Effect of Acidic Solutions on the Surface Roughness and Microhardness of Indirect Restorative Materials: A Systematic Review and Meta-analysis

Abstract

To evaluate the effects of acidic solutions on the surface roughness (SR) and surface microhardness (SMH) of indirect restorative materials by analyzing in vivo and in vitro studies. Studies comparing the SR and SMH of indirect restorative materials after erosion were included in the meta-analysis. Meta-analyses were conducted with a random-effects model at a significance level of P < .05 using Review Manager software (Cochrane Collaboration). The literature search was conducted using Web of Science, MEDLINE (PubMed), and the Cochrane Library, with no limitations on publication year. Of the 1,097 potentially relevant studies, 32 full-text articles were assessed for eligibility. A total of 16 articles were included in the systematic review, and 15 were included in the meta-analyses. The kappa score between the two reviewers was 0.80. The effects of erosion on ceramics, indirect composites, and hybrid ceramics were evaluated by immersion in or rinsing with acidic solutions (eg, hydrochloric acid [HCl], cola drinks, and juices). An increase in the SR (Ra values) (P < .00001; mean difference [MD] = -0.04; 95% CI = -0.06 to -0.03) and a decrease in the SMH (Vickers microhardness) (P < .00001; MD = 13.94; 95% CI = 12.33 to 15.55) were found after erosion. Subgroup analyses revealed that in vitro erosion led to significantly higher Ra values and lower VHN values than in vivo erosion; cola drinks and juices led to more surface degradation than HCl; and the SR and SMH of polymer-infiltrated ceramic network (PICN) materials remained unchanged after erosion. After acidic challenges, a significantly rougher and softened surface was found for indirect restorative materials. Among all the indirect restorative materials, PICN showed the best acid resistance. Nevertheless, the changes in the SR and SMH of indirect restorative materials after erosion detected in the present study were minor and may not have any clinical significance.