Effect of Different Surface Treatments on the Long-Term Repair Bond Strength of Aged Methacrylate-Based Resin Composite Restorations: A Systematic Review and Network Meta-analysis

Abstract

This systematic review and network meta-analysis is aimed at investigating the effect of common surface treatments on the long-term repair bond strength of aged resin composite restorations and to rank and compare these surface treatments. In vitro studies evaluating the methacrylate-based resin composites subjected to rigorous aging protocols before and after being repaired with a new composite were included. A frequentist network meta-analysis was carried out using a random effects model. $P$ scores were used to rank the efficacy of the surface treatments. Also, the global and node-split inconsistencies were evaluated. Web of Science, PubMed/Medline, Scopus, and Embase databases were searched until July 07, 2022. Twenty-six studies were included in the meta-analysis. The results showed that the application of silane and a total-etch (shear MD 32.35 MPa, 95% CI: 18.25 to 46.40, $P$ score 0.95; tensile MD 33.25 MPa, 95% CI: 25.07 to 41.44; $P$ score 0.77) or a self-etch (shear MD 38.87 MPa, 95% CI: 21.60 to 56.14, $P$ score 0.99; tensile MD 32.52 MPa, 95% CI: 23.74 to 41.29; $P$ score 0.73) adhesion protocol subsequent to the roughening with diamond bur produced the highest (micro)tensile and (micro)shear bond strengths compared to diamond bur alone as the control group. There was no difference between self- and total-etch adhesive protocols. Mechanical surface treatments yielded greater bond strength when used alongside the chemical adhesive agents. Further, it is possible to achieve acceptable repair bond strength using common dental clinic equipment. Therefore, clinicians could consider repairing old resin composites rather than replacing them.