Bonding to hypomineralized enamel – A systematic review

The aim of this paper was to systematically analyze the published literature on bonding adhesive resin to hypomineralized enamel, in order to answer the questions: “Does resin dental adhesives achieve inferior bonding to hypomineralized enamel when compared to normal enamel?” “Does self-etch dental adhesives bond better to hypomineralized enamel when compared with etch-and-rinse adhesives?” “Does deproteinization with 5% NaOCl before adhesive application procedure enhance bonding performance of resin dental adhesives to hypomineralized enamel?” Three electronic databases (Pubmed, Scopus and ISI web of Science) were searched to identify original studies that evaluated the bond achieved between resin adhesives and hypomineralized enamel. Only articles that met the specific inclusion criteria were included in the review. Among 6 studies included in this review, 4 studies that tested bond strength of resin composite to hypomineralized enamel showed significantly lower bond strength than that to sound enamel. Bonding was not compared between adhesives in 5 included studies as only one adhesive was used. Three out of four studies showed improved bonding performances when deproteinization was performed with 5% NaOCl to hypomineralized enamel before adhesive application. Resin dental adhesives achieve inferior bonding to hypomineralized enamel when compared to normal enamel. There are no sufficient evidences to prove that self-etch dental adhesives bond better to hypomineralized enamel when compared with etch-and-rinse adhesives. Enamel deproteinization with 5% NaOCl before adhesive application procedure may enhance bonding performance of resin dental adhesives to hypomineralized enamel.