Effect of contamination and decontamination methods on the bond strength of adhesive systems to dentin: A systematic review

Abstract Introduction In a suitable condition, it is important to perform any dental restorative procedure using an operatory field isolated. Then, the aim of this study was to compare the bond strength of composite restorations to dentin affected by any contamination agent through a systematic review. Methods This systematic review was performed following the PRISMA 2020 guidelines. The literature search was conducted until September 2022 by scanning the following databases: Embase, PubMed, Scielo, Scopus, and Web of Science. Manuscripts evaluated the bond strength of resin‐based materials to permanent human dentin contaminated with blood or saliva were selected for full‐text review. The risk of bias was assessed by the RoBDEMAT tool. Results A total of 3750 papers resulted from the search from all databases. After the full‐text reading, a total of 62 articles remained for the qualitative analysis. The contamination agents used were blood, saliva, and hemostatic agents. A great variety of protocols were used to contaminate the dentin surface, and the contamination process occurred in several steps of the bonding process, including before and after the etching process, after the primer application and after the adhesive application. Also, several decontamination procedures were tested, including reapplication of the etching material, rinsing with water, chlorhexidine or sodium hypochlorite and reapplication of the adhesive system. Conclusion Any contamination with blood or saliva impaired the bond strength of resin‐based materials to dentin. Decontamination procedures including water‐spray and reapplication of the bonding system could revert the impairment produced by the saliva or blood contamination. The use of hemostatic agents as a method of blood decontamination is not recommended. Clinical Significance Clinicians should avoid contamination during a bonding procedure, otherwise, a reduction in the bond quality is expected.