Grazioli Guillermo, de León Cáceres Elisa, Tessore Romina, Lund Rafael Guerra, Monjarás-Ávila Ana Josefina, Lukomska-Szymanska Monika, Hardan Louis, Bourgi Rim, Cuevas-Suárez Carlos Enrique
Department of Dental Materials, School of Dentistry, Universidad de la República, Av. General Las Heras 1925, Montevideo 11300, Uruguay.
Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas 96010-610, Brazil.
Antioxidants (Basel). 2024 Sep 14;13(9):1116. doi: 10.3390/antiox13091116.
This systematic review aims to evaluate whether the application of antioxidant solutions can enhance the bond strength of resin-based materials to sodium hypochlorite (NaOCl)-treated dentin. This study follows the PICOT strategy: population (sodium hypochlorite-treated dentin), intervention (application of antioxidants), control (distilled water), outcome (bond strength), and type of studies (in vitro studies). The systematic review and meta-analysis were conducted following PRISMA guidelines. Electronic databases were searched for in vitro studies evaluating the effects of antioxidants on bond strength to sodium hypochlorite-treated dentin. Two independent reviewers screened articles, extracted data, and assessed risk of bias. Meta-analyses were performed using a random-effects model to compare standardized mean differences in bond strength between antioxidant pretreatment and control groups. Inclusion criteria consisted of in vitro studies that examined the bond strength of resin-based materials to NaOCl-treated dentin with antioxidant application, while exclusion criteria included studies with incomplete data, those not using a control group, or those that did not directly measure bond strength. From 3041 initial records, 29 studies were included in the qualitative analysis and 25 in the meta-analysis. Ascorbic acid, sodium ascorbate, grape seed extract, green tea, and rosmarinic acid significantly improved bond strength to sodium hypochlorite-treated dentin ( < 0.05). The effectiveness of grape seed extract varied with adhesive system type. Hesperidin, p-toluene sulfonic acid, and sodium thiosulfate did not significantly improve bond strength. Most studies had a high risk of bias. This suggests that the conclusions drawn from these studies should be interpreted with caution, and further research with more robust methodologies may be needed to confirm the findings. In conclusion, this systematic review implies that certain antioxidants can improve bond strength to sodium hypochlorite-treated dentin, with efficacy depending on the specific agent and adhesive system used. Further standardized studies are needed to optimize protocols and confirm these findings.
本系统评价旨在评估抗氧化剂溶液的应用是否能增强树脂基材料与经次氯酸钠（NaOCl）处理的牙本质之间的粘结强度。本研究遵循PICOT策略：研究对象（经次氯酸钠处理的牙本质）、干预措施（应用抗氧化剂）、对照（蒸馏水）、结局指标（粘结强度）以及研究类型（体外研究）。本系统评价和荟萃分析按照PRISMA指南进行。检索电子数据库，查找评估抗氧化剂对与经次氯酸钠处理的牙本质粘结强度影响的体外研究。两名独立的评审员筛选文章、提取数据并评估偏倚风险。采用随机效应模型进行荟萃分析，以比较抗氧化剂预处理组和对照组之间粘结强度的标准化均值差异。纳入标准包括体外研究，这些研究考察了应用抗氧化剂时树脂基材料与经NaOCl处理的牙本质之间的粘结强度，而排除标准包括数据不完整的研究、未使用对照组的研究或未直接测量粘结强度的研究。从3041条初始记录中，29项研究纳入定性分析，25项纳入荟萃分析。抗坏血酸、抗坏血酸钠、葡萄籽提取物、绿茶和迷迭香酸显著提高了与经次氯酸钠处理的牙本质的粘结强度（<0.05）。葡萄籽提取物的有效性因粘结系统类型而异。橙皮苷、对甲苯磺酸和硫代硫酸钠并未显著提高粘结强度。大多数研究存在较高的偏倚风险。这表明从这些研究得出的结论应谨慎解读，可能需要采用更可靠方法进行进一步研究以证实这些发现。总之，本系统评价表明某些抗氧化剂可提高与经次氯酸钠处理的牙本质的粘结强度，其疗效取决于所使用的特定试剂和粘结系统。需要进一步开展标准化研究以优化方案并证实这些发现。
