Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Campus Universitário, Quinta da Granja, Monte de Caparica, 2829-511, Almada, Portugal.
Division of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK.
Sci Rep. 2022 Jul 29;12(1):13028. doi: 10.1038/s41598-022-17371-0.
Strategies aiming to improve the longevity of resin-dentin adhesive interface developed so far have only been able to retard the problem. Different approaches are thus needed. The objective of this review was to determine whether the use of collagen-depletion strategies after acid-etching procedures may improve the bond strength of resin-based materials to dentin. A systematic review was planned following 2021 PRISMA statement guidelines, with a search strategy performed in five electronic databases: PubMed/Medline, Scopus, EMBASE, SciELO and IADR Abstract Archive (last search: 17/01/2022). Inclusion criteria encompassed studies which evaluated a collagen-depletion strategy in acid-etched human dentin and tensile/shear bond strength tests. Risk of bias assessment was carried out by two reviewers, working independently on an adapted five-domain risk of bias (RoB) checklist for laboratory studies. Results were synthesized qualitatively, as a meta-analysis was not possible due to limited number of studies and their RoB. A total of eight studies were eligible for inclusion in the systematic review after inclusion/exclusion criteria application. Out of these, two evaluated the effect of using NaOCl followed by an antioxidant, and the remaining six evaluated different enzymatic treatments (bromelain, chondroitinase ABC, papain, and trypsin). None of the studies reported a decrease of bond strength when a collagen-depletion strategy was used, in comparison to traditional hybrid layers (control). All enzymatic treatment studies which respected the inclusion criteria improved the bond strength to dentin. Some specific collagen-depletion strategies seem to play a favorable role in improving immediate bond strengths to dentin. Further research with sound methodology is required to consolidate these findings, since limitations in RoB and a low number of studies were found. The assessment of further proteolytic agents and long-term outcomes is also required.
迄今为止，旨在提高树脂-牙本质粘结界面耐久性的策略只能延缓该问题的发生。因此，需要不同的方法。本综述的目的是确定酸蚀处理后使用胶原耗竭策略是否可以提高树脂基材料对牙本质的粘结强度。根据 2021 年 PRISMA 声明指南，计划进行系统综述，在五个电子数据库中进行搜索策略：PubMed/Medline、Scopus、EMBASE、SciELO 和 IADR 摘要档案（最后一次搜索：2022 年 1 月 17 日）。纳入标准包括评估酸蚀人牙本质中胶原耗竭策略和拉伸/剪切粘结强度试验的研究。两名审稿人独立使用改良的五领域偏倚风险（RoB）检查表对实验室研究进行偏倚风险评估。由于研究数量有限且 RoB 较高，因此无法进行荟萃分析，仅对结果进行定性综合。在应用纳入/排除标准后，共有 8 项研究符合纳入系统综述的条件。其中，两项研究评估了使用 NaOCl 后再使用抗氧化剂的效果，其余 6 项研究评估了不同的酶处理（菠萝蛋白酶、透明质酸酶 ABC、木瓜蛋白酶和胰蛋白酶）。与传统混合层（对照）相比，使用胶原耗竭策略时，没有研究报告粘结强度降低。所有符合纳入标准的酶处理研究均提高了牙本质的粘结强度。一些特定的胶原耗竭策略似乎在提高牙本质的即刻粘结强度方面发挥了有利作用。需要进一步进行具有良好方法学的研究来证实这些发现，因为发现了 RoB 存在局限性和研究数量较少的问题。还需要评估其他蛋白水解剂和长期结果。
