J Adhes Dent. 2019;21(1):7-26. doi: 10.3290/j.jad.a41975.
To evaluate through a systematic review and meta-analysis whether the immediate and long-term bonding performance of universal adhesives would be improved by prior acid etching.
Two reviewers performed a literature search up to April 2018 in eight databases: PubMed, Web of Science, Cochrane Library, SciELO, Scopus, LILACS, IBECS, and BBO. Only studies that evaluated the dentin or enamel bond strength of universal adhesives using a self-etch or etch-and-rinse strategy were included. Analyses were carried out using RevMan 5.3.5 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). A global analysis comparing self-etch or etch-and-rinse strategies and the influence of aging on bonding performance was performed with random-effects models at a significance level of p < 0.05.
A total of 59 in vitro studies were included in the meta-analysis. The enamel bond strength of universal adhesives was improved by the etch-and-rinse approach (p < 0.05). In dentin, this effect was observed for ultra-mild and intermediately strong universal adhesives (p < 0.05). Irrespective of the strategy employed, intermediately strong adhesives showed a decrease in bond strength after all types of aging. This effect was also observed for ultra--mild universal adhesives used in the etch-and-rinse approach (p < 0.05). Mild universal adhesives showed bond strength stability in both strategies (p > 0.05).
The in vitro evidence suggests that bonding performance of mild universal adhesives can be improved by using the selective enamel-etch strategy. Mild universal adhesives seem to be the more stable materials, in both etch-and-rinse or self-etch strategies.
通过系统评价和荟萃分析评估通用粘结剂的即刻和长期粘结性能是否通过预先酸蚀得到改善。
两名审查员在截至 2018 年 4 月的 8 个数据库中进行了文献检索：PubMed、Web of Science、Cochrane Library、SciELO、Scopus、LILACS、IBECS 和 BBO。仅纳入了使用自酸蚀或酸蚀-冲洗策略评估通用粘结剂的牙本质或牙釉质粘结强度的研究。分析使用 RevMan 5.3.5（北欧 Cochrane 中心，Cochrane 协作网，丹麦哥本哈根）进行。使用随机效应模型在 0.05 水平上进行了全局分析，比较了自酸蚀或酸蚀-冲洗策略以及老化对粘结性能的影响。
共有 59 项体外研究纳入荟萃分析。通用粘结剂的牙釉质粘结强度通过酸蚀-冲洗法得到改善（p<0.05）。在牙本质中，这种效果在超轻度和中度强度通用粘结剂中观察到（p<0.05）。无论使用何种策略，中度强度粘结剂在所有类型的老化后粘结强度均下降。这种效果也在酸蚀-冲洗法中使用的超轻度通用粘结剂中观察到（p<0.05）。轻度通用粘结剂在两种策略中均表现出粘结强度稳定性（p>0.05）。
体外证据表明，使用选择性牙釉质酸蚀策略可以提高轻度通用粘结剂的粘结性能。在酸蚀-冲洗或自酸蚀策略中，轻度通用粘结剂似乎是更稳定的材料。
