Bond strength tests of dental adhesive systems and their correlation with clinical results - A meta-analysis

Siegward D. Heintze*, Valentin Rousson, Eduardo Mahn

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Objective To evaluate the variability of bond strength test results of adhesive systems (AS) and to correlate the results with clinical parameters of clinical studies investigating cervical restorations. Materials and methods Regarding the clinical studies, the internal database which had previously been used for a meta-analysis on cervical restorations was updated with clinical studies published between 2008 and 2012 by searching the PubMed and SCOPUS databases. PubMed and the International Association for Dental Research abstracts online were searched for laboratory studies on microtensile, macrotensile and macroshear bond strength tests. The inclusion criteria were (1) dentin, (2) testing of at least four adhesive systems, (3) same diameter of composite and (4) 24 h of water storage prior to testing. The clinical outcome variables were retention loss, marginal discoloration, detectable margins, and a clinical index comprising the three parameters by weighing them. Linear mixed models which included a random study effect were calculated for both, the laboratory and the clinical studies. The variability was assessed by calculating a ratio of variances, dividing the variance among the estimated bonding effects obtained in the linear mixed models by the sum of all variance components estimated in these models. Results Thirty-two laboratory studies fulfilled the inclusion criteria comprising 183 experiments. Of those, 86 used the microtensile test evaluating 22 adhesive systems (AS). Twenty-seven used the macrotensile test with 17 AS, and 70 used the macroshear test with 24 AS. For 28 AS the results from clinical studies were available. Microtensile and macrotensile (Spearman rho = 0.66, p = 0.007) were moderately correlated and also microtensile and macroshear (Spearman rho = 0.51, p = 0.03) but not macroshear and macrotensile (Spearman rho = 0.34, p = 0.22). The effect of the adhesive system was significant for microtensile and macroshear (p < 0.001) but not for macrotensile. The effect of the adhesive system could explain 36% of the variability of the microtensile test, 27% of the macrotensile and 33% of the macroshear test. For the clinical trials, about 49% of the variability of retained restorations could be explained by the adhesive system. With respect to the correlation between bond strength tests and clinical parameters, only a moderate correlation between micro- and macrotensile test results and marginal discoloration was demonstrated. However, no correlation between these tests and a retention loss or marginal integrity was shown. The correlation improved when more studies were included compared to assessing only one study. Significance The high variability of bond strength test results highlights the need to establish individual acceptance levels for a given test institute. The weak correlation of bond-strength test results with clinical parameters leads to the conclusion that one should not rely solely on bond strength tests to predict the clinical performance of an adhesive system but one should conduct other laboratory tests like tests on the marginal adaptation of fillings in extracted teeth and the retention loss of restorations in non-retentive cavities after artificial aging.

Original languageEnglish
Pages (from-to)423-434
Number of pages12
JournalDental Materials
Issue number4
StatePublished - 1 Apr 2015

Bibliographical note

Publisher Copyright:
© 2015 Academy of Dental Materials.


  • Bond strength
  • Class V
  • Clinical relevance
  • Macroshear
  • Meta-analysis
  • Microtensile
  • Tensile


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