01 April 2021

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STATE OF THE ART OF UNIVERSAL ADHESISIVES; CLINICAL PERFORMANCE: A systematic review of literature

Authors: Stefano Daniele, Andrea Alessandri

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The aim of this systematic review it’s to provide a critical evaluation about Universal adhesives to the currently adhesive’s procedures considered as gold standard in dental adhesion strategy during composite resin restoration of NCCL lesion.

In detail has been considered the overall success of composite restoration, the presence of aesthetical alterations (marginal discoloration), biological (secondary caries, hypersensitivity) and functional (retention and fracture, marginal adaptation) of these using the adhesive strategy in exam according their instructions use.

MATERIALS AND METHODS:  A research of scientific literature has been conducted between October and December 2018 using the following digital databases : Medline via Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL), Epistermonikos, Reserchgate using  “Universal dental adhesive“ tag.

Has been selected only randomized double blind clinical trial with control group (RCT) published in the last 5 years from the start date of the review, in English language, and that considered composite resin adhesive restoration of NCCL cavity. . 

The PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) was used to write this systematic review.

Has been excluded from the review in vitro studies, with a follow-up less than 6 months, that used for the intervention other materials than conventional composite resin, that compared Universal adhesives with other adhesives not classified as gold standard from international litterature and clinical studies that considered primary dentition.

RESULTS: Among 2289 articles initially funded only 1 clinical trial have been included in this systematic review with 24 months as last follow-up. The clinical performance of Universal adhesive was assessed by USPHS criteria during re evaluation ed showed a percentage survival of composite resin restoration of NCCL in 100% using the Universal adhesive in etch & rinse (ER), in 94,9% in self-etch (SE) mode and 87,6% the survival rate of the restorations made with adhesive considered as gold standard, in this case etch & rinse 3 steps.

The included study present bias in the methods and in the interpretation of the data in re evaluation too.

CONCLUSIONS:  From the only paper included, the performance of Universal adhesive considered appear satisfied, also if compared to adhesive gold standard strategy in the adhesive restoration of cervical lesions NCCL.

The bias present in the included study, the short follow-up of restorations, do not allow to draw scientific evidence about the real clinical performance of Universal adhesive systems

CLINICAL IMPLICATIONS: Despite the encouraging data highlighted by the included study, more rigorous studies in the methodology are necessary to suggest the clinician to replace a nowadays gold standard with a Universal adhesive.