Can the inclusion of the dimethylaminohexadecyl methacrylate (DMAHDM) monomer in adhesive systems provide to them an antibacterial effect? A systematic review

This systematic review aimed to evaluate if the inclusion of dimethylaminohexadecyl methacrylate (DMAHDM), an antibacterial monomer, in dental adhesive systems can provide them with an antibacterial effect without impairing the material`s properties. The electronic search was performed in Pubmed, Web of Science and Scopus, retrieving studies that evaluated the antimicrobial capacity of DMAHDM added in adhesive systems. The initial search identified 547 articles. After duplicates removal, screening title, abstract and full-text reading, 18 articles were approved to compose the final sample. The results demonstrated DMAHDM`s efficacy as an antibacterial agent through different approaches, such as bacterial metabolic activity, polysaccharide production, lactic acid production, and colony-forming units (CFU) count. Most studies were in vitro and reported that dentin shear bond strength was not compromised compared to control groups, with only two exceptions. Long-term analysis was less reported in the studies, although no loss of antibacterial efficacy was observed after 30 days to 12 months. The quality assessment of primary studies resulted in a low risk of bias for all articles. The in vitro studies in the literature pointed to DMAHDM as an effective antibacterial agent in dental adhesives for several caries-related bacteria. The adhesive properties were preserved in the analyzed studies when DMAHDM was added up to 5% by wt%. However, there are still gaps regarding materials` biocompatibility and long-term effectiveness.