Advances in Bioactive Dental Adhesives for Caries Prevention: A State-of-the-Art Review

The long-term success of composite restorations largely depends on the performance of dental adhesives at the adhesive-tooth interface. Despite ongoing improvements, secondary caries remains the leading cause of restoration failure, primarily due to the adhesive layer's susceptibility to hydrolytic degradation, bacterial invasion, and limited biological functionality. This review provides a comprehensive overview of recent advances in bioactive dental adhesives for preventing recurrent caries, focusing on their mechanisms of action, material performance, therapeutic functions, and clinical potential. Bioactive adhesives combine durable bonding with biofunctional benefits, including remineralization, antimicrobial activity, enzymatic inhibition, and support for tissue regeneration. By integrating these properties, they enhance both the durability of the adhesive interface and oral health. Recent strategies include the incorporation of ion-releasing fillers such as calcium phosphate and bioactive glass, antimicrobial monomers such as MDPB and quaternary ammonium methacrylates, enzymatic inhibitors, and hydrolytically stable resin matrices. Together, these components strengthen the adhesive interface and provide biologically active effects to prevent recurrent caries. Although in vitro findings are promising, challenges remain, including limited long-term clinical data, the absence of standardized evaluation protocols, and barriers to clinical translation. Addressing these gaps is essential to ensure predictable clinical outcomes. Bioactive dental adhesives represent a paradigm shift in restorative dentistry, evolving from passive bonding agents to multifunctional therapeutic materials. By combining structural durability with biological protection, they hold significant potential to prevent recurrent caries and improve the long-term success of composite restorations.