild Universal Adhesives
Clinical Question When placing a resin composite restoration, is the etch-and-rinse or self-etching mode the best protocol for dentin and enamel adhesion when using a universal adhesive system?
Clinical Bottom Line For mild universal adhesives, prior phosphoric acid etching improves the bond strength to enamel, but not to dentin. For the ultra-mild universal adhesive All-Bond Universal (pH 3.1), both the enamel and dentin bond strengths were improved. Based on this meta-analysis, selective enamel etching is an advisable strategy prior to the application of a mild universal adhesive for optimizing bonding.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
25882585Rosa/2015604 teeth in 10 included studies Systematic Review and Meta-Analysis of In Vitro Studies
Key resultsThe bond strength to enamel showed an improvement with the etch-and-rinse approach in all analyses. There was not a statistically significant deference between the etch- and-rinse and self-etch modes when evaluating the bond strength to dentin for mild universal adhesives (p ≥ 0.05). However, when using the ultra-mild All-Bond Universal adhesive, there was a significant difference in bond strength to dentin when using the etch-and-rinse mode compared to the self-etch mode. (p ≤ 0.05).
Evidence Search Universal dental adhesives, systematic review
Comments on
The Evidence
Validity: This systematic review was conducted in accordance with the guidelines of the PRISMA statement. 10 articles were included in the meta-analysis All of the studies included in the analysis, randomized their samples, used samples with similar dimensions, had controls, and evaluate the mode of failure. None of them provided a sample size calculation, and only two of them blinded the examiners, leaving them at a medium risk for bias. Perspective: Based on this systematic review, selective enamel etching is a practical approach for improving the bond to enamel when using a universal adhesive with composite restorations.
Applicability “Universal” or “multi-mode “ adhesive systems can be used with either an etch-and-rinse or self-etching mode, and thus enable the practitioner to decide on a specific adhesive protocol that is most suited for the cavity being prepared. The information in this systematic review guides the practitioner to make those decisions based on the best scientific evidence available.
Specialty (General Dentistry) (Restorative Dentistry)
Keywords Adhesives, Dental bonding, Dental materials, Systematic review
ID# 3081
Date of submission 05/03/2016
E-mail youngce@livemail.uthscsa.edu
Author Catherine Young
Co-author(s) e-mail
Faculty mentor Karen Troendle, DDS, MPH
Faculty mentor e-mail troendle@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available