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VOLUME 2 , ISSUE 1--2 ( January-June, 2023 ) > List of Articles


Universal Adhesives in Clinical Dentistry

Fusun Ozer, Shilpa Patnaikuni

Keywords : Adhesion, Bonding, Review, Universal adhesive

Citation Information : Ozer F, Patnaikuni S. Universal Adhesives in Clinical Dentistry. 2023; 2 (1--2):6-11.

DOI: 10.5005/jp-journals-11005-0045

License: CC BY-NC 4.0

Published Online: 29-09-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Aim: This narrative review aims to present information on current adhesive strategies in operative dentistry and provide details on the status and adhesion potential of universal adhesives. Background: Adhesive dentistry is a fast-developing field and plays an important role in clinical practice. The new adhesive bonding systems have been developed to simplify and enhance the adhesion between the resin restorative materials and the tooth surface. The bonding mechanisms of these adhesive materials depend on the tooth substrate and the mode of application. Review results: Increasing demand for simplified adhesive systems and the need to use them in different clinical situations led to the development of new adhesive materials. Multifunctional universal adhesives have been developed in the last decade, becoming an addition to the well-accepted etch-and-rinse and self-etch (SE) adhesives. These adhesives have the versatility to be applied to dental hard tissues with any adhesion strategy and used with direct and indirect restorative materials. However, additional assessments are needed to ensure long-term durability and the versatility of universal adhesives on different surfaces. Conclusion: Studies have confirmed that universal adhesives provide a better bond strength values and clinical durability with the SE application mode on dentin surfaces. For enamel surfaces, selective enamel etching is recommended to increase adhesive bonding performance. Clinical significance: Universal adhesives are a promising new class of dental adhesives. However, it is important for clinicians to understand the limitations and correct management of these latest adhesive systems for clinical applications.

  1. Summit JB, Robbins JW, Hilton TJ, et al. Fundamentals of operative dentistry. 3rd edition. Quintessence Publishing Co, Inc; 2006.
  2. Gwinnett AJ. Bonding basics: what every clinician should know. Esthetic Dent Update 1994;5(2):35–41.
  3. Nakabayashi N, Kojima K, Masuhara E. The promotion of adhesion by the infiltration of monomers into tooth substrates. J Biomed Mater Res 1982;16(3):265–273. DOI: 10.1002/jbm.820160307
  4. Fukegawa D, Hayakawa S, Yoshida Y, et al. Chemical interaction of phosphoric acid ester with hydroxyapatite. J Dent Res 2006;85(10):941–944. DOI: 10.1177/154405910608501014
  5. Van Landuyt KL, Yoshida Y, Hirata I, et al. Influence of the chemical structure of functional monomers on their adhesive performance. J Dent Res 2008;87(8):757–761. DOI: 10.1177/154405910808700804
  6. Ozer F, Blatz MB. Self-etch and etch-and-rinse adhesive systems in clinical dentistry. Compend Contin Educ Dent 2013;34(1):12–14, 16, 18; quiz 20, 30. PMID: 23550327.
  7. Van Meerbeek B, Yoshihara K, Van Landuyt K, et al. From Buonocore's pioneering acid-etch technique to self-adhering restoratives. a status perspective of rapidly advancing dental adhesive technology. J Adhes Dent 2020;22(1):7–34. DOI: 10.3290/j.jad.a43994
  8. Inoue S, Vargas MA, Abe Y, et al. Microtensile bond strength of eleven contemporary adhesives to dentin. J Adhes Dent 2001;3(3):237–245. DOI: 10.3290/j.jad.a7363
  9. Kasahara Y, Takamizawa T, Hirokane E, et al. Comparison of different etch-and-rinse adhesive systems based on shear fatigue dentin bond strength and morphological features the interface. Dent Mater 2021;37(3):e109–e117. DOI: 10.1016/
  10. Pashley DH, Tay FR, Breschi L, et al. State of the art etch-and-rinse adhesives. Dent Mater 2011;27(1):1–16. DOI: 10.1016/
  11. Feitosa VP, Sauro S, Zenobi W, et al. Degradation of adhesive-dentin interfaces created using different bonding strategies after five-year simulated pulpal pressure. J Adhes Dent 2019;21(3):199–207. DOI: 10.3290/j.jad.a42510
  12. Perdigão J, Lopes MM, Gomes G. In vitro bonding performance of self-etch adhesives: II–ultramorphological evaluation. Oper Dent 2008;33(5):534–549. DOI: 10.2341/07-133
  13. Tsuchiya S, Nikaido T, Sonoda H, et al. Ultrastructure of the dentin-adhesive interface after acid-base challenge. J Adhes Dent 2004;6(3):183–190. DOI: 10.3290/j.jad.a9507
  14. Inoue G, Tsuchiya S, Nikaido T, et al. Morphological and mechanical characterization of the acid-base resistant zone at the adhesive-dentin interface of intact and caries-affected dentin. Oper Dent 2006;31(4):466–472. DOI: 10.2341/05-62
  15. Van Meerbeek B, Yoshihara K, Yoshida Y, et al. State of the art of self-etch adhesives. Dent Mater 2011;27(1):17–28. DOI: 10.1016/
  16. Breschi L, Mazzoni A, Ruggeri A, et al. Dental adhesion review: aging and stability of the bonded interface. Dent Mater 2008;24(1):90–101. DOI: 10.1016/
  17. Peumans M, Kanumilli P, De Munck J, et al. Clinical effectiveness of contemporary adhesives: a systematic review of current clinical trials. Dent Mater 2005;21(9):864–881. DOI: 10.1016/
  18. Brackett WW, Covey DA, St Germain. One-year clinical performance of a self-etching adhesive in class V resin composites cured by two methods. Oper Dent 2002;27(3):218–222.
  19. Sarr M, Benoist FL, Bane K, et al. Bonding effectiveness of self-etch adhesives to dentin after 24 h water storage. J Conserv Dent 2018;21(2):142–146. DOI: 10.4103/JCD.JCD_257_17
  20. Peumans M, De Munck J, Mine A, et al. Clinical effectiveness of contemporary adhesives for the restoration of non-carious cervical lesions. a systematic review. Dent Mater 2014;30(10):1089–1103. DOI: 10.1016/
  21. Alex G. Universal adhesives: the next evolution in adhesive dentistry? Compend Contin Educ Dent 2015;36(1):15–40. PMID: 25822403.
  22. Cuevas-Suárez CE, da Rosa WLO, Lund RG, et al. Bonding performance of universal adhesives: an updated systematic review and meta-analysis. J Adhes Dent 2019;21(1):7–26. DOI: 10.3290/j.jad.a41975
  23. Perdigão J, Swift EJ Jr. Universal adhesives. J Esthet Restor Dent 2015;27(6):331–334. DOI: 10.1111/jerd.12185
  24. Fehrenbach J, Lacerda-Santos R, Machado LS, et al. Which self-etch acidic composition may result in higher dental bonds at the long-term? A network meta-analysis review of in vitro studies. J Dent 2022;126:104283. DOI: 10.1016/j.jdent.2022.104283
  25. Yoshida Y, Yoshihara K, Nagaoka N, et al. Self-assembled nano-layering at the adhesive interface. J Dent Res 2012;91(4):376–381. DOI: 10.1177/0022034512437375
  26. Peumans M, De Munck J, Van Landuyt K, et al. Thirteen-year randomized controlled clinical trial of a two-step self-etch adhesive in non-carious cervical lesions. Dent Mater 2015;31(3):308–314. DOI: 10.1016/
  27. Yoshihara K, Hayakawa S, Nagaoka N, et al. Etching efficacy of self-etching functional monomers. J Dent Res 2018;97(9):1010–1016. DOI: 10.1177/0022034518763606
  28. Chen H, Feng S, Jin Y, et al. Comparison of bond strength of universal adhesives using different etching modes: a systematic review and meta-analysis. Dent Mater J 2022;41(1):1–10. DOI: 10.4012/dmj.2021-111
  29. Elkaffas AA, Hamama HHH, Mahmoud SH. Do universal adhesives promote bonding to dentin? A systematic review and meta-analysis. Restor Dent Endod 2018;43(3):e29. DOI: 10.5395/rde.2018.43.e29
  30. Assis P, Silva C, Nascimento A, et al. Does acid etching influence the adhesion of universal adhesive systems in noncarious cervical lesions? a systematic review and meta-analysis. Oper Dent 2023;48(4):373–390. DOI: 10.2341/22-067-LIT
  31. De Munck J, Van Landuyt K, Peumans M, et al. A critical review of the durability of adhesion to tooth tissue: methods and results. J Dent Res 2005;84(2):118–132. DOI: 10.1177/154405910508400204
  32. Cardoso MV, de Almeida Neves A, Mine A, et al. Current aspects on bonding effectiveness and stability in adhesive dentistry. Aust Dent J 2011;56 Suppl 1:31–44. DOI: 10.1111/j.1834-7819.2011.01294.x
  33. Perdigão J, Araujo E, Ramos RQ, et al. Adhesive dentistry: current concepts and clinical considerations. J Esthet Restor Dent 2021;33(1):51–68. DOI: 10.1111/jerd.12692
  34. Hanabusa M, Mine A, Kuboki T, et al. Bonding effectiveness of a new ‘multi-mode’ adhesive to enamel and dentine. J Dent 2012;40(6):475–484. DOI: 10.1016/j.jdent.2012.02.012
  35. Beltrami R, Chiesa M, Scribante A, et al. Comparison of shear bond strength of universal adhesives on etched and nonetched enamel. J Appl Biomater Funct Mater 2016;14(1):e78–e83. DOI: 10.5301/jabfm.5000261
  36. Suda S, Tsujimoto A, Barkmeier WW, et al. Comparison of enamel bond fatigue durability between universal adhesives and two-step self-etch adhesives: effect of phosphoric acid pre-etching. Dent Mater J 2018;37(2):244–255. DOI: 10.4012/dmj.2017-059
  37. Josic U, Mazzitelli C, Maravic T, et al. The influence of selective enamel etch and self-etch mode of universal adhesives’ application on clinical behavior of composite restorations placed on non-carious cervical lesions: a systematic review and meta-analysis. Dent Mater 2022;38(3):472–488. DOI: 10.1016/
  38. Ma KS, Wang LT, Blatz MB. Efficacy of adhesive strategies for restorative dentistry: a systematic review and network meta-analysis of double-blind randomized controlled trials over 12 months of follow-up. J Prosthodont Res 2023;67(1):35–44. DOI: 10.2186/jpr.JPR_D_21_00279
  39. Moszner N, Salz U, Zimmermann J. Chemical aspects of self-etching enamel-dentin adhesives: a systematic review. Dent Mater 2005;21(10):895–910. DOI: 10.1016/
  40. Van Landuyt KL, Snauwaert J, De Munck J, et al. Systematic review of the chemical composition of contemporary dental adhesives. Biomaterials 2007;28(26):3757–3785. DOI: 10.1016/j.biomaterials.2007.04.044
  41. Ahmed MH, Yoshihara K, Yao C, et al. Multiparameter evaluation of acrylamide HEMA alternative monomers in 2-step adhesives. Dent Mater 2021;37(1):30–47. DOI: 10.1016/
  42. Szczepanska J, Poplawski T, Synowiec E, et al. 2-hydroxylethyl methacrylate (HEMA), a tooth restoration component, exerts its genotoxic effects in human gingival fibroblasts trough methacrylic acid, an immediate product of its degradation. Mol Biol Rep 2012;39(2):1561–1574. DOI: 10.1007/s11033-011-0895-y
  43. Tauscher S, Angermann J, Catel Y, et al. Evaluation of alternative monomers to HEMA for dental applications. Dent Mater 2017;33(7):857–865. DOI: 10.1016/
  44. Perdigão J, Gomes G, Lee IK. The effect of silane on the bond strengths of fiber posts. Dent Mater 2006;22(8):752–758. DOI: 10.1016/
  45. Yao C, Yu J, Wang Y, et al. Acidic pH weakens the bonding effectiveness of silane contained in universal adhesives. Dent Mater 2018;34(5):809–818. DOI: 10.1016/
  46. Cuevas-Suárez CE, de Oliveira da Rosa WL, Vitti RP, et al. Bonding strength of universal adhesives to indirect substrates: a meta-analysis of in vitro studies. J Prosthodont 2020;29(4):298–308. DOI: 10.1111/jopr.13147
  47. Hardan L, Bourgi R, Cuevas-Suárez CE, et al. Effect of different application modalities on the bonding performance of adhesive systems to dentin: a systematic review and meta-analysis. Cells 2023;12(1): DOI: 10.3390/cells12010190
  48. Moritake N, Takamizawa T, Ishii R, et al. Effect of active application on bond durability of universal adhesives. Oper Dent 2019;44(2):188–199. DOI: 10.2341/17-384-L
  49. Loguercio AD, Raffo J, Bassani F, et al. 24-month clinical evaluation in non-carious cervical lesions of a two-step etch-and-rinse adhesive applied using a rubbing motion. Clin Oral Investig 2011;15(4):589–596. DOI: 10.1007/s00784-010-0408-8
  50. Loguercio AD, Muñoz MA, Luque-Martinez I, et al. Does active application of universal adhesives to enamel in self-etch mode improve their performance? J Dent 2015;43(9):1060–1070. DOI: 10.1016/j.jdent.2015.04.005
  51. Tang C, Ahmed MH, Yao C, et al. Experimental two-step universal adhesives bond durably in a challenging high C-factor cavity model. Dent Mater 2023;39(1):70–85. DOI: 10.1016/
  52. Sezinando A, Luque-Martinez I, Muñoz MA, et al. Influence of a hydrophobic resin coating on the immediate and 6-month dentin bonding of three universal adhesives. Dent Mater 2015;31(10):e236–e246. DOI: 10.1016/
  53. Ermis RB, Ugurlu M, Ahmed MH, et al. Universal adhesives benefit from an extra hydrophobic adhesive layer when light cured beforehand. J Adhes Dent 2019;21(2):179–188. DOI: 10.3290/j.jad.a42344
  54. Katsuki S, Takamizawa T, Yokoyama M, et al. Influence of bonding agent application method on the dentin bond durability of a two-step adhesive utilizing a universal-adhesive-derived primer. Eur J Oral Sci 2022;130(3):e12868. DOI: 10.1111/eos.12868
  55. Tsujimoto A, Fischer NG, Barkmeier WW, et al. Bond durability of two-step HEMA-free universal adhesive. J Funct Biomater 2022;13(3). DOI: 10.3390/jfb13030134
  56. Yamanaka A, Mine A, Matsumoto M, et al. Back to the multi-step adhesive system: a next-generation two-step system with hydrophobic bonding agent improves bonding effectiveness. Dent Mater J 2021;40(4):928–933. DOI: 10.4012/dmj.2020-272
  57. Luque-Martinez IV, Perdigão J, Muñoz MA, et al. Effects of solvent evaporation time on immediate adhesive properties of universal adhesives to dentin. Dent Mater 2014;30(10): 1126–1135. DOI: 10.1016/
  58. Awad MM, Alrahlah A, Matinlinna JP, et al. Effect of adhesive air-drying time on bond strength to dentin: a systematic review and meta-analysis. Int J Adhes Adhes 2019;90:154–162. DOI: 10.1016/j.ijadhadh.2019.02.006
  59. Mazzitelli C, Maravic T, Sebold M, et al. Effect of shelf-life of a universal adhesive to dentin. Int J Adhes Adhes 2020;102:102673. DOI: 10.1016/j.ijadhadh.2020.102673
  60. Iliev G, Hardan L, Kassis C, et al. Shelf life and storage conditions of universal adhesives: a literature review. Polymers (Basel) 2021;13(16): DOI: 10.3390/polym13162708
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