Effect of 2% Chlorhexidine Following Acid Etching on Microtensile Bond Strength of Resin Restorations: A Meta-Analysis

Abstract

Background and Objectives: The aim of this systematic review was to examine the effect of 2% chlorhexidine following acid etching on the microtensile bond strength of resin restorations for different follow-up times. Materials and Methods: A thorough search of PubMed, Scopus, and Embase databases were conducted. In vitro experimental studies or in vivo studies published up to December 2018 with an experimental group treated with a 2% chlorhexidine solution following acid etching and a control group were included, wherein the final restoration used a resin composite in both the groups. Results: Twenty-one articles were identified for qualitative analysis and 18 for meta-analysis. The difference in the means of microtensile bond strength between the two groups was calculated for the different follow-up times. The differences were significant for 6 months (4.30 MPa; 95% CI 2.72–5.89), 12 months (8.41 MPa; 95% CI 4.93–11.88), and 2–5 years including aged and thermocycling samples (9.08 MPa; 95% CI 5.36–12.81). There were no significant differences for the type of adhesive used. A meta-regression model showed a significant effect of time on the microtensile bond strength. Conclusions: The application of a 2% chlorhexidine solution after acid etching increased the microtensile bond strength significantly for follow-up times of 6 months or more. The adhesive type had no influence.

The effect of chlorhexidine primer application on the clinical performance of composite restorations: a literature review

“…Even though the in vitro studies reported that CHX had the ability to preserve bond‐strength of composite restorations even after 5 years of artificial aging, 23 and to preserve the integrity of the HL after 10 years of aging, 15 all the clinical trials included in this paper clearly demonstrated that CHX did not affect the retention and survival rates of composite restorations placed in NCCL. There are several possible explanations for these observations.…”

“…However, the beneficial effect of CHX on resin‐based restorations became evident in the function of time, since significantly higher mean bond‐strength values were observed in groups where CHX was used between phosphoric acid etching step and adhesive application. The reported differences in microtensile bond‐strengths between CHX and control groups were 5.02 MPa, 6.2 MPa and 10.52 MPa for 6, 12 and 24 months, respectively 23 . These values were calculated by the authors of the meta‐analyses, based on the data from the available in vitro studies, and it was speculated that the effect of CHX on bond‐strength is time‐dependent.…”

“…In order to confirm the time‐dependent attribute of the inhibitory effect of CHX, the authors ran further subgroup analyses, which demonstrated that the adhesive system did not influence microtensile bond‐strength. However, it should be pointed out that this meta‐analysis 23 only considered different brands of etch‐and‐rinse adhesives and no self‐etch adhesive systems were included.…”

Selective toxicity of antibacterial agents—still a valid concept or do we miss chances and ignore risks?

“…Marketing authorizations have been granted for treatment of rosacea and periodontal diseases with sub-antimicrobial doses of doxycycline due to MMP inhibition [136][137][138][139][140][141][142]. Interestingly, several disinfectants inhibiting MMPs via cation-chelation are used clinically in dentistry [143][144][145][146][147][148][149][150][151][152]. Aminoglycosides exhibited anti-neoplastic effects as well, which were due to drug-induced increases in readthrough of premature stop codons and not, as expected, inhibition of MMPs due to a lack of chelation with zinc (Table S2).…”

Incorporación del digluconato de clorhexidina como agente inhibidor de las metaloproteinasas en los procesos adhesivos para acrecentar su durabilidad

“…Dentro del tejido dentinario se ha identificado cuatro tipos de metaloproteinasas (MMP-2 y MMP-9 (gelatinasas), MMP-8 (colagenasa), y MMP-20 (enamelisina)). 6 Las Metaloproteinasas de matriz dentinaria (MMPs), constituyen un factor asociado a la disminución de la longevidad de las restauraciones, ya que son responsables de la degradación del colágeno. 7 Actualmente se han introducido a los protocolos de adhesión de grabado total, la aplicación y frotación de clorhexidina embebida por quince o treinta segundos en el fondo de la cavidad previa a su restauración, este efecto desinfectante elimina potencialmente las bacterias que podrían irritar el tejido pulpar provocando sensibilidad postoperatoria y caries secundaria, además disminuye la degradación de la capa híbrida, inhibiendo la actividad proteolítica de las metaloproteínasas garantizando de manera directa la longevidad de las restauraciones.…”