Analysis of laboratory adhesion studies in eroded enamel and dentin: a scoping review

Figures & data

Table 1. Laboratory adhesion studies in eroded substrates included in the scoping review.

Author	Country	Substrate	Sample size	Adhesive	Intervention	Test	Statistical Significance*	Conclusion
Siqueira et al. [32]	Brazil	Dentin	n = 7	Prime&Bond Elect Scotchbond U AdheSE U	Use of primers containing MMP inhibitors RFV and PAA	µTBS (24h and 24 months) Nanoleakage Nanohardness	Significant	The inclusion of cross-linking agents contributed to improving the immediate properties and stabilized the adhesive interface long-term.
Ferreti et al. [33]	Brazil	Dentin	n = 10	Clearfil SE	Cigarette smoke exposure and erosive protocol on bond strength and nanohardness	µSBS (24h) SEM Microhardness	Not significant	The erosive protocol studied did not alter the bond strength of the self-etch, when compared to sound dentin.
Krithi et al. [34]	India	Dentin	n = 15	Adper SB 2 Clearfil SE	Effect of remineralization of NaF, CPP-AP and NovaMin	µSBS (24h)	Significant	The type of adhesive influences bond strength to eroded dentin. Sodium fluoride and NovaMin showed improvement in bond strength results.
Murase et al. [35]	Japan	Enamel Dentin	n = 10	Fusio Liquid Dentin LLB-CR6 Clearfil SE Bond	Test a new bond strength setup and self-adhesive composites to eroded enamel/dentin	TBS (24h) Microhardness	Significant	Self-adhesive flowable composites show no differences between eroded and non-eroded substrates and may be a viable strategy clinically.
Costa et al. [36]	Brazil	Dentin	n = 6	Clearfil SE	Pretreatment with MMP inhibitors epigallocatechin-3-gallate and 2% CHX	µTBS (24h and 6 months)	Significant	The use of 2% chlorhexidine digluconate negatively affected eroded and non-eroded substrates, while epigallocatechin showed no difference.
Yabuki et al. [37]	Japan	Enamel	n = 10	AdheSE U All Bond U Scotchbond U	Different universal adhesives in eroded enamel	SBS (24h) CLSM	Significant	Bond strength to eroded enamel, in all adhesives, is higher than to sound enamel.
Zumstein et al. [38]	Switzerland	Dentin	n = 23	Clearfil SE Scotchbond U	Pretreatment with SnCl2/AmF	µTBS (24h and 12 months)	Significant	Bonding to eroded dentin is significantly lower than to sound. The pretreatment was not signifcant. No differences among adhesives, but aging was significantly lower.
Siqueira et al. [39]	Brazil	Dentin	n = 8	Adper SB 2 Scotchbond U	Effect of deproteinization (5.2% NaOCl)	µTBS (24h and 36 months) Nanoleakage	Significant	Deproteinization influences the stability of a resin-eroded dentin interface in the tested adhesives.
Moda et al. [40]	Brazil	Dentin	n = 9	RelyX U200	Effect of 3 surface treatments: EDTA, 20% polyacrylic acid and 2% CHX	µTBS (24h and 8 months)	Significant	In general, the surface pretreatments promoted an increase in bond strength to the eroded substrate, immediate and long-term.
Augusto et al. [41]	Brazil	Dentin	n = 10	FuturaBond M+	The effect of different application modes of a universal adhesive to eroded, deproteinized and abraded dentin	µTBS (24h and 6 months)	Significant	NaOCl at 10% as a deproteinizing agent increased the bond strength results and maintained stability to eroded dentin. Differences were found regarding the application mode.
Siqueira et al. [42]	Brazil	Dentin	n = 5	AdheSE U AllBond Universal Ambar Universal Clearfil Universal Futurabond U One Coat 7 U Peak Universal B Prime & Bond Elect Scotchbond U Xeno Select	Effect of different universal adhesives on eroded dentin	µTBS (24h)	Significant	MDP-containing adhesives showed better results in both application modes in sound and eroded substrates.
Deari et al. [43]	Switzerland	Dentin	n = 6	Optibond FL	Effect of different pretreatments: bur abrasion, 10% NaOCl, 2% CHX and prolonged application of the primer (60 s)	µTBS (24h)	Significant	Bur abrasion and pretreatment with NaOCl achieved higher bond strengths to eroded dentin.
Forgerini et al. [44]	Brazil	Dentin	n = 10	Adper SB Plus Clearfil SE Scotchbond U	Immediate and long-term performance of a universal adhesive	µSBS (24h and 6 months)	Significant	The performance is irrespective of application mode, however it is less effective in eroded dentin.
Flury et al. [45]	Switzerland	Dentin	n = 16	Scotchbond 1 XT Optibond FL	Artificially eroded samples with or without 1% BAC incorporation	SBS (24h and 12 months) SEM	Significant	BAC increased the 24 h SBS to eroded dentin and had no effect on the 12 month results.
Frattes et al. [46]	Brazil	Enamel Dentin	n = 22	Scotchbond U	Erosive conditions and acid-etching	µTBS (24h) SEM	Significant	Erosive challenge increased µTBS for the adhesive to enamel but not to dentin.
Giacomini et al. [47]	Brazil and USA	Dentin	n = 90	Adper SB Universal	Erosive conditions, acid etching and pretreatment with 2% CHX	µTBS (24h)	Significant	All tested factors were significant. Lower µTBS in artificial carious dentin and eroded dentin.
Bergamin et al. [48]	Brazil	Dentin	n = 10	Adper SB 2 Clearfil SE	Pretreatment with an arginine-containing toothpaste followed by different adhesives	µTBS (24h)	Not significant	No differences were found between toothpastes, adhesives or interaction between both in eroded dentin.
Maeda et al. [49]	Brazil	Dentin	n = 10	Adper SB 2 Adper SE Plus	Nd:YAG laser irradiation and its effect on bond strength to eroded and non-eroded substrate	SBS (24h)	Significant	Under erosive challenge, Nd:YAG laser seems to be beneficial in improving bond strength. An etch-and-rinse approach is preferred.
Giacomini et al. [50]	Brazil	Enamel	n = 8	Adper Scotchbond Adper SB 2 Clearfil SE	Effect of different adhesives on eroded and abraded enamel	µTBS (24h)	Significant	Bond strength to eroded enamel is not affected, although it is material-dependent. Authors state phosphoric acid suffices in this substrate.
Francisconi-dos-Rios et al. [51]	Brazil	Dentin	n = 7	Adper SB 2	Pretreatment with 2% CHX solution on bond strength to eroded dentin compared to sound dentin	µTBS (24h and 6 months) CLSM	Significant	Eroded dentin had lower µTBS. 2% CHX on bond strength conservation to both eroded and sound dentin was not effective except after 6 months aging.
Cruz et al. [52]	Brazil	Dentin	n = 10	Adper Easy One Adper SB 2 Clearfil SE	Effect of different adhesives and different time points on eroded and sound dentin	µSBS (24h and 6 months)	Not significant	No differences in bonding performance of the adhesives tested.
Machado et al. [53]	Brazil	Dentin	n = 10	Adper SB 2	Pretreatment with 2% CHX as an MMP inhibitor	µSBS (1 and 6 months)	Significant	2% CHX was not effective neither on sound nor eroded dentin at 1 and 6 months.
Wang et al. [13]	Brazil	Enamel	n = 13	Adper SB 2	Simulating abrasion with toothbrushing, erosion and erosion + abrasion simultaneously	µTBS (24h)	Not significant	Neither erosive nor abrasive lesions resulting from the in situ challenges affected the resin-enamel bonding.
Casas-Apayco et al. [54]	Brazil	Enamel	n = 8	Adper SB 2	Effect of different cola drinks on the adhesion to eroded enamel	µTBS (24h)	Significant	All cola drinks reduced the bond strength to enamel.
Flury et al. [55]	Switzerland	Dentin	n = 20	Clearfil SE	Pretreatment with NaF or SnF on eroded dentin	µTBS (24h) and SEM	Significant	Treatment of erosively demineralized dentin with a NaF solution or SnF mouth rinse increased bond strength of resin composite.
Lenzi et al. [56]	Netherlands	Enamel	n = 12	Adper SB 2 Vitro fil LC	Comparison of an etch-and-rinse adhesive to a resin-modified glass ionomer cement in eroded enamel	SBS (24h)	Significant	When bonding to eroded enamel, bond strength of the etch-and-rinse increases while the glass ionomer shows no difference.
Ramos et al. [57]	Brazil and Germany	Dentin	n = 104	Clearfil SE Scotchbond U	Pretreatment with Er,Cr:YSGG laser irradiation	µTBS (24h) and SEM	Significant	The surface treatment with Er,Cr:YSGG laser prior to bonding with a self-etching adhesive system improves bond strength to eroded dentin.
Zimmerli et al. [58]	Switzerland	Dentin	n = 20	Clearfil SE Optibond FL	Surface preparation techniques on eroded dentin	µTBS (24h and 12 months) and SEM	Significant	Erosion reduced bond strength in all groups but this effect was less prominent when eroded dentin was prepared by diamond bur.
Cruz et al. [59]	Brazil	Dentin	n = 6	Adper SB 2 Ketac Molar Easy Mix Vitremer	Comparison of an etch-and-rinse to glass ionomer cements in eroded dentin	µSBS (24h)	Not significant	All materials behaved equally when comparing eroded to non-eroded substrates.

*Significance was considered if the null hypothesis of the study was rejected by statistical analysis. µSBS: microshear bond strength; µTBS: Microtensile bond strength; AmF: amide fluoride; BAC: benzalkonium chloride; CHX: chlorhexidine; CLSM: Confocal Laser Scanning Microscopy; CPP-AP: casein phosphopeptide-amorphous calcium phosphate nanocomplex; EDTA : ethylenediaminetetraacetic acid; Er,Cr:YSGG: erbium, chromium: yattrium-scandium-gallium-garnet laser; LLB-CR6: experimental adhesive; NaOCl: sodium hypochlorite; NaF: sodium fluoride Nd:YaG: neodymium-doped yttrium aluminium garnet; MMP: matrix metalloproteinases; PAA: Proanthrocyanidins; RFV: riboflavin; SBS: shear bond strength; SEM: Scanning electron microscopy; SnF: strontium fluoride; TBS: tensile bond strength.

Figure 1. PRISMA-ScR flowchart used for the scoping review. Reasons for study exclusion included: studies which looked at acid-base resistance zones (ABRZ), evaluating erosion after the restorative procedure, studies which evaluated adhesion to orthodontic brackets, or studies which did not use resin composite as a restorative material.

Figure 2. List of adhesives and their respective categories included in the primary studies.

Table 2. Erosion protocols discriminated by study and frequency of appearance (n).

Solution used for erosion	Studies (n)	References
Citric acid pH range [2.1–3.75]	16	Siqueira et al. [32], Ferreti et al. [33], Krithi et al. [34], Costa et al. [36], Yabuki et al. [37], Zumstein et al. [38], Siqueira et al. [39], Augusto et al. [41], Siqueira et al. [42], Deari et al. [43], Flury et al. [45], Frattes et al. [46], Bergamin et al. [48], Flury et al. [55], Ramos et al. [57], Zimmerli et al. [58]
Coca-Cola, Coca-Cola Light or Coca-Cola Zero	10	Siqueira et al. [32], Murase et al. [35], Siqueira et al. [42], Forgerini et al. [44], Francisconi-dos-Rios et al. [51], Machado et al. [53], Wang et al. [13], Casas-Apayco et al. [54], Lenzi et al. [56], Cruz et al. [59]
Sprite Zero, Sprite Light	2	Maeda et al. [49], Cruz et al. [52]
Orange Juice	2	Giacomini et al. [47], Giacomini et al. [50]
HCl-pepsin (Hydrochloric acid and pepsin)	1	Moda et al. [40]

Figure 3. Weighted summary plot of the seven domains included in the risk of bias assessment.

Table 3. Quality assessment of the primary studies included in this review, using a Yes/No scale for seven different domains.

Study	Sample randomization	Sound teeth	Sample size calculation	Control group	Erosion protocol reproducible	Adhesives according to manufacturers instructions	Blinding of the operator in the test machine	Overall
Siqueira et al. [32]	Y	Y	N	N	Y	Y	N	Moderate
Ferreti et al. [33]	N	N	N	Y	Y	Y	N	High
Krithi et al. [34]	Y	N	N	Y	Y	Y	N	Moderate
Murase et al. [35]	N	N	N	Y	Y	N	N	High
Costa et al. [36]	Y	Y	N	Y	Y	Y	N	Low
Yabuki et al. [37]	N	N	Y	Y	N	N	N	High
Zumstein et al. [38]	N	Y	N	Y	Y	N	N	High
Siqueira et al. [39]	Y	Y	N	Y	Y	N	N	Moderate
Moda et al. [40]	N	N	N	Y	Y	N	N	High
Augusto et al. [41]	Y	Y	Y	Y	Y	Y	N	Low
Siqueira et al. [42]	Y	Y	Y	Y	Y	Y	N	Low
Deari et al. [43]	Y	Y	N	Y	Y	Y	N	Low
Forgerini et al. [44]	Y	Y	N	Y	Y	Y	N	Low
Flury et al. [45]	N	Y	N	Y	N	N	N	High
Frattes et al. [46]	Y	Y	N	Y	Y	Y	N	Low
Giacomini et al. [47]	Y	Y	N	Y	Y	Y	N	Low
Bergamin et al. [48]	Y	Y	N	Y	Y	Y	N	Low
Maeda et al. [49]	Y	Y	N	Y	N	Y	N	Moderate
Giacomini et al. [50]	Y	Y	N	Y	Y	N	N	Moderate
Francisconi-dos-Rios et al. [51]	N	Y	N	Y	Y	N	N	High
Cruz et al. [52]	Y	Y	N	Y	Y	Y	N	Low
Machado et al. [53]	Y	Y	N	Y	N	N	N	High
Wang et al. [13]	Y	Y	N	Y	Y	N	N	Moderate
Casas-Apayco et al. [54]	Y	Y	N	Y	N	N	N	High
Flury et al. [55]	Y	Y	Y	Y	Y	Y	N	Low
Lenzi et al. [56]	Y	Y	N	Y	Y	Y	N	Low
Ramos et al. [57]	Y	N	N	N	Y	N	N	High
Zimmerli et al. [58]	N	N	N	Y	Y	Y	N	High
Cruz et al. [59]	Y	Y	N	Y	Y	Y	N	Low

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