Non-Cochrane · intervention · PM41878562
Effect of chlorhexidine pretreatment on clinical performance of adhesive restorations: a systematic review and meta-analysis.
Bourgi Rim, Holiel Ahmed A, Cuevas-Suárez Carlos Enrique, et al. · Frontiers in dental medicine · 2026 · PubMed · doi:10.3389/fdmed.2026.1746184
Findings
Population Patients receiving adhesive restorations in vital teeth
7 findings
| Dentin pretreatment with chlorhexidine (CHX) before adhesive application | No CHX pretreatment (conventional adhesive procedure, placebo or water) | Postoperative sensitivity Longest available follow-up · Overall | RD 0.01 [-0.04, 0.06] Moderate Downgraded: imprecision 4 studies · 202 participants |
| Dentin pretreatment with chlorhexidine (CHX) before adhesive application | No CHX pretreatment (conventional adhesive procedure, placebo or water) | Restoration retention Long term (>=6 months) · Follow-up >=6 months | RD 0.02 [-0.03, 0.06] GRADE not reported 6 studies · 516 participants |
| Dentin pretreatment with chlorhexidine (CHX) before adhesive application | No CHX pretreatment (conventional adhesive procedure, placebo or water) | Secondary caries Long term (>=6 months) · Follow-up >=6 months | RD 0.00 [-0.04, 0.03] GRADE not reported 5 studies · 436 participants |
| Dentin pretreatment with chlorhexidine (CHX) before adhesive application | No CHX pretreatment (placebo/water or conventional adhesive protocol) | Secondary caries Short-term and long-term follow-up combined · Clinical trials of adhesive restorations · Overall | RD 0.00 [-0.03, 0.03] Low Downgraded: imprecision 5 studies · 516 participants |
| Dentin pretreatment with chlorhexidine (CHX) before adhesive application | No CHX pretreatment (conventional adhesive procedure, placebo or water) | Restoration retention Longest available follow-up (>=6 months) · Overall | RD 0.01 [-0.02, 0.04] Moderate Downgraded: imprecision 7 studies · 756 participants |
| Dentin pretreatment with chlorhexidine (CHX) before adhesive application | No CHX pretreatment (conventional adhesive procedure, placebo or water) | Secondary caries Short term (<6 months) · Follow-up <6 months | RD 0.00 [-0.05, 0.05] GRADE not reported 1 study · 80 participants |
| Dentin pretreatment with chlorhexidine (CHX) before adhesive application | No CHX pretreatment (conventional adhesive procedure, placebo or water) | Restoration retention Short term (<6 months) · Follow-up <6 months | RD 0.00 [-0.05, 0.05] GRADE not reported 3 studies · 240 participants |
Included primary studies 11
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Altintop 2025 A prospective randomized clinical trial and an in vitro evaluation of the microtensile bond strength of a chlorhexidine-containing dentin… PMID:40223065 | 2025 | this review only | not stated | not extracted yet |
| Araujo 2015 Two-year clinical evaluation of chlorhexidine incorporation in two-step self-etch adhesive. PMID:25046536 | 2015 | this review only | not stated | not extracted yet |
| Dutra-Correa 2013 Effect of chlorhexidine on the 18-month clinical performance of two adhesives. PMID:23560258 | 2013 | this review only | not stated | not extracted yet |
| Favetti 2017 Effectiveness of pre-treatment with chlorhexidine in restoration retention: A 36-month follow-up randomized clinical trial. PMID:28237629 | 2017 | this review only | not stated | not extracted yet |
| Galafassi 2017 Clinical evaluation of composite restorations in Er:YAG laser-prepared cavities re-wetting with chlorhexidine. PMID:27376544 | 2017 | this review only | not stated | not extracted yet |
| Hajizadeh 2013 Randomized clinical evaluation of the effect of chlorhexidine on postoperative sensitivity of posterior composite resin restorations. PMID:23878845 | 2013 | this review only | not stated | not extracted yet |
| Montagner 2015 Effect of pre-treatment with chlorhexidine on the retention of restorations: a randomized controlled trial. PMID:26200146 | 2015 | this review only | not stated | not extracted yet |
| Nemt-Allah 2022 Marginal Integrity of Composite Restoration with and without Surface Pretreatment by Gold and Silver Nanoparticles vs Chlorhexidine: A… PMID:35197374 | 2021 | this review only | not stated | not extracted yet |
| Sartori 2013 Influence of chlorhexidine digluconate on the clinical performance of adhesive restorations: a 3-year follow-up. PMID:24076103 | 2013 | this review only | not stated | not extracted yet |
| Sobral 2005 Prevention of postoperative tooth sensitivity: a preliminary clinical trial. PMID:16102079 | 2005 | this review only | not stated | not extracted yet |
| Valerio 2020 Four-year clinical prospective follow-up of resin composite restoration after selective caries removal using Er:YAG laser. PMID:31686235 | 2020 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients receiving adhesive restorations in vital teeth | Adult and child patients with Class I, II and V adhesive restorations in permanent and primary teeth (14 to 60 participants per trial; n=11 trials) |
| Intervention | Dentin pretreatment with chlorhexidine (solution or incorporated into the adhesive) | CHX 0.2% to 2% applied 15-60 s or incorporated into adhesive (n=11) |
| Comparison | No CHX pretreatment or conventional adhesive procedure | No CHX, placebo or water (n=11) |
| Outcomes | Restoration retention, marginal adaptation, marginal discoloration, postoperative sensitivity, secondary caries | Restoration retention (n=7 trials pooled); postoperative sensitivity (n=4); secondary caries (n=5) |
| Study designs | Randomized controlled trials or controlled clinical trials | Randomized clinical trials (n=11) |
| Timing | Minimum follow-up 1 week; short-term (<6 months) and long-term (>=6 months) analyses | 6 months to 4 years (range 1 week to 4 years) |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Partial Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | RCT: Yes · NRSI: N/A | yes |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | RCT: No · NRSI: N/A | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |