Effect of Different Surface Treatments on the Long-term Repair Bond Strength of Aged Methacrylate-based Composite Resin Restorations: A Systematic Review and Network Meta-analysis

Abstract

Introduction: Composite resin restorations need to be repaired or replaced, over different time periods following placement due to different reasons. Based on the extent of the defected part, repair may be a viable option to replacement. Recent advances in adhesive dentistry, and equivalent or even superior clinical survival rates of repaired composite resin restorations than replaced ones have led to a paradigm shift from full replacement of slightly defective old composite resin restorations towards repairing the defected portion. Objectives: This systematic review and network meta-analysis aimed to investigate the effect of common surface treatments on the long-term repair bond strength of aged composite resin restorations and to rank and compare them. Methods: In-vitro studies evaluating the methacrylate-based composite resins subjected to rigorous aging protocols before and after being repaired with a new composite were included. A frequentist network meta-analysis was carried out using a random-effects model. P-scores were used to rank the efficacy of the surface treatments. Also, the global and node-split inconsistencies were evaluated. Web of Science, PubMed/Medline, Scopus, and Embase databases were searched until July 07, 2022. Results: Twenty-six studies were included in the meta-analysis. The results showed that the application of silane and a total-etch (shear MD 32.35 MPa, 95% CI 18.25 to 46.40, P-score 0.95; tensile MD 33.25 MPa, 95% CI 25.07 to 41.44; P-score 0.77) or a self-etch (shear MD 38.87 MPa, 95% CI 21.60 to 56.14, P-score 0.99; tensile MD 32.52 MPa, 95% CI 23.74 to 41.29; P-score 0.73) adhesion protocol subsequent to the roughening with diamond bur, produced the highest (micro)tensile and (micro)shear bond strengths compared to diamond bur alone as control group. There was no difference between self- and total-etch adhesive protocols. Mechanical surface treatments yielded greater bond strength when used alongside the chemical adhesive agents.Conclusion: Ultimately, it is possible to achieve acceptable repair bond strength using common dental clinic equipment. Therefore, clinicians could consider repairing old composite resins rather than replacing them.