Effectiveness of adhesive strategies for direct posterior composite restorations in permanent teeth: A systematic...

This systematic review and network meta-analysis (NMA) compared the clinical performance of adhesive strategies used in direct posterior composite restorations in permanent teeth. Randomized controlled trials were retrieved from PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. Studies reporting dichotomous clinical outcomes assessed with USPHS or FDI criteria were included. A frequentist random-effects NMA estimated relative treatment effects as odds ratios with 95% confidence intervals; treatments were ranked using P-scores, and evidence certainty was assessed with the Confidence in Network Meta-Analysis (CINeMA) framework. Nine studies were identified, of which six contributed to the 12-month NMA. Multiple adhesive strategies combining different etching approaches and adhesive systems were evaluated. No significant differences were found for marginal adaptation or retention loss. Although etch-and-rinse and universal adhesives showed higher P-scores, these findings were uncertain. CINeMA indicated moderate confidence in the evidence, with imprecision as the main limitation. At 12 months, no statistically significant differences were detected among contemporary adhesive strategies for marginal adaptation or retention loss; however, the estimates were imprecise, so these results indicate a lack of demonstrated differences rather than proven equivalence between strategies.