Surface Conditioning Prior to the Application of Glass-Ionomer Cement: A Systematic Review and Meta-analysis.

PURPOSE To systematically review the literature to determine whether the laboratory and clinical performance of glass-ionomer cement (GIC) is influenced by surface conditioning with polyacrylic acid (PAA). MATERIALS AND METHODS This systematic review was conducted according to PRISMA and registered in PROSPERO (CRD42016039305). A comprehensive literature search was conducted in seven electronic databases considering clinical and laboratory studies published up to July 2018, with no limit on year of publication. Two reviewers independently selected papers, extracted data, and assessed the risk of bias. Of 141 eligible studies, 23 were fully analyzed. A total of 15 studies (12 laboratory and three clinical trials) were included in the systematic review and three laboratory studies concerning the microtensile bond strength (μTBS) were included in the meta-analysis. RESULTS The meta-analysis showed that pretreating the surface with PAA before using GIC significantly improved the μTBS (OR = 3.17; 95% CI: 0.51-5.83; p = 0.02). In the longitudinal clinical trials, no significant difference was observed between applying PAA or not into the cavities before using GIC. Risk of bias was considered high in all study designs. CONCLUSION Surface preconditioning with PAA has a positive effect on the bond strength of GIC. However, this finding was not confirmed in longitudinal clinical trials.