Impact of active vs. passive application of dental adhesives on bond strength to dentin and enamel: A systematic review and meta-analysis of in vitro studies
Gabriela Luiza Moreira Carvalho, Paulo Matias Moreira, Bruna Tavares Carneiro, Thaís Yumi Umeda Suzuki, Marcos Daniel Septímio Lanza, Hugo Henriques Alvim, Marcelo Giannini, Carolina Bosso André
Abstract
studies comparing active versus passive application of adhesives on enamel and dentin, regardless of classification. A comprehensive search was conducted in PubMed/Medline, Embase, Scopus, Web of Science, Lilacs, and Grey Literature. Included studies assessed bond strength with active or passive application. Meta-analyses were stratified by substrate (enamel and dentin) and application mode (etch-and-rinse or self-etching), using a random-effects model and I² index for heterogeneity. The RobDEMAT tool assessed the risk of bias. Out of 3022 articles, 23 met the inclusion criteria. Meta-analysis showed that passive application of universal adhesives in etch-and-rinse mode resulted in higher bond strength to enamel. However, active application of etch-and-rinse or universal adhesives in etch-and-rinse mode improved bond strength on dentin. For self-etching or universal adhesives in self-etching mode, active application enhanced bond strength on both enamel and dentin. Few studies assessed longevity, but those that did reported positive outcomes for active application. One self-curing universal adhesive showed significantly different results. In conclusion, active application improves bond strength to dentin in two-step etch-and-rinse mode and to unconditioned enamel and dentin in self-etching mode.