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      Effect of 2% Chlorhexidine Following Acid Etching on Microtensile Bond Strength of Resin Restorations: A Meta-Analysis

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          Abstract

          Background and Objectives: The aim of this systematic review was to examine the effect of 2% chlorhexidine following acid etching on the microtensile bond strength of resin restorations for different follow-up times. Materials and Methods: A thorough search of PubMed, Scopus, and Embase databases were conducted. In vitro experimental studies or in vivo studies published up to December 2018 with an experimental group treated with a 2% chlorhexidine solution following acid etching and a control group were included, wherein the final restoration used a resin composite in both the groups. Results: Twenty-one articles were identified for qualitative analysis and 18 for meta-analysis. The difference in the means of microtensile bond strength between the two groups was calculated for the different follow-up times. The differences were significant for 6 months (4.30 MPa; 95% CI 2.72–5.89), 12 months (8.41 MPa; 95% CI 4.93–11.88), and 2–5 years including aged and thermocycling samples (9.08 MPa; 95% CI 5.36–12.81). There were no significant differences for the type of adhesive used. A meta-regression model showed a significant effect of time on the microtensile bond strength. Conclusions: The application of a 2% chlorhexidine solution after acid etching increased the microtensile bond strength significantly for follow-up times of 6 months or more. The adhesive type had no influence.

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          Most cited references55

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          State of the art etch-and-rinse adhesives.

          The aim of this study was to explore the therapeutic opportunities of each step of 3-step etch-and-rinse adhesives. Etch-and-rinse adhesive systems are the oldest of the multi-generation evolution of resin bonding systems. In the 3-step version, they involve acid-etching, priming and application of a separate adhesive. Each step can accomplish multiple goals. Acid-etching, using 32-37% phosphoric acid (pH 0.1-0.4) not only simultaneously etches enamel and dentin, but the low pH kills many residual bacteria. Some etchants include anti-microbial compounds such as benzalkonium chloride that also inhibits matrix metalloproteinases (MMPs) in dentin. Primers are usually water and HEMA-rich solutions that ensure complete expansion of the collagen fibril meshwork and wet the collagen with hydrophilic monomers. However, water alone can re-expand dried dentin and can also serve as a vehicle for protease inhibitors or protein cross-linking agents that may increase the durability of resin-dentin bonds. In the future, ethanol or other water-free solvents may serve as dehydrating primers that may also contain antibacterial quaternary ammonium methacrylates to inhibit dentin MMPs and increase the durability of resin-dentin bonds. The complete evaporation of solvents is nearly impossible. Manufacturers may need to optimize solvent concentrations. Solvent-free adhesives can seal resin-dentin interfaces with hydrophobic resins that may also contain fluoride and antimicrobial compounds. Etch-and-rinse adhesives produce higher resin-dentin bonds that are more durable than most 1 and 2-step adhesives. Incorporation of protease inhibitors in etchants and/or cross-linking agents in primers may increase the durability of resin-dentin bonds. The therapeutic potential of etch-and-rinse adhesives has yet to be fully exploited. Copyright © 2010 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
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            The promotion of adhesion by the infiltration of monomers into tooth substrates.

            The effectiveness of 4-methacryloxyethyl trimellitate anhydride (4-META) on the adhesion of an acrylic rod with etched dentine and enamel was studied. Etching of tooth substrates with a 10% citric acid-3% ferric chloride solution prior to the adhesion proved effective. Monomers with both hydrophobic and hydrophilic groups like 4-META promoted the infiltration of monomers into the hard tissue. The infiltrated monomers polymerized in situ and good adhesion with the tooth substrates took place. The tensile adhesive strength was 18 MPa on the etched dentine. Scanning electron microscopic studies suggested that the monomers possess affinity with the hard tissue. The good adhesion was not provided by the interlocking at the tubules as had been considered previously.
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              Inhibition of the activities of matrix metalloproteinases 2, 8, and 9 by chlorhexidine.

              Matrix metalloproteinases (MMPs) are a host cell-derived proteolytic enzyme family which plays a major role in tissue-destructive inflammatory diseases such as periodontitis. The aim of the present study was to evaluate the inhibitory effect of chlorhexidine (CHX) on MMP-2 (gelatinase A), MMP-9 (gelatinase B), and MMP-8 (collagenase 2) activity. Heat-denatured type I collagen (gelatin) was incubated with pure human MMP-2 or -9 activated with p-aminophenylmercuric acetate (APMA), and the proteolytic degradation of gelatin was monitored by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Coomassie blue staining. The effect of CHX on MMP-8 activity was also studied with a cellular model addressing the ability of phorbol myristate acetate (PMA)-triggered human peripheral blood neutrophils (polymorphonuclear leukocytes [PMNs]) to degrade native type I collagen. CHX inhibited the activities of both gelatinases (A and B), but MMP-2 appeared to be more sensitive than MMP-9. Adding calcium chloride to the assay mixtures almost completely prevented the inhibition of MMP-9 activity by CHX, while the inhibition of MMP-2 activity could be reversed only when CHX was used at a low concentration. This observation suggests that CHX may act via a cation-chelating mechanism. CHX dose-dependently inhibited collagenolytic activity of MMP-8 released by PMA-triggered PMNs. MMP-8 without APMA activation was inhibited clearly more efficiently than APMA-activated MMP-8. Our study suggests that the direct inhibition of the MMPs' activities by CHX may represent a new valuable effect of this antimicrobial agent and explains, at least in part, the beneficial effects of CHX in the treatment of periodontitis.
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                Author and article information

                Journal
                Medicina (Kaunas)
                medicina
                Medicina
                MDPI
                1010-660X
                1648-9144
                02 December 2019
                December 2019
                : 55
                : 12
                : 769
                Affiliations
                Stomatology Department, University of Valencia, 46010 Valencia, Spain; tasham@ 123456alumni.uv.es (T.H.-N.); carlos.bellot@ 123456uv.es (C.B.-A.); vanessa.paredes@ 123456uv.es (V.P.-G.); agustin.pascual@ 123456uv.es (A.P.-M.); jose.m.almerich@ 123456uv.es (J.M.A.-S.); jose.maria.montiel@ 123456uv.es (J.M.M.-C.)
                Author notes
                Author information
                https://orcid.org/0000-0001-9605-3833
                https://orcid.org/0000-0002-3952-7681
                Article
                medicina-55-00769
                10.3390/medicina55120769
                6955988
                31810222
                db26dc9d-6c7a-4d30-a985-0613e1fd845c
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 11 November 2019
                : 27 November 2019
                Categories
                Review

                chlorhexidine,microtensile bond strength,adhesion,dental adhesive,acid etching

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