Effect of Cavity Disinfectants on Dentin Bond Strength and Clinical Success of Composite Restorations-A Systematic Review of In Vitro, In Situ and Clinical Studies.

Ana Coelho,Inês Amaro,Eunice Carrilho,Carlos Miguel Marto,José Saraiva,Gianrico Spagnuolo,Anabela Paula,Inês Marcelino,Beatriz Rascão,Manuel Marques Ferreira

doi:10.3390/ijms22010353

Abstract

Cavity disinfection becomes an important step before a dental restorative procedure. The disinfection can be obtained cleaning the dental cavity with antimicrobial agents before the use of adhesive systems. The aim of this study was to conduct a systematic review on the effect of different cavity disinfectants on restorations’ adhesion and clinical success. A search was carried out through the Cochrane Library, PubMed, and Web of Science. In vitro and in situ studies reporting results on dentin bond strength tests, and clinical studies published until August 2020, in English, Spanish and Portuguese were included. The methodological quality assessment of the clinical studies was carried out using the Revised Cochrane risk-of-bias tool. Chlorhexidine could preserve adhesion to dentin. EDTA and ethanol had positive results that should be further confirmed. Given the significant lack of scientific evidence, the use of lasers, fluoridated agents, sodium hypochlorite, or other products as cavity disinfectants should be avoided. Chlorhexidine is a safe option for cavity disinfection with adequate preservation of adhesion to dentin. Moreover, future researches should be focused on the efficacy of these disinfectants against cariogenic bacteria and their best application methods.

Highlights

Rehabilitation failure may be related to tooth and/or restoration fracture and secondary caries, which often occurs at the interface between restorative material and dentin [5,6,7,8]
In this review only studies that tested, at most, one cavity disinfection method per experimental group were included as a way to try to perceive each disinfectant’s true effect regarding bond strength alterations
A variety of different products is available for cavity disinfection prior to adhesive procedures

Summary

Introduction

Dental caries is the most prevalent pathology in the oral cavity, affecting most of the world population. Caries results from the interaction between dental structure and microbial biofilm, highly organized and formed on its surface, being characterized by the alternating phenomena of demineralization and remineralization [1,2,3]. Demineralization overcomes remineralization, leading to the dissolution of hard tissues of the tooth, degradation of collagen fibers and impairment of the mechanical properties of dentin, resulting in caries [1,2,4]. In situations where remineralization is insufficient to resolve the pathology, the treatment of dental caries consists in the removal of infected tissue and subsequent rehabilitation. Rehabilitation failure may be related to tooth and/or restoration fracture and secondary caries, which often occurs at the interface between restorative material and dentin [5,6,7,8]

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Discussion

Conclusion