HEMA-free Versus HEMA-containing Adhesive Systems: a Systematic Review

Overview

Journal Syst Rev

Publisher Biomed Central

Date 2025 Jan 22

PMID 39838443

Authors

Esraa Abdelkhalek

Hamdi H Hamama

Salah H Mahmoud

Affiliations

Soon will be listed here.

Abstract

Background: Hydrophilic monomer 2-hydroxyethyl methacrylate (HEMA)-free adhesive systems are gaining increasing popularity nowadays. Although the addition of HEMA to dental adhesives improves dentin wettability and resin diffusion into demineralized collagen fibrils, HEMA's high hydrophilicity can lead to hydrolytic degradation of the adhesive interface. Thus, HEMA-free adhesive systems have been developed. Unfortunately, the lack of HEMA in the adhesive composition may lead to a separation phase between hydrophobic and hydrophilic components. The aim of this systematic review was to evaluate the clinical performance of HEMA-free adhesive systems and compare them with HEMA-containing ones.

Methods: An electronic search of The National Library of Medicine (MEDLINE/PubMed) was conducted. Eligibility criteria were reporting empirical data from clinical studies published between 2013 and 2023 about the clinical performance of HEMA-free adhesive systems for direct resin composite restorations. Studies with at least 2-year clinical follow-up done in permanent dentition in any form of cavities were selected. The included studies were assessed for risk of bias using the modified Cochrane Collaboration tool criteria.

Results: The database search returned 147 studies; a total of 7 studies were included in this review; the majority of studies reported no significant difference between the two types of adhesives for the parameter of retention.

Conclusions: HEMA-free adhesive systems exhibited good clinical performance with regard to retention. There was some concern about their influence on marginal adaptation and marginal discoloration due to the conflicted results reported by the included trials. Thus, the results need to be confirmed with long-term evaluations.

Systematic Review Registration: PROSPERO CRD42023448952.

References

Moher D, Schulz K, Altman D . The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. JAMA. 2001; 285(15):1987-91. DOI: 10.1001/jama.285.15.1987. View

Dutra-Correa M, Kiyan V, Ciaramicoli M, Pecorari V, Rodrigues F, Saraceni C . Randomized clinical trial of four adhesion strategies: A 42 month study. Indian J Dent Res. 2019; 30(4):487-495. DOI: 10.4103/ijdr.IJDR_466_16. View

da Silva T, de Castro R, Magno M, Maia L, da Silva E Souza Junior M . Do HEMA-free adhesive systems have better clinical performance than HEMA-containing systems in noncarious cervical lesions? A systematic review and meta-analysis. J Dent. 2018; 74:1-14. DOI: 10.1016/j.jdent.2018.04.005. View

Oliveira B, Ubaldini A, Baesso M, Andrade L, Lima S, Giannini M . Chemical Interaction and Interface Analysis of Self-Etch Adhesives Containing 10-MDP and Methacrylamide With the Dentin in Noncarious Cervical Lesions. Oper Dent. 2018; 43(5):E253-E265. DOI: 10.2341/17-366-L. View

van Dijken J . A 6-year prospective evaluation of a one-step HEMA-free self-etching adhesive in Class II restorations. Dent Mater. 2013; 29(11):1116-22. DOI: 10.1016/j.dental.2013.08.205. View

van Dijken J, Pallesen U . Durability of a low shrinkage TEGDMA/HEMA-free resin composite system in Class II restorations. A 6-year follow up. Dent Mater. 2017; 33(8):944-953. DOI: 10.1016/j.dental.2017.04.021. View

Tichy A, Hosaka K, Yang Y, Motoyama Y, Sumi Y, Nakajima M . Can a New HEMA-free Two-step Self-etch Adhesive Improve Dentin Bonding Durability and Marginal Adaptation?. J Adhes Dent. 2021; 23(6):505-512. DOI: 10.3290/j.jad.b2288233. View

Yuan Y, Shimada Y, Ichinose S, Sadr A, Tagami J . Effects of dentin characteristics on interfacial nanoleakage. J Dent Res. 2007; 86(10):1001-6. DOI: 10.1177/154405910708601016. View

Burrow M, Tyas M . Comparison of two all-in-one adhesives bonded to non-carious cervical lesions--results at 3 years. Clin Oral Investig. 2011; 16(4):1089-94. DOI: 10.1007/s00784-011-0595-y. View

10.

Moher D, Jones A, Lepage L . Use of the CONSORT statement and quality of reports of randomized trials: a comparative before-and-after evaluation. JAMA. 2001; 285(15):1992-5. DOI: 10.1001/jama.285.15.1992. View

11.

Page M, Moher D, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021; 372:n160. PMC: 8005925. DOI: 10.1136/bmj.n160. View

12.

Oliveira R, de Paula B, de Melo Alencar C, Alves E, Silva C . A randomized clinical study of the performance of self-etching adhesives containing HEMA and 10-MDP on non-carious cervical lesions: A 2-year follow-up study. J Dent. 2023; 130:104407. DOI: 10.1016/j.jdent.2022.104407. View

13.

Saboia V, Silva F, Nato F, Mazzoni A, Cadenaro M, Mazzotti G . Analysis of differential artificial ageing of the adhesive interface produced by a two-step etch-and-rinse adhesive. Eur J Oral Sci. 2009; 117(5):618-24. DOI: 10.1111/j.1600-0722.2009.00665.x. View

14.

Moretto S, Russo E, Carvalho R, De Munck J, Van Landuyt K, Peumans M . 3-year clinical effectiveness of one-step adhesives in non-carious cervical lesions. J Dent. 2013; 41(8):675-82. DOI: 10.1016/j.jdent.2013.05.016. View

15.

Thalacker C . Dental adhesion with resin composites: a review and clinical tips for best practice. Br Dent J. 2022; 232(9):615-619. DOI: 10.1038/s41415-022-4144-7. View

16.

Loguercio A, Luque-Martinez I, Lisboa A, Higashi C, Queiroz V, Rego R . Influence of Isolation Method of the Operative Field on Gingival Damage, Patients' Preference, and Restoration Retention in Noncarious Cervical Lesions. Oper Dent. 2015; 40(6):581-93. DOI: 10.2341/14-089-C. View

17.

Vanherle G, Verschueren M, Lambrechts P, Braem M . Clinical investigation of dental adhesive systems. Part I: An in vivo study. J Prosthet Dent. 1986; 55(2):157-63. DOI: 10.1016/0022-3913(86)90333-1. View

18.

Tsujimoto A, Fischer N, Barkmeier W, Latta M . Bond Durability of Two-Step HEMA-Free Universal Adhesive. J Funct Biomater. 2022; 13(3). PMC: 9505787. DOI: 10.3390/jfb13030134. View

19.

Stangel I, Ellis T, Sacher E . Adhesion to tooth structure mediated by contemporary bonding systems. Dent Clin North Am. 2007; 51(3):677-94, vii. DOI: 10.1016/j.cden.2007.04.007. View

20.

Chee B, Rickman L, Satterthwaite J . Adhesives for the restoration of non-carious cervical lesions: a systematic review. J Dent. 2012; 40(6):443-52. DOI: 10.1016/j.jdent.2012.02.007. View