Bonding Strength of Universal Adhesives to Indirect Substrates: A Meta‐Analysis of in Vitro Studies

• Published in: Journal of prosthodontics Vol. 29; no. 4; pp. 298 - 308
• Main Authors: Cuevas‐Suárez, Carlos Enrique, de Oliveira da Rosa, Wellington Luiz, Vitti, Rafael Pino, da Silva, Adriana Fernandes, Piva, Evandro
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-04-2020
• Subjects: Adhesives; Alloys; Bond strength; Ceramics; Composite materials; Composite Resins; Dental Bonding; Dental Cements; Dental Porcelain; Dentistry; glass‐based ceramics; Lithium; Materials Testing; Meta-analysis; metal alloys; Polymers; Resin Cements; resin‐based material; Surface Properties; Yttrium; Zirconia; zirconia‐based ceramics; Zirconium; glass-based ceramics; zirconia-based ceramics; Bond strength; metal alloys; resin-based material
• ISSN: 1059-941X; 1532-849X
• DOI: 10.1111/jopr.13147

Purpose
To evaluate the in vitro bond strength of universal adhesive systems to indirect substrates.
Material and Methods
Two reviewers performed a literature search up to March 2018 in seven databases: PubMed, Web of Science, SciELO, Scopus, LILACS, IBECS, and BBO. The review included studies that compared the bond strength of universal adhesives and well‐established material‐specific primers to indirect substrates: lithium disilicate ceramic, yttrium‐stabilized zirconium dioxide ceramic, leucite‐reinforced ceramic, feldspathic porcelain, polymer infiltrated ceramic material, resin composite or metal alloys. Analyses were carried out using RevMan 5.3.5. A global comparison was performed with the standardized mean difference using a random‐effects models at a significance level of p < 0.05.
Results
A total of 45 studies were included in the qualitative analysis, and the meta‐analysis was performed with 42 studies. Bond strength to glass‐based ceramics and alloys was improved with the use of a specific‐primer as separate step before the bonding procedures (lithium disilicate, p < 0.001; alloys, p < 0.001). The bond strength to zirconium substrates was improved with the use of universal adhesives (p < 0.001). For bond strength to composite resin as indirect substrate, universal adhesives performed in a manner similar to that of the material‐specific primer (p = 0.11).
Conclusions
The clinical procedure of luting zirconia and resin composite restorations could be simplified by using single‐bottle universal adhesives. However, the ability of universal adhesives to achieve an adequate and durable bond to glass‐based ceramics and alloys appears to be limited.