Adhesive Bond Strength of Restorative Materials to Caries-Affected Dentin Treated with Antimicrobial Photodynamic Therapy: A Systematic Review and Meta-Analysis.

Objective: This systematic review aimed to evaluate the adhesive bond strength of restorative materials to caries-affected dentin (CAD) treated with antimicrobial photodynamic therapy (aPDT) in comparison with conventional chemical disinfectants. Methods: Three databases, including the Web of Science, Scopus, and PubMed, were searched to address the focused question: "What is the effect of aPDT compared to conventional chemical disinfection techniques on the adhesive bond strength of restorative materials to CAD?." Search keywords included "dentin*" "adhes bond*" "caries-affected dentin" "photodynamic "photochemotherapy" "photosensitizing agent" "phototherapy" "photoradiation" "laser" "light activated" "photoactivated." A fixed-effects model was used in each meta-analysis and the inverse variance was used to calculate the standard mean difference (SMD). For evaluating the statistical heterogeneity, the Cochrane's Q test and the I2 statistics were used. The risk of bias was evaluated based on the Cochrane Collaboration's tool. Results: Fourteen studies were included in the qualitative as well as quantitative analysis. The results of the meta-analyses exhibited an SMD of 2.38% [95% confidence interval (CI): 2.03-2.73; p < 0.00001], indicating a statistically significant difference in the shear bond strength scores between the tested group (samples treated with aPDT) and the control group (i.e., favoring the sound dentin and/or conventional chemical disinfectants). Contrarily, an SMD of -1.46% (95% CI: -2.04 to -0.88; p < 0.00001) and -0.37% (95% CI: -0.70 to -0.03; p = 0.03) was observed, indicating a statistically significant difference in the microtensile bond strength (µTBS), as well as microleakage scores between the tested group (favoring the samples treated with aPDT) and the control group (i.e., sound dentin and/or conventional chemical disinfectants). Conclusions: Adhesive bond strength of restorative materials to CAD treated with conventional chemical disinfectants showed superior outcomes compared to photodynamic therapy (aPDT).