Restorative survival rate -self-adhesive resin cement versus selective-etch, total-etch and self-etch adhesives


Bonding of restorations to enamel and dentine is part of modern dental practice although dentine bonding is more challenging. Various bonding systems are available and manufactures a consistently aiming to improve their materials. Self-adhesive luting resins were introduced in 2002 and there are now a number of clinical and comparative laboratory studies of self-adhesive luting resins versus other adhesive techniques

The aim of this review was to assess the durability of self-adhesive resin bonding, postoperative sensitivity, and the overall survival rate of indirect restorations compared to total-etch, selective-etch, and self-etch adhesives.


A protocol for the review was registered in the PSOSPERO database. Searches were conducted in the PubMed/Medline, BioMed Central, Cochrane and Scopus databases. Randomised controlled trials (RCTs) comparing self-adhesive luting resins with total-etch, selective-etch with dentine adhesives, selective etch without dentine adhesives or self-etch adhesives were considered. Two reviewers independently selected studies extracted data and assessed risk of bias using the Cochrane Collaboration Risk of Bias Tool 2 (ROB 2). The main outcomes were the survival rate, postoperative sensitivity, and debonding incidence of indirect restorations.


  • 9 RCTs were included, 2 studies involved indirect composite restorations and 7 involved ceramic inlays and partial crowns
  • 2 RCTs compared self-adhesive luting resins with the total-etch (etch and rinse) adhesive technique, and one RCT compared self-adhesive luting resins with total-etch and self-etch adhesive systems.
  • 2 RCTs compared self-adhesive luting resins with enamel selective-etch and self-etch adhesive systems while 4RCTs studied selective-etch surface pre-treatment before using self-adhesive luting resin.
  • 3 RCTs were considered to be at low risk of bias and two RCTs at high risk of bias with 4 RCTs having an unclear risk of bias.
  • Meta-analysis found significant difference in the postoperative sensitivity of self-adhesive luting resin to other systems (see table)
  No. of studies Risk Ratio (95%CI)
total-etch adhesive systems 3 2.05 (0.09 to 44.94
self-etch adhesives 2 1.49 (0.25 to 8.91
selective-etch with dentine bond 1 1.00 (0.06 to 15.55)
selective etch without dentine bond 4 0.86 (0.23 to 3.17)
  • For loss of retention (bonding durability) meta-analysis also showed no statistically significant differences for self-adhesive luting resins compared with total-etch adhesive systems. However less debonding was seen with self-adhesive luting resins and selective-etch adhesive system with and without dentine bond (see table below).
  No. of studies Risk Ratio (95%CI)
total-etch adhesive systems 3 0.03 (0.01 to 7.45)
self-etch adhesives 3 0.17 (0.05 to 0.55)
selective-etch with dentine bond 2 0.05 (0.01 to 0.39)
selective etch without dentine bond 4 0.25 (0.07 to 0.87)
  • Meta-analyses found no statistically significant difference between total-etch luting systems and self-adhesive luting resins but survival rate was higher for self-etch adhesive and selective-etch adhesive systems than for self-adhesive luting resins (see table below).
  No. of studies Risk Ratio (95%CI)
total-etch adhesive systems 3 0.55 (0.02 to 15.15)
self-etch adhesives 3 0.33 (0.16 to 0.68)
selective-etch with dentine bond 2 0.11 (0.04 to 0.36)
selective etch without dentine bond 4 0.48 (0.26 to 0.91)
  • Meta-analysis demonstrated no statistically significant difference between self-adhesive luting resins and all comparators for tooth integrity or restoration integrity (see table below).
  Risk Ratio (95%CI)
Tooth integrity  
total-etch adhesive systems 0.16 (0.20 to 1.30)
self-etch adhesives 0.50 (0.13 to 71.92)
selective-etch with dentine bond 0.50 (0.13 to 71.92)
selective etch without dentine bond 0.29 (0.06 to 1.34)
Restoration integrity
total-etch adhesive systems 1.06 (0.76 to 1.48)
self-etch adhesives 0.27 (0.20 to 1.58)
selective-etch with dentine bond 0.24 (0.05 to 1.16)
selective etch without dentine bond 0.73 (0.36 to 1.47)
  • Marginal integrity
    • The marginal integrity of restorations luted with total-etch adhesive systems was significantly better than the restorations luted with self-adhesive luting resins RR =0.51 (95%CI: 0.34 to 0.76).
    • Enamel selective-etch adhesive system with dentine adhesive showed statistically significantly better marginal integrity than self-adhesive luting resins RR = 4.50 (95%CI:1.02 to 19.79).
    • Single-step self- adhesive luting resin exhibited no statistically significant difference to self-etch adhesive system RR= 1.20 (95%CI: 0.54 to 2.53) or enamel selective-etch without dentin adhesive RR= 0.58 (95%CI: 0.24 to 1.44).


The authors concluded: –

Postoperative sensitivity might not be affected by the adhesive protocol. In relatively short observation, total-etch revealed comparable survival to self-adhesive luting resins for intracoronal restorations. Self-etch and selective etch adhesives exhibited the best clinical outcomes, followed by selective etch without dentine adhesives. Selective etch, and self-etch adhesives are preferable to self-adhesive resins.


The authors have preregistered a protocol on the PROSPERO database and searched a good range of relevant databases. 9 relatively small RCTs were identified involving between 10-50 patients and 24 to 150 restorations per study with follow up ranging between 1 – 6.5 years. Meta-analyses were conducted for a number of outcomes for the various agents used with some statistically significant differences being identified. However, these finding should be interpreted cautiously and most of the meta-analyses were conducted on small number of studies and only 3 of the included studies were considered to be at low risk of bias.


Primary Paper

Alghauli MA, Alqutaibi AY, Wille S, Kern M. Clinical reliability of self-adhesive luting resins compared to other adhesive procedures: A systematic review and meta-analysis. J Dent. 2023 Feb;129:104394. doi: 10.1016/j.jdent.2022.104394. Epub 2022 Dec 22. PMID: 36566829.

Review protocol in PROSPERO

Other references

Dental Elf – 11th Jul 2020

Improving the bond between glass ceramics and resin-based materials: Does an adhesive layer help?



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