HEMA-free versus HEMA-containing adhesive systems: a systematic review.

Publisher: BioMed Central Country of Publication: England NLM ID: 101580575 Publication Model: Electronic Cited Medium: Internet ISSN: 2046-4053 (Electronic) Linking ISSN: 20464053 NLM ISO Abbreviation: Syst Rev Subsets: MEDLINE

Original Publication: London : BioMed Central

Methacrylates*; Humans ; Dental Cements ; Composite Resins ; Dental Restoration, Permanent/methods

Competing Interests: Declarations. Ethics approval and consent to participate: This systematic review study does not require approval from an ethics committee. The results will be disseminated in peer-reviewed journals and at international conferences and scientific meetings. Competing interests: The authors declare that they have no competing interests.
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.
(© 2025. The Author(s).)

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Keywords: Bonding durability; Dental bonding; HEMA; HEMA-free; Systematic review

6E1I4IV47V (hydroxyethyl methacrylate)
0 (Methacrylates)
0 (Dental Cements)
0 (Composite Resins)

Date Created: 20250122 Date Completed: 20250122 Latest Revision: 20250125

20250125

PMC11748282

10.1186/s13643-025-02763-w

39838443