Which is the best adhesive system for primary tooth enamel? A systematic review and network meta-analysis of bond strength data.

Abstract

<h4>Purpose</h4>Evaluate the bond strength performance of the different types of adhesive systems to the primary tooth enamel.<h4>Methods</h4>This study was registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/YURB4). A two-stage literature search was conducted by two independent reviewers on PubMed, Embase, Web of Science, Scopus, and gray literature to identify <i>in vitro</i> studies evaluating the bond strength of different adhesive systems to primary tooth enamel. The risk of bias was evaluated with the QUIN tool. A Bayesian network meta-analysis was conducted to evaluate the bond strength at 24 h.<h4>Results</h4>The final sample was composed of 14 articles. The 2-bottle universal adhesive system with phosphoric acid etching (PAE) was statistically similar to the 3-step etch-and-rinse (E&R). In addition, self-etch and etch-and-rinse adhesives with the same number of steps had similar performances. In the ranking, 3-step E&R had the highest probability of being ranked the best adhesive, while 1-step self-etch without PAE had the lowest. All studies had a low risk of bias.<h4>Conclusion</h4>2-bottle universal adhesive systems with PAE can probably provide similar bond strength to primary tooth enamel compared to 3-Step E&R. In addition, the similar performance of some of the tested adhesive systems indicates the possibility to reduce clinical steps.