The effect of post space irrigation protocol and adhesive strategy on push out bond strength to radicular dentin: A network meta-analysis

Abstract

This network meta-analysis is aimed at investigating the effect of cement and irrigation protocols on push put bond strength to radicular dentin. In vitro studies evaluating self- etch, self-adhesive, total etch resin cements and EDTA, NaOCl, distilled water, Chlorhexidine irrigants were included. A network meta-analysis was carried out using a random effects model. P scores were used to rank the efficacy of the different irrigation and adhesion protocols. WOS, PubMed, Scopus, and Embase databases were searched until October, 2022. 21 studies were included in the meta-analysis. The results showed that the irrigation protocol and adhesive strategy with the greatest chance of producing higher bond strength was EDTA+NaOCL/Total etch (push out MD 6.69 MPa, P score = 0.95) proceed with Chlorhexidine/Self etch (push out MD 3.70 MPa, P score =0.77) compared to Distilled water/Total etch as the control group. Network meta-analyses identified EDTA+NaOCL/Total etch resin cement and Self-adhesive cements/ CHX as the most efficient protocols for increasing push out bond strength to radicular dentin.