Comparison of the Antibacterial Properties of Resin Cements with and without the addition of Nanoparticles: A Systematic review and Meta-analysis

doi:10.21203/rs.3.rs-3467496/v1

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Comparison of the Antibacterial Properties of Resin Cements with and without the addition of Nanoparticles: A Systematic review and Meta-analysis

https://doi.org/10.21203/rs.3.rs-3467496/v1

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published 22 Nov, 2024

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Resin cement exhibits numerous therapeutic advantages in comparison to conventional luting materials. However, the effectiveness of its antibacterial properties remains uncertain. Nanotechnology provides a viable option, whereby the integration of nanoparticles (NPs) can potentially augment the antibacterial effectiveness of resin cement. The objective of this study is to conduct a comprehensive literature review and do a meta-analysis in order to assess the antibacterial effectiveness of incorporating nanoparticles into resin cement. A comprehensive search of the PubMed and Scopus databases up to September 12, 2023 was conducted in order to identify relevant scholarly articles that have examined and evaluated the antibacterial effectiveness of resin cement with and without the incorporation of nanoparticles (NPs). The systematic review and meta-analyses adhered to the PRISMA guidelines for reporting. The study was conducted using Review Manager (RevMan) version 5.4, and the results were evaluated and provided in terms of standardized mean difference (SMD) along with a matching 95% confidence interval. (CI). The search retrieved seven eligible studies. The analysis found that resin cement with NPs significantly reduced the colony forming unit (CFU) counts compared to resin cement without NPs (SMD = -4.91, 95% CI (-7.03, -2.78), P < 0.00001). Furthermore, resin cement, in addition to NPs, significantly reduced bacterial metabolic activity compared to the control group (SMD = -7.05, 95% CI (-10.43, -3.66), P < 0.0001). The use of nanoparticles (NPs) in resin cement has been shown to enhance its antibacterial properties, possibly mitigating the occurrence of secondary caries. Future clinical trials are required to validate the beneficial effects of NPs in conjunction with resin cement in the prevention of secondary caries.

Material Science

Resin Cement

Nanoparticles

Antibacterial

Nanomaterials

Resin cement is an innovative luting material that has been developed specifically for use in dental applications. The composition includes a resin matrix, comprising constituents such as urethane dimethacrylate and Bis-GMA, in addition to finely dispersed inorganic filler particles. Resin cement distinguishes itself through its characteristic of possessing low viscosity and an optimized distribution of fillers, rendering it a composite material capable of achieving a thin film [1]. Resin cement possesses distinct characteristics in comparison to composites, mostly attributable to their reduced filler concentration and viscosity.

Resin cement can be classified into three categories based on their polymerization mechanisms: light-cured, chemical-cured, and dual-cured. Additionally, they can be categorized according to their adhesive scheme, which includes total-etch, self-etching, and self-adhesive approaches [2, 3]. Resin cement exhibits remarkable versatility in a wide range of dental applications, encompassing the cementation of various dental restorations, such as full-cast metal crowns, ceramic crowns, zirconia constructions, indirect composite restorations, traditional metal-ceramic constructions, metal and glass fiber posts, implant-supported crowns and bridges, and ceramic veneers. [4].

Compared to previously used luting materials, resin cement demonstrates superior mechanical and physical qualities [5, 6]. These materials exhibit excellent compression resistance, Improved hardness and good flexural strength. In addition, resin cements have substantial strength against fatigue and demonstrate the ability to bond well with a diverse array of materials. In addition, these dental restorations possess the capability to modify shade and color, have excellent durability, display resistance to wear at the restoration's edge, and exhibit minimal marginal permeability. [7–9]. Nevertheless, it is crucial to take into account that resin cement may exhibit a comparatively lesser capacity to limit caries progression when juxtaposed with alternative luting materials, such as glass-ionomer cements. This raises concerns regarding their capacity to inhibit secondary caries. [10, 11].

Nanotechnology has emerged as a promising field of study within the realm of dental research, exhibiting significant potential for augmenting the antibacterial and mechanical characteristics of dental materials. [12]. By incorporating nanoparticles (NPs) into dental materials, such as silver nanoparticles, it is possible to create materials that effectively inhibit bacterial buildup and the development of secondary caries [13, 14]. Although there has been a limited number of research examining the antibacterial properties of resin cement when nanoparticles are used, a comprehensive investigation on this subject has not yet been undertaken. The antibacterial efficiency of resin cement after nanoparticle integration was examined in this comprehensive review and meta-analysis.

These nanoparticles have unique antibacterial characteristics. This thorough review shows how nanoparticles improve resin cements' antibacterial characteristics. Dental professionals need this expertise to find and use the best materials to prevent bacterial growth and dental diseases.

Resin cements are commonly used in restorative dentistry and dental prostheses, which are susceptible to bacterial colonization and infection. Understanding the antibacterial properties of resin cements, especially those containing nanoparticles, helps in selecting materials that can effectively prevent bacterial growth and reduce the risk of post-treatment infections. This comparison aids in improving patient outcomes and minimizing the need for additional interventions due to infections.

The comparison of resin cements with and without nanoparticles allows dental professionals to make informed decisions when selecting materials for various dental applications. By considering the antibacterial properties, dentists can choose resin cements that are more effective in preventing bacterial colonization, leading to better long-term results and reduced risk of complications.

Systematic reviews and meta-analyses provide a comprehensive analysis of existing scientific literature. This particular review contributes to evidence-based dentistry by summarizing and evaluating the available research on the antibacterial properties of resin cements with and without nanoparticles. Dental professionals can rely on this evidence to guide their clinical decision-making and ensure their treatment approaches are supported by scientific research.

The comparison of resin cements with and without nanoparticles highlight areas that require further study and development. If certain nanoparticles are found to significantly enhance the antibacterial properties of resin cements, future research can focus on optimizing their usage, concentration, or combination with other materials.

Our systematic review aimed to examine the literature on this topic. Our objective was to expand our comprehension of the antibacterial capabilities of resin cement by including nanoparticles through a comprehensive search of diverse databases and a detailed analysis of the chosen studies. The methodology utilized in the studies included was assessed, evidence quality was reviewed, and findings were synthesized to draw the conclusions.

The systematic review and meta-analysis conducted in this study will make a significant scholarly contribution by offering useful insights into the antibacterial efficacy of resin cement when nanoparticles are incorporated. The provided information will empower dental professionals to make well-informed judgements regarding the most effective utilization of resin cement in dental procedures. Moreover, this could potentially facilitate future investigations, advancements and utilization of nanotechnology to enhance the effectiveness and efficiency of resin cements.

In summary, resin cement is a revolutionary luting material with unique properties, making it an ideal choice for various dental applications. Its superior mechanical and physical qualities, along with its potential to incorporate nanoparticles for enhanced antibacterial activity, make resin cement a promising option for dental professionals. Our systematic study and meta-analysis aim to comprehend resin cement with nanoparticles' antimicrobial abilities to serve the dental community.

The authors ensured that they complied with all PRISMA recommendations for the reporting of systematic reviews and meta-analyses. [15]. The protocol used for this systematic review was the registered International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) (2023100035).

2.1 Research Question:

What is the comparative analysis of the antibacterial properties of resin cements with and without the incorporation of nanoparticles?

2.2 Eligibility criteria

The papers included in our analysis were selected based on their adherence to the PICOS criteria, which included the following elements: population, intervention, control, outcomes, and research design. The population of interest in our study was resin cement. The intervention used in the study consisted of using nanoparticles. The experimental control used in this study included the utilization of all intervention materials, with the exception of nanoparticles. In order for the research study to demonstrate that it satisfies the criteria for inclusion, it must first engage in the process of evaluation and then give a comprehensive analysis of the outcomes that are pertinent to our research aims. Our study exclusively incorporated comparative designs, encompassing both randomized and non-randomized methodologies, while also encompassing studies conducted in vivo or in vitro.

The analysis excluded single-arm studies and conference publications. Furthermore, any research that incorporated the utilization of composite resin or resin-modified glass ionomer cement was excluded from the analysis. The study did not incorporate commercial control groups.

2.3 Information source

Using the PubMed and Scopus databases, a comprehensive investigation was conducted, which included the time period from the databases' inception until September 12, 2023. This research project ultimately led to the exploration of relevant scientific publications. The examination of the reference lists of articles that were eligible led to the finding of further studies of interest.

We searched the databases using the following search strategy: (cement* AND resin*) AND (nanoparticle* OR nanotechnology) AND (antibact* OR anti-bact* OR antimicro* OR anti-micro* OR antibiofilm* OR anti-biofilm* OR antiinfect* OR anti-infect* OR bactericidal* OR bacteriostatic*). No filters were applied.

2.4 Selection process

The software application Endnote was used to consolidate and merge all of the individual information. The data underwent conversion into an Excel spreadsheet, thereafter being submitted in two distinct steps for the purpose of identifying studies that met the eligibility criteria. The first phase involves the completion of title and abstract screening, with the subsequent progression of eligible records to the subsequent stage of full-text screening. The eligibility of each paper in each step was subject to independent examination by two writers The resolution of conflicts was attained through the process of dialogue

2.5 Data collection process

In this systematic review and meta-analysis, the primary author played a crucial role in developing Excel spreadsheets that were meticulously organized. These spreadsheets served as a valuable tool for the reviewing authors to extract the relevant data from the included research studies. The systematic extraction process involved two researchers who independently collected data from each study, ensuring a thorough and comprehensive approach.

To maintain accuracy and consistency, the collaborating researchers engaged in a collaborative discourse to discuss and analyze the findings obtained from the data extraction process. This collaborative effort helped in minimizing errors and enhancing the reliability of the extracted data.

To effectively manage any instances of incomplete or conflicting data, the suggested methodologies as outlined in the Cochrane Handbook were diligently followed (16). These methodologies provided a standardized approach for addressing and resolving any discrepancies or missing information. By adhering to these suggested methodologies, the review authors were able to maintain the integrity and validity of the data, ensuring that the final findings were based on reliable and accurate information.

2.6 Data items (outcomes)

The primary focus of this study was to investigate and compare the antibacterial characteristics of resin cements. To achieve this objective, the researchers employed specific methodologies to assess the effectiveness of these cements in preventing bacterial growth.

One of the key measurements used in this evaluation was the colony-forming unit (CFU) count. This quantification provided valuable information about the antibacterial properties of the different resin cements under investigation. In addition to CFU counts, the study also assessed the metabolic activity of bacteria using the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. The incorporation of these measurements, CFU counts and MTT activity, allowed for a comprehensive evaluation of the antibacterial properties of resin cements.

2.7 Data items (other variables)

The authors of this research conducted a compilation of several study parameters, encompassing study ID, study title, resin cement type, nanoparticle type, description of the intervention and control, specifics of antibacterial tests, and species of bacteria employed, as well as the findings derived from each investigation.

2.8 Effect measures and synthesis methods

All analyses were done with RevMan 5.4. [17]. All data were collected in the form of means and standard deviations (SD). The effect size was calculated and reported as standardized mean difference (SMD) and the corresponding 95% confidence interval (95% CI). The heterogeneity was assessed using Cochrane's Q test and the I2 statistic. Significant heterogeneity was deemed to be present if the P value was less than 0.05, and the I2 statistic exceeded 60%. In order to ascertain the source of heterogeneity, a sensitivity analysis was performed utilizing the leave one out approach. The utilization of the random effects model was employed to effectively address the existence of heterogeneity and appropriately accommodate the variations in the characteristics of the studies.

3.1 Literature search

During the initial stage of this systematic review, a comprehensive search was conducted, resulting in the identification of 266 relevant records. These records were then subjected to a meticulous screening process, which involved evaluating the titles and abstracts to determine their suitability for inclusion in the study. As a result, 63 records progressed to the subsequent stage of full-text screening, where a more detailed assessment was carried out.

Following a rigorous evaluation of the full-text articles, 57 records were excluded due to various reasons, such as not meeting the specific inclusion criteria outlined for this study. Ultimately, a total of 7 studies were deemed to meet the requirements and were included in the final analysis. To provide a visual representation of the selection process, Fig. 1 presents a flowchart depicting the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) process. The relevance of this information lies in its transparency and methodological rigor. By disclosing the number of records initially identified, the screening process, and ultimately the inclusion of studies, this systematic review ensures transparency in its methodology and provides readers with a clear understanding of how the final set of studies was determined.

3.2 Study characteristics

Our analysis includes a total of seven comparable in vitro trials. The antibacterial efficacy of resin cement, in conjunction with nanoparticles, was evaluated by all researchers in relation to its impact on Streptococcus mutans. This research included several types of nanoparticles: silver nanoparticles (AgNPs) in four instances [18–21], magnesium oxide nanoparticles (MgONPs) in one instance [22], zinc oxide nanoparticles (ZnONPs) in one instance [23], and nano-silica with quaternary ammonium salts in one instance [24]. Table 1 summarizes the relevant study features of the analyzed studies.

Table 1

Studies characteristic
Study ID	Resin	Intervention	Control	Nanoparticles	Test for antibacterial efficacy	Findings
Wang et al. 2023a	Dual-cure resin cement self-etching adhesive	a- Resin cement + 10% MgONPs b- Resin cement + 7.5% MgONPs c- Resin cement + 5% MgONPs d- Resin cement + 2.5% MgONPs	Resin cement + 0% MgONPs	Magnesium oxide nanoparticles (MgONPs)	Antibacterial performance against S. mutans using colony-forming unit (CFU) counts and MTT metabolic activity	The incorporation of magnesium oxide nanoparticles (MgONPs) into resin cements has been found to significantly improve the antibacterial properties of these materials, while maintaining their mechanical, bonding, and physicochemical characteristics. In general, the incorporation of magnesium oxide nanoparticles (MgONPs) into resin cements can serve as a viable option for inhibiting cariogenic bacteria. This approach aims to mitigate the occurrence of secondary caries associated with biofilm formation, hence enhancing the long-term effectiveness of cementation.
Magalhães et al. 2016	Two Dual-cure resin cement (one conventional "RelyX ARC" and one self-adhesive, RelyX U200)	a- RelyX ARC with 0.05% NAg b- RelyX ARC with 0.07% Nag c- RelyX U200 with 0.05% NAg d- RelyX U200 with 0.07% NAg	1- RelyX U200 2- RelyX ARC	Silver nanoparticles (AgNPs)	Antibacterial performance against S. mutans .	The incorporation of silver nanoparticles (NAg) into resin-luting cements did not inhibit Streptococcus mutans. The materials containing NAg exhibited noticeable alterations in colour and demonstrated increased sorption capabilities compared to the ones without NAg.
Seo et al. 2023	orthodontic resin cement	a- 95% Resin + ZnO b- 95% Resin + ZnO + HNTs	100% Resin	a- Zinc oxide nanoparticles (ZnONPs) b- Zinc oxide (ZnO)-Loaded Halloysite Nanotubes	Antibacterial performance against S. mutans using MTT metabolic activity	A nanocomposite material used in this research showed antibacterial efficiency against S. mutans while maintaining the mechanical, physical, and chemical properties of orthodontic resin cement.
Hu et al. 2020	Self-adhesive resin cement	a- Resin cement + 10% Nano-silica b- Resin cement + 7.5% Nano-silica c- Resin cement + 5% Nano-silica d- Resin cement + 2.5% Nano-silica	Resin cement + 0% Nano-silica	Nano-silica with quaternary ammonium salts	Antibacterial performance against S. mutans using colony-forming unit (CFU) counts	Dental plaque microcosm biofilm metabolic activity was significantly reduced by nano-antibacterial inorganic fillers in resin cement at 2.5% or higher. This finding suggests that the resin cement exhibited an effective antibacterial effect.
Kreve et al. 2022	Dual-cure resin cement	1- Resin cement + 2.5% β-AgVO3 2- Resin cement + 5% β-AgVO3	Resin cement + 0% β-AgVO3	Semiconductor nanostructured silver vanadate decorated with silver nanoparticles (β-AgVO3)	Antibacterial performance against Staphylococcus aureus, Streptococcus mutans, and Enterococcus faecalis using the Agar Diffusion Test	Antimicrobial activity against Staphylococcus aureus, Streptococcus mutans, and Enterococcus faecalis was observed at both concentrations.
Lim et al. 2012	Light-cure resin cement	Resin cement + 250 ppm NAg	Resin cement + 0 ppm	Silver nanoparticles (NAg)	Antibacterial performance against cariogenic streptococci using the Agar Diffusion Test	The inclusion of silver nanoparticles in resin cement resulted in a notable deceleration of bacterial growth compared to resin cement without silver nanoparticles.
Magalhães et al. 2012	Resin luting cement (Rely X ARC)	Resin cement + 0.05% NAG	RelyX ARC	Silver nanoparticles (NAg)	Antibacterial performance against S. mutans using the Agar Diffusion Test	Vitrebond exhibited bactericidal action both in the absence and presence of silver, with the latter showing a stronger effect.

3.3 Qualitative synthesis

Two studies [22, 24] investigated the effects of NPs on colony-forming unit (CFU) counts in resin cements and discovered that NPs dramatically lowered CFU counts compared to resin cements without NPs. Two studies [22, 23] investigated the influence of NPs on MTT metabolic activity and discovered that resin cements containing NPs dramatically reduced biofilm metabolic activity compared to a control group. The agar diffusion test was used in three studies to evaluate antibacterial performance. Kreve et al. [21] discovered that the NPs had a dose-dependently significant larger inhibition halos for Staphylococcus aureus, Streptococcus mutans, and Enterococcus faecalis. Lim et al. [20] discovered that resin cement containing silver nanoparticles considerably reduced bacterial growth compared to resin cement containing no silver nanoparticles. Magalhães et al. [18] revealed that incorporation of silver NPs enhanced the bactericidal activity. Only one study [19] found that NPs had no antibacterial effect, as measured by the optical density of the culture broths.

3.4 Quantitative synthesis

3.4.1 Antibacterial performance as measured by colony-forming unit (CFU) counts

In this meta-analysis, two studies [22, 24] were included in the analysis, which investigated the impact of different concentrations of nanoparticles on resin cement. Within these studies, a total of eight different groups were identified based on the varying concentrations of nanoparticles in the resin cements.

The results of the analysis demonstrated a significant reduction in colony-forming unit (CFU) counts when resin cement with nanoparticles (NPs) was compared to resin cement without nanoparticles. The standardized mean difference (SMD) was calculated to be -4.91, indicating a substantial decrease in bacterial growth associated with resin cements containing nanoparticles. The confidence interval (CI) for this finding was (-7.03, -2.78), further supporting the statistically significant difference.

To visually represent the findings, Fig. 2 shows the comparison between the CFU counts of resin cement with and without NPs. The considerable reduction observed in the CFU counts of the nanoparticles-containing resin cement group emphasizes the antibacterial properties conferred by the nanoparticles. These results highlight the potential of utilizing resin cements with nanoparticles to effectively inhibit bacterial growth in dental applications.

However, it is important to note that the pooled analysis exhibited heterogeneity (I = 95%, P < 0.00001), indicating variations among the included studies. Despite conducting sensitivity analysis, the identified sources of heterogeneity could not be resolved. This suggests that factors other than the concentration of nanoparticles may have influenced the observed differences among the studies.

The relevance of these findings lies in their implications for dental practitioners and researchers. The inclusion of different concentrations of nanoparticles in resin cements offers the opportunity to tailor the antibacterial properties, which can enhance infection control in dental procedures. However, the observed heterogeneity in the pooled analysis signifies the need for further investigation to elucidate the underlying factors contributing to the variation among the studies (Fig. 2).

3.4.2 Antibacterial performance as measured by MTT metabolic activity

In this meta-analysis, two studies [22, 23] were carefully selected for analysis. These studies evaluated the impact of nanoparticles (NPs) and their concentrations on resin cement in the context of reducing bacterial metabolic activity. Collectively, these studies comprised a total of six different groups, each representing a distinct combination of NPs and their concentrations.

The results of the analysis unequivocally demonstrated the significant effect of resin cement with NPs in reducing bacterial metabolic activity when compared to the control group. The calculated standardized mean difference (SMD) was found to be -7.05, indicating a substantial reduction in bacterial metabolic activity associated with the use of resin cements containing NPs. The 95% confidence interval (CI) for this finding ranged from (-10.43, -3.66), further emphasizing the statistical significance of the observed effect.

To present the findings visually, Fig. 3 displays the comparison between bacterial metabolic activity in resin cement with NPs versus the control group. The significant reduction in bacterial metabolic activity observed in the NPs-containing resin cement group highlights the efficacy of incorporating NPs in resin cements to inhibit bacterial growth and metabolic processes.

It is important to acknowledge that the pooled analysis exhibited heterogeneity (I = 97%, P < 0.00001), which suggests variations among the included studies. Despite conducting sensitivity analysis, the sources of heterogeneity could not be resolved in this meta-analysis. This indicates the presence of factors beyond the concentration of NPs that may have contributed to the observed differences among the studies (Fig. 3).

Resin cement represents the latest development in luting materials designed for dental applications. Resin cements exhibit superior mechanical and physical qualities compared to their predecessors in the field of luting materials. Nevertheless, available information indicates that resin cement may exhibit lower efficacy in preventing the formation of caries compared to conventional luting materials. Nanotechnology is a potential solution, and adding NPs to resin cement could improve its antibacterial properties. This study is the first comprehensive evaluation of resin cements' antibacterial effectiveness with and without nanoparticles. (NPs). Our research found that nanoparticles in resin cement reduced bacterial colony numbers and metabolic activities statistically. Moreover, our analysis revealed that the utilization of NPs resulted in the generation of a more extensive zone of inhibition and a deceleration of bacterial proliferation in comparison to the control cohort.

The integration and implementation of nanoparticles into dentistry has been encouraged due to their broad-spectrum antibacterial impact, which does not lead to bacterial resistance as shown with antibiotics. [25, 26]. Silver NPs and magnesium oxide NPs are the most common NPs that are known for their antibacterial effects. However, the mechanism is not fully understood. Some of the proposed mechanisms are as follows:1) oxygen changes into reactive oxygen species and hydroxyl radicals, which cause structural damage to the bacteria [27, 28]; 2) silver and magnesium oxide ions are bioactive and, when released, interact with cell membrane structures, preventing the replication of the bacteria [27, 29]; and 3) NPs, when attached to the cell membrane, release ions at a very high concentration, which is cytotoxic [28].

Our findings are consistent with a previous systematic review [30], which concluded that nanoparticle-modified dental materials had much better antibacterial activity than untreated materials. However, they did not assess the efficacy of the resin cement modified with NPs, and they only assessed the antibacterial effect measured by CFU. Here, we found similar effects for resin cement integrated with NPs and found that NPs have a positive effect on MTT metabolic activity as well.

The higher antibacterial performance for NPs was consistent across all of the included studies, except for Magalhães et al. 2016 [19]. Magalhães et al. measured the antibacterial performance of silver NPs using the optical density of the broths and found no significant effect between the groups. A similar finding was reported by Wang et al. [22], where magnesium NPs significantly reduced CFU and MTT, but produced a non-significant effect on the optical density. Wang et al. [22] suggested that MgONPs may directly inactivate adherent bacteria rather than inhibit plankton development by releasing a high bioactive material concentration into the culture.

The antibacterial efficacy exhibited a positive correlation with the filler content, whereas the mechanical characteristics demonstrated a negative association, yielding an inverse outcome. [31]. It is worth noting that studies have shown that NPs have no effect on the mechanical, bonding, or physicochemical performance of resin cement. Wang et al. [22] discovered that magnesium NPs had no effect on shear bond strength, water sorption, or solubility when MgONPs were added at less than 10%. Seo et al. [23] discovered similar results, revealing that zinc oxide NPs had strong antibacterial effects.

The findings from our study have substantial implications for the field. Secondary caries, at the interface between dental restorations and the tooth, along with subsequent acid attacks, pose a significant challenge to restoration durability. This review revealed that the incorporation of nanoparticles (NPs) effectively decreases bacterial colonization and metabolic activity. By integrating NPs into resin cement, we can harness the material's inherent advantages in chemical and physical properties while simultaneously augmenting its antibacterial effects. Consequently, NP-modified resin cement emerges as a viable solution for mitigating biofilm-associated secondary caries and enhancing the durability of cementation. To substantiate these findings, further research involving in vivo experiments and randomized clinical trials should be undertaken in the future.

4.1 Strengths and limitations

This is the first meta-analysis and systematic review to evaluate the efficacy of NPs in addition to resin cement. We included trials regardless of language. However, this study had several limitations. First, the pooled analysis showed significant heterogeneity, which could be attributed to the different types and concentrations of the nanoparticles used, as well as the different incorporation methods that were applied. However, we used a random-effects model to produce more robust results. Moreover, the absence of sufficient data hindered our ability to conduct subgroup analyses aimed at examining the impact of various types and quantities of nanoparticles. The studies in this review varied in numerous ways, including the incubation period, sample handling techniques, and the specific type of resin cement employed.

This study demonstrates a substantial enhancement in the antibacterial properties of resin cement through the incorporation of nanoparticles (NPs), without compromising the material's mechanical, physical, and chemical characteristics. However, to validate these findings and assess the efficacy of NP-modified resin cement in the prevention of secondary caries, it is crucial to conduct future clinical trials. Moreover, due to the significant heterogeneity observed in the results, additional research is necessary to establish a standardized protocol regarding the selection of NP type, optimal concentration, and appropriate method of incorporation.

Ethical Approval and consent to participate: Not Applicable.
Consent to Publication – Not Applicable.
Data Availability statement – The data will be available on reasonable request from the corresponding author.
Conflict of interest – The authors declare no conflict of interest.
Funding – The authors thank the Deanship of Scientific Research at King Khalid University, Abha, Saudi Arabia, for supporting the present research study through [GRP/246/44].
Acknowledgement: Open Access funding provided by Qatar National Library. All the authors are thankful to King Khalid University, Saudi Arabia, for the financial Support.
Author Contribution: “Conceptualization, R.S.; S.K.V.; S.A.; D.S.; K.C.S.; methodology, R.S.; S.K.V.; S.A.Q.; S.A.; D.S.; K.C.S.; software, R.S.; S.A.Q.; S.A.B.; S.A.; K.C.S.; valida-tion, R.S.; S.K.V.; M.A.K.; S.A.Q.; K.C.S.; formal analysis, R.S.; D.S.; K.C.S.; writing—original draft preparation, R.S.; S.K.V.; S.A.; D.S.; K.C.S.; writ-ing—review and editing, R.S.; S.K.V.; M.A.K.; S.A.Q.; S.A.B.; S.A.; D.S.; K.C.S.; supervision, R.S.; funding acquisition, S.A.B.; and S.A. All authors have read and agreed to the published version of the manuscript.

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No competing interests reported.

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Comparison of the Antibacterial Properties of Resin Cements with and without the addition of Nanoparticles: A Systematic review and Meta-analysis

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Journal Publication

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Abstract

Figures

1. Introduction

2. Materials and Methods

2.1 Research Question:

2.2 Eligibility criteria

2.3 Information source

2.4 Selection process

2.5 Data collection process

2.6 Data items (outcomes)

2.7 Data items (other variables)

2.8 Effect measures and synthesis methods

3. Results

3.1 Literature search

3.2 Study characteristics

3.3 Qualitative synthesis

3.4 Quantitative synthesis

3.4.1 Antibacterial performance as measured by colony-forming unit (CFU) counts

3.4.2 Antibacterial performance as measured by MTT metabolic activity

4. Discussion

4.1 Strengths and limitations

5. Conclusions

Declarations

References

Additional Declarations

Status:

Journal Publication

Version 1