Bonding of Glass-Ionomer Cement and Adhesives to Silver Diamine Fluoride-treated Dentin: An Updated Systematic Review and Meta-Analysis.

Purpose: To evaluate through a systematic review and meta-analysis the bonding performance of adhesive materials to silver diamine fluoride (SDF)-treated dentin.

Materials and methods: Studies located in PubMed, Web of Science, LILACS, and Scopus up to September 2020, which compared the bond strength of adhesives (AD) or glass-ionomer cement (GIC) to SDF-treated and untreated (control) dentin were included. Mean differences were estimated separately by material and dentin condition (sound or caries-affected), with a random-effects model, at a 5% significance level.

Results: Twenty-two studies, including 11 new studies not included in our previous systematic review, met the eligibility criteria, and 21 studies were considered in the meta-analyses. SDF dentin pretreatment did not influence the bonding of GIC (Z = 0.53; p = 0.60), independent of dentin condition. SDF treatment significantly impaired the bonding of AD (Z = 2.43; p = 0.01). A rinsing step after SDF eliminated this effect in sound dentin (Z = 1.82; p = 0.07) and increased the bond strength to caries-affected dentin (Z = 2.14; p = 0.03).

Conclusion: SDF pretreatment does not influence the bond strength of GIC. A rinsing step after SDF application can improve the bond strength of AD to caries-affected dentin.