Effect of adhesive air-drying time on bond strength to dentin: A systematic review and meta-analysis

Objective: The objective of this review was to evaluate the effect of air-drying time on the adhesion (bond) strength of adhesives to dentin in previously published studies and to conduct a meta-analysis to quantify the differences in the bond strength obtained after the different air-drying times. Methods: An electronic search was performed using the Medline, Cochrane library, and Scopus databases. The included studies were laboratory studies that investigated the effect of adhesive air-drying time on adhesion (bond) strength of resin-based adhesives to corona]. dentin. Studies which evaluated the effect of adhesives air drying time on physical and mechanical properties of adhesives, interfacial properties, bond strength to root dentin, enamel, or bond strength of indirect composite restoration or orthodontic bracket, were excluded. The methodological quality of included studies was assessed. Meta-analysis was performed using Comprehensive Meta-Analysis software, version 2.0 (Biostat, Englewood, NJ, USA). The results of the meta-analysis were subjected to a further one-way analysis of variance, followed by the Tukey post hoc multiple comparison using R-software, version 3.4.3 (R Foundation for Statistical Computing, Vienna, Austria). Results: Thirteen studies fulfilled the inclusion criteria of this review, while only five studies were included in meta-analysis. The effect of adhesive air-drying time on the bond strength was significant in eight studies (61.5%), material-dependent in four studies (30.8%), and not significant in one study (7.7%). Eight studies (61.54%) presented a medium-risk of bias, three studies (23.08%) presented a low-risk of bias, and two studies (15.38%) presented a high-risk of bias. The analysis of micro-tensile bond strength (mu TBS) of adhesives showed statistically significant difference between different air-drying times (p < 0.05). The highest mean mu TBS values were: 52.9 +/- 11.38 MPa (obtained after air-drying of adhesives for 30 s), followed by 48.26 +/- 9.77 MPa (15 s), and 37.76 +/- 1.45 (25 s), while the lowest mean mu TBS was 33.98 +/- 2.30 MPa and 35.79 +/- 6.63 MPa (5 s) obtained after 10 s and 5 s respectively. Conclusion: The air-drying time of adhesives is crucial to the adhesion strength to coronal dentin. Adhesive air-drying for shorter durations (5-10 s) may be insufficient to obtain adequately durable bonding to dentin, instead, Air-drying should be performed for longer durations (15-30 s), considering the pressure and distance of air-drying source.