{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:43:54Z","timestamp":1792550634577,"version":"4.5.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Dent. Med."],"abstract":"<jats:sec>\n                    <jats:title>Statement of problem<\/jats:title>\n                    <jats:p>The long-term stability of resin\u2013dentin adhesion remains a major concern in restorative dentistry. Hydrolytic and enzymatic degradation of the hybrid layer contributes to the deterioration of resin-bonded restorations. Inhibition of matrix metalloproteinases (MMPs) by chlorhexidine digluconate (CHX) has been proposed to preserve the hybrid layer and improve adhesive durability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This systematic review and meta-analysis evaluated the effect of dentin pretreatment with CHX on the clinical performance and longevity of resin-based restorations compared with no CHX application.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, electronic searches were conducted in PubMed, Scopus, Web of Science, and the Cochrane Library up to September 2025. Randomized and non-randomized clinical trials assessing CHX pretreatment before adhesive application were included. Primary outcomes were restoration retention, postoperative sensitivity, and secondary caries after \u22656 months of follow-up. Data extraction and risk of bias assessment were performed independently using the Cochrane RoB 2.0 tool. Random-effects meta-analyses were performed using risk differences (RDs) with 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eleven clinical trials (6 months\u20134 years of follow-up) met the inclusion criteria. CHX concentrations ranged from 0.2% to 2% with application times of 15\u201330\u2005s. Most studies used etch-and-rinse adhesives. Pooled analyses showed no significant differences between CHX and control groups for restoration retention (RD\u2009=\u20090.01; 95% CI, \u22120.02 to 0.04;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.53), postoperative sensitivity (RD\u2009=\u20090.01; 95% CI, \u22120.04 to 0.06;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.67), or secondary caries (RD\u2009=\u2009\u20130.00; 95% CI, \u22120.03 to 0.03;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.80), with no heterogeneity (I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Although CHX demonstrates MMPs inhibition\n                      <jats:italic>in vitro<\/jats:italic>\n                      , current clinical evidence does not support its routine use for enhancing the longevity of resin\u2013dentin bonds, particularly with etch-and-rinse adhesive systems. CHX may still be useful for antimicrobial purposes or in high-caries-risk patients. Further standardized, long-term randomized clinical trials are warranted to clarify its potential benefits with self-etch and universal adhesives.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>PROSPERO CRD420251165239.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fdmed.2026.1746184","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T06:46:34Z","timestamp":1773038794000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Effect of chlorhexidine pretreatment on clinical performance of adhesive restorations: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"7","author":[{"given":"Rim","family":"Bourgi","sequence":"first","affiliation":[{"name":"Department of Biomaterials and Bioengineering, INSERM 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Tlaxiaca, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel \u00c1ngel","family":"Fern\u00e1ndez-Barrera","sequence":"additional","affiliation":[{"name":"Dental Materials Laboratory, Academic Area of Dentistry, Autonomous University of Hidalgo State","place":["San Agust\u00edn Tlaxiaca, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evandro","family":"Piva","sequence":"additional","affiliation":[{"name":"Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas","place":["Pelotas, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Hardan","sequence":"additional","affiliation":[{"name":"Department of Restorative and Esthetic Dentistry, Faculty of Dental Medicine, Saint-Joseph University of Beirut","place":["Beirut, Lebanon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiana","family":"Roman","sequence":"additional","affiliation":[{"name":"Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, University of Strasbourg","place":["Strasbourg, France"]},{"name":"Department of Prosthetic Dentistry, Faculty of Dental Medicine, Strasbourg University","place":["Strasbourg, France"]},{"name":"P\u00f4le de M\u00e9decine et Chirurgie Bucco-Dentaire, H\u00f4pital Civil, H\u00f4pitaux Universitaire de Strasbourg","place":["Strasbourg, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naji","family":"Kharouf","sequence":"additional","affiliation":[{"name":"Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, University of Strasbourg","place":["Strasbourg, France"]},{"name":"Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg","place":["Strasbourg, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youssef","family":"Haikel","sequence":"additional","affiliation":[{"name":"Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, University of Strasbourg","place":["Strasbourg, France"]},{"name":"P\u00f4le de M\u00e9decine et Chirurgie Bucco-Dentaire, H\u00f4pital Civil, H\u00f4pitaux Universitaire de Strasbourg","place":["Strasbourg, France"]},{"name":"Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg","place":["Strasbourg, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.dental.2011.09.011","article-title":"Durability of bonds and clinical success of adhesive restorations","volume":"28","author":"Carvalho","year":"2012","journal-title":"Dent 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