Effectiveness of universal adhesives on primary tooth enamel: a literature review

Over recent years, minimally invasive techniques have been increasingly adopted in pediatric dentistry, leading to recommendations for materials that optimize clinical time and minimize handling errors. Consequently, the concept of a single-step adhesive—also known as a universal adhesive—has been widely described in permanent teeth and even in primary dentin as a reliable alternative capable of achieving predictable adhesive results, even without the application of phosphoric acid. However, there is no consensus regarding its use on the enamel of primary teeth. Therefore, the objective of the present literature review was to compile the available evidence to evaluate the effectiveness of universal adhesives. The literature search was conducted in PubMed, Scopus, ScienceDirect, LILACS, Wiley, and SciELO, including only articles published within the last ten years, in English and Spanish, that evaluated or compared at least one universal (single-bottle) adhesive. Both in vitro and clinical studies were considered. Thirteen studies met the eligibility criteria: 10 in vitro studies, 2 clinical trials, and 1 study with a mixed design that simultaneously conducted a clinical trial and an in vitro investigation. Most in vitro studies were performed on sound enamel, with the micro-shear bond strength (µSBS) test being the most frequently used. Overall, the findings suggested that selective enamel etching improved the bond strength of universal adhesives. In contrast, clinical trials evaluated only carious enamel and applied the United States Public Health Service (USPHS) criteria. The maximum follow-up period was 18 months, after which the results were heterogeneous. Although in vitro studies demonstrated increased effectiveness of universal adhesives with selective phosphoric acid etching, current clinical evidence remains insufficient to establish their efficacy in practice. Therefore, further well-designed, controlled clinical trials are warranted to clarify the clinical performance of these adhesives.

Primary teeth; Dental enamel; Primary enamel; Universal adhesive

[1] Lenzi TL, Pires CW, Soares FZM, Raggio DP, Ardenghi TM, de Oliveira Rocha R. Performance of universal adhesive in primary molars after selective removal of carious tissue: an 18-month randomized clinical trial. Pediatric Dentistry. 2017; 39: 371–376.

[2] Costa VPP, de Queiroz IQD, Lia ÉN. Primary and permanent dentitions: characteristics and differences. In Coelho Leal S, Takeshita EM (eds.) Pediatric restorative dentistry (pp. 23–29). Springer International Publishing: Cham. 2019.

[3] da Silva CL, Cavalheiro CP, Gimenez T, Imparato JCP, Bussadori SK, Lenzi TL. Bonding performance of universal and contemporary adhesives in primary teeth: a systematic review and network meta-analysis of in vitro studies. Pediatric Dentistry. 2021; 43: 170–177.

[4] Antoniazzi BF, Nicoloso GF, Lenzi TL, Soares FZM, Rocha R de O. Selective acid etching improves the bond strength of universal adhesive to sound and demineralized enamel of primary teeth. The Journal of Adhesive Dentistry. 2016; 18: 311–316.

[5] Hamdy D, Amend S, Lücker S, Frankenberger R, Krämer N. Effect of application mode and aging on microtensile bond strength of universal adhesives to enamel of primary teeth. International Journal of Paediatric Dentistry. 2025; 35: 815–828.

[6] Fröhlich TT, Gindri LD, Soares FZM, de Oliveira Rocha R. Does the etching strategy influence the bonding of universal adhesive systems to primary teeth? A systematic review and meta-analysis of in vitro studies. European Archives of Paediatric Dentistry. 2021; 22: 1015–1022.

[7] de Goes MF, Shinohara MS, Freitas MS. Performance of a new one-step multi-mode adhesive on etched vs. non-etched enamel on bond strength and interfacial morphology. The Journal of Adhesive Dentistry. 2014; 16: 243–250.

[8] Giannini M, Makishi P, Ayres APA, Vermelho PM, Fronza BM, Nikaido T, et al. Self-etch adhesive systems: a literature review. Brazilian Dental Journal. 2015; 26: 3–10.

[9] Van Meerbeek B, Yoshihara K, Yoshida Y, Mine A, De Munck J, Van Landuyt KL. State of the art of self-etch adhesives. Dental Materials. 2011; 27: 17–28.

[10] Memarpour M, Shafiei F, Razmjouei F, Soltani M. Shear bond strength and scanning electron microscopy characteristics of universal adhesive in primary tooth dentin: an in vitro study. Dental Research Journal. 2018; 15: 264–270.

[11] Perdigão J, Loguercio AD. Universal or multi-mode adhesives: why and how? The Journal of Adhesive Dentistry. 2014; 16: 193–194.

[12] Ghajari MF, Ghasemi A, Badiee M, Abdolazimi Z, Baghban AA. Microshear bond strength of Scotchbond Universal adhesive to primary and permanent dentin: a six-month in vitro study. Frontiers in Dentistry. 2019; 16: 173–180.

[13] de Boer M, Zimmermann M, Attin T, Tauböck TT, Hamza B. Marginal integrity of simplified adhesive strategies in primary teeth. International Dental Journal. 2023; 73: 881–888.

[14] Perdigão J, Araujo E, Ramos RQ, Gomes G, Pizzolotto L. Adhesive dentistry: current concepts and clinical considerations. Journal of Esthetic and Restorative Dentistry. 2021; 33: 51–68.

[15] Fujita-Nakajima K, Aoki-Tabei N, Arita A, Nishiyama N. NMR study on the demineralization mechanism of the enamel and dentin surfaces in MDP-based all-in-one adhesive. Dental Materials Journal. 2018; 37: 693–701.

[16] Suyama Y, Lührs AK, De Munck J, Mine A, Poitevin A, Yamada T, et al. Potential smear layer interference with bonding of self-etching adhesives to dentin. The Journal of Adhesive Dentistry. 2013; 15: 317–324.

[17] Cuevas-Suárez CE, da Rosa WL de O, Lund RG, da Silva AF, Piva E. Bonding performance of universal adhesives: an updated systematic review and meta-analysis. The Journal of Adhesive Dentistry. 2019; 21: 7–26.

[18] Pitchika V, Metz I, Rothmaier K, Crispin A, Hickel R, Bücher K, et al. Comparison of different protocols for performing adhesive restorations in primary teeth—a retrospective clinical study. The Journal of Adhesive Dentistry. 2016; 18: 447–453.

[19] Kim MJ, Kim J, Song JS, Chung SH, Hyun HK. Shear bond strength of different MDP-containing adhesive systems on enamel and dentin from primary teeth. Journal of Clinical Pediatric Dentistry. 2021; 45: 186–192.

[20] Hanabusa M, Mine A, Kuboki T, Momoi Y, Van Ende A, Van Meerbeek B, et al. Bonding effectiveness of a new ‘multi-mode’ adhesive to enamel and dentine. Journal of Dentistry. 2012; 40: 475–484.

[21] Xu X, Zhu J, Mei ML, Wu H, Xie K, Wang S, et al. Exploration and preliminary clinical investigation of an adhesive approach for primary tooth restoration. The Journal of Biomedical Research. 2023; 37: 138–147.

[22] Assunção CM, Dos Santos NM, Essvein TE, Silva MGR, Erhardt MCG, Rodrigues JA. Microshear bond strength of adhesive systems on eroded primary enamel and dentin. Pediatric Dentistry. 2020; 42: 47–52.

[23] Nozari A, Pakniyat Jahromi M, Haji Abbas Oghli F, Jowkar Z, Hamidi SA. Influence of different application modes of a universal adhesive system on the bond strength of bulk-fill composite resin to enamel and dentin in primary teeth. Clinical and Experimental Dental Research. 2024; 10: e947.

[24] Tichý A, Yang Y, Sayed M, Shimada Y, Hosaka K. The effect of bonding strategy and aging on adhesion to primary enamel: an in-vitro study. The Journal of Adhesive Dentistry. 2023; 25: 187–194.

[25] Alsaadawi A, Felemban O, Nassar HM, Abdelbaki M. Shear bond strength and fluoride release of a universal adhesive: an in-vitro study on primary teeth. Materials. 2023; 16: 2573.

[26] Assunção CM, Goulart M, Essvein TE, Santos NM, Erhardt MCG, Lussi A, et al. Effect of erosive challenges on deciduous teeth undergoing restorative procedures with different adhesive protocols—an in vitro study. Journal of Applied Oral Science. 2018; 26: e20170053.

[27] Omidi BR, Heidari S, Farahbakhshpour F, Ardakani ET, Mirzadeh M. The effect of dental adhesive composition and etching mode on microleakage of bonding agents in primary molar teeth. Journal of Dentistry. 2022; 23: 393–401.

[28] Ortolani AM, Cortese SG, Biondi AM. A clinical comparison of bonding systems with selective etching in primary teeth. Revista de la Facultad de Odontología. 2016; 31: 27–33. (In Spanish)

[29] Giannini M, Vermelho PM, de Araújo Neto VG, Soto-Montero JR. An update on universal adhesives: indications and limitations. Current Oral Health Reports. 2022; 9: 57–65.

[30] Polesso Patias M, Fernandes-E-Silva P, Carreño NLV, Lund RG, Piva E, da Silva AF, et al. Comparative clinical performance of universal adhesives versus etch-and-rinse and self-etch adhesives: a meta-analysis. Clinical Oral Investigations. 2025; 29: 352.

[31] Gifani M, Talafi Noghani M, Sarraf Shirazi A, Boruziniat A. Effects of a universal adhesive system and the snow-plow technique on microleakage of Class II composite restorations in primary molars. Frontiers in Dentistry. 2025; 22: 17.

[32] Beloica M, Goracci C, Carvalho CA, Radovic I, Margvelashvili M, Vulicevic ZR, et al. Microtensile vs microshear bond strength of all-in-one adhesives to unground enamel. The Journal of Adhesive Dentistry. 2010; 12: 427–433.

[33] Tedesco T, Soares F, Grande R, Rodrigues Filho L, Rocha R. Effect of cariogenic challenge on bond strength of adhesive systems to sound and demineralized primary and permanent enamel. The Journal of Adhesive Dentistry. 2014; 16: 421–428.

[34] Pires CW, Soldera EB, Bonzanini LIL, Lenzi TL, Soares FZM, Montagner AF, et al. Is adhesive bond strength similar in primary and permanent teeth? A systematic review and meta-analysis. The Journal of Adhesive Dentistry. 2018; 20: 87–97.

[35] Suzuki T, Takamizawa T, Barkmeier W, Tsujimoto A, Endo H, Erickson R, et al. Influence of etching mode on enamel bond durability of universal adhesive systems. Operative Dentistry. 2016; 41: 520–530.

[36] Han F, Liang R, Xie H. Effects of phosphoric acid pre-etching on chemisorption between enamel and MDP-containing universal adhesives: chemical and morphological characterization, and evaluation of its potential. ACS Omega. 2021; 6: 13182–13191.

[37] Perdigão J, Chew HP, Lee IK, Woodis K, Hatch B. Prospective, randomized clinical trial evaluating the clinical performance of a new universal adhesive in Class I and Class II restorations at 1 year. Clinical Oral Investigations. 2024; 29: 38.

[38] Schmalz G, Ryge G. Reprint of criteria for the clinical evaluation of dental restorative materials. Clinical Oral Investigations. 2005; 9: 215–232.

[39] de Paris Matos T, Perdigão J, de Paula E, Coppla F, Hass V, Scheffer RF, et al. Five-year clinical evaluation of a universal adhesive: a randomized double-blind trial. Dental Materials. 2020; 36: 1474–1485.