Enhancing the antibacterial effect of dental adhesives with DMAHDM by incorporating MPC monomer: A systematic review and meta-analysis of in vitro studies

Objective This systematic review aims to analyze if the combination of MPC and DMAHDM can enhance the antibacterial potential of DMAHDM without impairing the adhesive system`s bond strength. Methods A search was conducted on PubMed, Embase, Scopus, and Web of Science databases. Study selection was performed in two stages by two calibrated reviewers independently. The meta-analyses were conducted with the RevMan 5.4 software and evaluated metabolic activity (MA), lactic acid production (LA), protein repellent function (PRF), and dentin shear bond strength (DSBS) comparing DMAHDM vs. DMAHDM + MPC. The measure of effect was the mean or standardized mean difference. Quality assessment was evaluated with an adapted tool from a previous systematic review. Results The initial search resulted in 158 articles. Four articles were included in the final sample. The meta-analyses evidenced a statistically significant difference favoring the use of MPC to enhance DMAHDM`s antibacterial potential for inhibiting MA (SMD, 3.74; 95 % CI, 2.66, 4.83), LA (MD, −1.24; 95 % CI, −1.42, −1.06), while providing protein-repellent function (MD, −5.38; 95 % CI, −6.35, −4.41). The addition of MPC had a negative effect on DSBS in comparison to DMAHDM alone (MD, −4.23; 95 % CI, −5.63, −2.83). Conclusions The addition of MPC to DMAHDM-containing adhesives enhances the antibacterial efficacy and provides protein-repellent function, but impairs the bond strength. Future studies should test the addition of 5 % MPC.