Abstract
Objectives Resin-dentin bond strength decreases over time. This reduction is related to the loss of hybrid layer integrity. Collagenolytic enzymes, especially matrix metalloproteinases (MMPs), are responsible for the degradation of the collagen matrix of the hybrid layer. Various MMP inhibitors with the ability to prevent enzymatic degradation have been identified. This study aimed to systematically review the literature for studies which evaluated the effect of MMP inhibitors on the immediate and aged dentin bond strengths. Study SelectionScreening and analysis were carried out by two reviewers. Two databases were searched, and from a total of 740 articles, 43 were accepted for full review. 21 articles with 0.2%–2% chlorhexidine (CHX) treatments were included for meta-analysis. A risk of bias assessment was performed on all studies chosen for meta-analysis. A variety of MMP inhibitors have been studied, CHX being the most widely used. Conclusions A clear trend for a lower loss of dentin bond strength was observed with different MMP inhibitors. In meta-analysis, no significant difference was seen between the CHX and control in the immediate bond strengths. Bond strengths in the CHX group were significantly higher than the control group after aging (P < 0.001). The percentage of fractures occurring at the adhesive interface increased after aging. Five out of 21 studies included in the meta-analysis had high and the rest medium risk of bias. More long-term studies with lower risks of bias should be carried out to increase the reliability of results. Clinical RelevanceThe use of MMP inhibition with chlorhexidine can be recommended to increase the longevity of resin-dentin bond strength.
Highlights
Studies have shown that the bond between the adhesive systems and dentin weakens over time. is decrease in bond strength is related to the degradation of the hybrid layer [1, 2]. e hybrid layer is the area of adhesion formed by the dentin collagen matrix and resin adhesive
After exposure to acid or acidic monomers, the demineralized dentin collagen matrix is infiltrated with the applied adhesive resin [3, 4]. e collagen matrix is vulnerable to enzymatic degradation by the endogenous collagenolytic enzymes, matrix metalloproteinases (MMPs) and cysteine cathepsins, and these enzymes play an important role in bond destruction [2]
Systematic review and meta-analysis by Montagner et al [8] indicated that CHX is effective in maintaining long-term bond strength. is study aimed to provide an updated systematic review and meta-analysis of the literature involving studies which evaluated the effect of MMP inhibitors on the immediate and aged resin-dentin bond strength. e hypothesis was that MMP inhibitors have a significant effect on the longevity of bond strength, which becomes evident after 6 months
Summary
Studies have shown that the bond between the adhesive systems and dentin weakens over time. is decrease in bond strength is related to the degradation of the hybrid layer [1, 2]. e hybrid layer is the area of adhesion formed by the dentin collagen matrix and resin adhesive. Studies have shown that the bond between the adhesive systems and dentin weakens over time. Is decrease in bond strength is related to the degradation of the hybrid layer [1, 2]. E hybrid layer is the area of adhesion formed by the dentin collagen matrix and resin adhesive. MMP inhibitors can prevent the function of these enzymes, with chlorhexidine (CHX), galardin, and benzalkonium chloride being the most widely studied [5, 6]. Systematic review and meta-analysis by Montagner et al [8] indicated that CHX is effective in maintaining long-term bond strength. Is study aimed to provide an updated systematic review and meta-analysis of the literature involving studies which evaluated the effect of MMP inhibitors on the immediate and aged resin-dentin bond strength. Systematic review and meta-analysis by Montagner et al [8] indicated that CHX is effective in maintaining long-term bond strength. is study aimed to provide an updated systematic review and meta-analysis of the literature involving studies which evaluated the effect of MMP inhibitors on the immediate and aged resin-dentin bond strength. e hypothesis was that MMP inhibitors have a significant effect on the longevity of bond strength, which becomes evident after 6 months.
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