Comparative clinical performance of universal adhesives versus etch-and-rinse and self-etch adhesives: a meta-analysis

Abstract

Objective: To evaluate the clinical performance of universal adhesives (UA) in different modes in direct dental resin composite restorations compared to control self-etch and etch-and-rinse adhesives.

Materials and methods: The study is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A literature search was performed in five databases (Pubmed, Web of Science, Embase, Scopus, and Cochrane) until August 2024. Only RCTs that compared retention, marginal staining, and postoperative sensitivity of different forms of application of UA with etch-and-rinse and self-etching adhesives were included. The meta-analysis was performed using the Revman software (Cochrane Collaboration, UK), and this review was preregistered with the PROSPERO (CRD42022314408).

Results: A total of 15 RCTs were included, with a follow-up varied from 6 months to 4 years. In the global analysis, considering three outcomes, UA were statistically similar to control adhesives (etch-and-rinse and self-etch) regardless of the mode of application (ER, SE or EE), with a risk difference of -0.01 (-0.04, 0.02; p = 0.43; I² = 45%) for retention, -0.02 (-0.05, 0.01; p = 0.32; I² = 27%) for marginal discoloration and 0.00 (-0.01, 0.01; p = 0.82; I² = 0%) for postoperative sensitivity.

Conclusion: Universal adhesives had similar clinical performance to conventional ER and SE adhesives.

Clinical relevance: Universal adhesives provide clinical performance comparable to conventional etch-and-rinse and self-etch adhesives, offering a simplified and effective option for adhesive procedures.

Keywords: Adhesive strategy; Clinical retention; Direct resin composite restoration; Marginal staining; Postoperative sensitivity; Resin composite.