Bond Strength Evaluation of Ceramic Restorations with Immediate Dentin Sealing: A Systematic Review and Meta-Analysis

Abstract

Statement of the Problem: Immediate dentin sealing (IDS) was introduced to overcome the disadvantages of delayed dentin sealing like pollution of dentin tubules, microleakage, and bond strength destruction over time. The effect of IDS on the bond strength of indirect restorations is still debatable.Purpose: This study was conducted to determine the effect of IDS on the bond strength of ceramic restorations to dentin.Materials and Method: In this systematic review and meta-analysis, the study protocol was registered on the PROSPERO database under the registration number CRD420202014 27. MEDLINE (PubMed), Web of Science, Scopus, and ProQuest databases were searched until January 2021 and updated in January 2022. Worldcat.org and Opengrey.eu, ProQuest dissertation and thesis, and Google Scholar were searched to explore the grey literature. The in vitro studies evaluating the bond strength of ceramic restoration to dentin with and without IDS were included. Seven criteria were assessed to evaluate the risk of bias in the study. Statistical analyses were conducted using RevMan 5.3. The inverse variance method was used to determine the mean difference of micro-tensile bond strength (µTBS) and shear bond strength (SBS).Results: A total of 10 studies (20 datasets) were included in the meta-analysis. Regarding the µTBS analysis, IDS had a significantly higher bond strength than Delayed Dentin Sealing (DDS) (MD:1.16, 95%CI:0.28_2.03, I2=0%). However, no significant difference was found between them in the SBS analysis (MD:0.25, 95%CI: -0.56-1.06, I2=96%). All studies were categorized to have a moderate or high risk of bias.Conclusion: Most in vitro evidence showed favorable results for the effect of IDS on the bond strength and durability of indirect restorations. The adhesive system and the type of ceramic and its treatment before cementation are determining factors. Due to the heterogeneity of the outcomes and studies with a moderate/high risk of bias, the quality of the evidence was low.

Keywords

• dentin
• bonding agents
• resin cement
• shear strength
• tensile strength