Department of Operative Dentistry, School of Dentistry, University of the Republic, Montevideo, Uruguay.
Department of Technical Operative Dentistry, School of Dentistry, University of the Republic, Montevideo, Uruguay.
J Esthet Restor Dent. 2021 Jul;33(5):702-712. doi: 10.1111/jerd.12743. Epub 2021 May 11.
To evaluate whether natural antioxidant treatment would enhance the immediate bond strength of dental adhesives to bleached enamel through a systematic review and meta-analysis.
Two reviewers performed a literature search up to November 2019 in seven databases. Only in vitro studies that evaluated the effect of the application of natural antioxidants in the bond strength of dental adhesives to bleached enamel were included. Analyses were carried out using RevMan 5.3.5 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). A global analysis was performed with random-effects models at a significance level of p < 0.05.
Twenty-four studies were included in the meta-analysis. Both in-office (p ˂ 0.001) and at-home (p ˂ 0.001) bleaching reduced the immediate bond strength. When compared to bleached enamel, all antioxidants improved the bond strength, but only grape seed extract/proanthocyanidin and lycopene restored it to the control values (p ˃ 0.05).
In vitro available evidence suggests that the use of natural antioxidants can be beneficial when performing immediate resin-based restorations after bleaching, however, these results should be taken with caution since they are based on medium and high risk of bias studies; low bias studies are needed to draw relevant conclusions.
Despite the lack of clinical evidence, the present study confirms the benefits of applying natural antioxidant agents to enhance the in vitro bond strength when performing immediate esthetic restorations after bleaching. Since certain antioxidant agents proved more effective than others, clinical investigations may be focused on the ones that withhold the most promising results. The application of natural antioxidants after bleaching may enable immediate esthetic restorations to be performed.
通过系统评价和荟萃分析评估天然抗氧化剂处理是否会增强漂白牙釉质的牙科胶粘剂的即刻粘结强度。
两名评审员在七个数据库中进行了文献检索，截止到 2019 年 11 月。仅纳入评估天然抗氧化剂在漂白牙釉质的牙科胶粘剂粘结强度中应用效果的体外研究。使用 RevMan 5.3.5 （北欧 Cochrane 中心，Cochrane 协作组织，丹麦哥本哈根）进行分析。在 p<0.05 的显著性水平下，采用随机效应模型进行全局分析。
荟萃分析纳入了 24 项研究。诊室（p<0.001）和家庭（p<0.001）漂白均降低了即刻粘结强度。与漂白牙釉质相比，所有抗氧化剂均提高了粘结强度，但只有葡萄籽提取物/原花青素和番茄红素恢复至对照值（p>0.05）。
体外现有证据表明，在漂白后立即进行树脂基修复时，使用天然抗氧化剂可能是有益的，但是，由于这些结果基于中高偏倚风险的研究，因此应谨慎对待；需要进行低偏倚研究以得出相关结论。
尽管缺乏临床证据，但本研究证实了在漂白后立即进行美学修复时，应用天然抗氧化剂增强体外粘结强度的益处。由于某些抗氧化剂比其他抗氧化剂更有效，因此临床研究可能会集中在那些结果最有希望的抗氧化剂上。在漂白后应用天然抗氧化剂可能可以进行即时美学修复。
