Biomimetic Remineralization Strategies for Dentin Bond Stability-Systematic Review and Network Meta-Analysis

This systematic review and network meta-analysis aimed to evaluate the bond strength of artificial caries-affected dentin (ACAD) of permanent human teeth with and without biomimetic remineralization (BR), assessed based on in vitro studies. Following PRISMA guidelines, we conducted a systematic search until June 2023, identifying 82 eligible articles for full-text analysis. We assessed the study characteristics, methodological quality, and summary results. Bond strength was examined immediately and after artificial aging using three bond strength tests. We performed meta-regressions (using OpenBUGS software) to explore the relationship between the independent variable's adhesive application technique (Etch-and-Rinse or Self-Etch) and ACAD protocol (chemical or biological) and the dependent variable of bond strength. Additionally, we conducted random-effect NMAs (using CINEMA software) to compare the effect of multiple interventions per application technique and ACAD protocol simultaneously. Among the included studies that compared various BR strategies, most studies (19 out of 22) presented a medium risk of bias. In some comparisons, the meta-regression results revealed a significant association between bond strength at 24 h and both the adhesive application technique and the ACAD protocol. Our findings indicate the potential of BR to enhance bond strength in human ACAD in in vitro settings.