Effect of Silver Diammine Fluoride with Potassium Iodide on Dentin Bond Strength: Systematic Review and Meta-Analysis...

Purpose: To investigate through a meta-analysis and systematic review the influence of the combined use of silver diammine fluoride (SDF) and potassium iodide (KI) on the bonding of adhesive materials to sound and carious dentin. Methods: The PubMed/MEDLINE, Scopus, Embase, LILACS, Web of Science databases and grey literature were searched. In vitro studies comparing the bond strength of adhesive systems (AD) or glass ionomer cements (GIC) to SDF+KI and SDF-treated dentin were included. Mean differences were estimated, separately by dentin condition (sound or carious dentin) and tooth type (primary or permanent), considering the adhesive material as a subgroup. Results: Of 1,689 potentially eligible studies, 45 were selected for full-text analysis and 14 were included. There was no significant difference in the bond strength to permanent carious dentin pre-treated with SDF or SDF+KI (P=0.17; I²=97%), regardless of the adhesive material (GIC: P=0.32; AD: P=0.25). Subgroup analyses for primary carious dentin pre-treated with SDF or SDF+KI, performed separately for GIC and AD, also showed no significant differences (GIC: P=0.13; AD: P=0.28). However, when pooling all datasets, a statistically significant difference was observed (P=0.005; I²=94%), indicating that SDF+KI improved bond strength. No difference in the bond strength of GIC to permanent sound dentin pre-treated with SDF and SDF+KI was found (P=0.80; I²=0%). Conclusion: Pooled in vitro data suggest that SDF + KI do not affect bond strength to permanent carious or sound dentin and may enhance bond strength in primary carious dentin.