Effect of antibacterial agents on dentin bonding system: A systematic review and meta-analysis

Research on antibacterial dental adhesives has increased over the last few years. However, whether antibacterial agents improve the efficacy of dentin bonding has not yet been determined.

The purpose of this systematic review and meta-analysis was to evaluate whether antibacterial agents improve the efficacy of dentin bonding at the resin-dentin interface and to identify possible mechanisms.

Studies published within the last 10 years up to April 2024 were searched in 5 databases: PubMed (MedLine), EMBASE, Scopus, Web of Science, and Cochrane Library. A random-effects meta-analysis model was used, and pooled effect estimates were obtained by comparing the standardized mean difference (α=.05).

A total of 61 studies with 9 different types of antibacterial agent were included in the qualitative and quantitative analyses. The meta-analysis indicated that treatment with metal-based inorganic antibacterial agents improved both the immediate and long-term bond strength values (P<.05). Moreover, incorporating carbon-based substances, quaternary ammonium compounds, chlorhexidine, methacrylate derivatives, and antibiotics enhanced the long-term bond strength of the resin composites to dentin (P<.05). Subgroup analysis indicated that including metal-based inorganic antibacterial agents, quaternary ammonium compounds, and methacrylate derivatives in etch-and-rinse (ER) adhesives improved dentin bond strength (P<.05), whereas carbon-based materials in self-etching (SE) adhesives showed better bonding performance.

The introduction of some antibacterial agents into the bonding system improved in vitro bond strength and inhibited bacterial growth. However, clinical trials should be conducted to verify in vivo antibacterial effects and bond strength.