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
Abstract
The application method of adhesive systems affects both immediate and long-term bond strength. This systematic review analyzed in vitro 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.
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in cell cultures (in vitro), not in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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