Influência da adição da clorexidina ao cimento de ionômero de vidro para tratamento restaurador atraumático - Uma revisão sistemática

Abstract

The incorporation of chlorhexidine in the glass ionomer cement (GIC) seems to be an interesting alternative to prevent enamel demineralization and increase the antimicrobial and antibiofilm activity, especially against bacteria associated with the development of caries disease. The objective of this study it to evaluate the influence of the addition of chlorhexidine on the antimicrobial effect and on the survival of restorations after atraumatic restorative treatment. This systematic review was carried out according to the PRISMA list of recommendations and was registered in PROSPERO. The Embase, LILACS, PubMed, SciELO, Scopus and Web of Science databases were the primary study sources. OpenThesis and OpenGrey were used to partially capture "gray literature". Only clinical studies that evaluated the incorporation of chlorhexidine (CHX) in glass ionomer cements (GIC) in restorations after atraumatic restorative technique were included, without restrictions of year or publication status. Cochrane Collaboration’s Risk of Bias 2 (ROB2) assessed the risk of bias. The results were described by the narrative descriptive style. The GRADE tool assessed the certainty of the evidence. Initially, 1518 studies were found after the primary search. Only seven studies met the inclusion criteria (n = 590 restorations) and were considered in the descriptive / narrative analyzes. The studies were published between 2007 and 2020, the concentration of chlorhexidine varied between 0.5% and 2% and the bacterial reduction was evaluated in the dentin, saliva and in the biofilm. The risk of bias was evaluated as low risk to some concerns. In general, the addition of CHX to GIC promoted greater reductions in Streptococcus mutans and Lactobacillus acidophilus when compared to conventional GIC. There is not a study has shown a difference in the survival of restorations between the GIC- CHX and conventional GIC. The certainty of the evidence was rated very low. There is a limited evidence regarding the benefit of the incorporation of chlorhexidine in glass ionomer cements, however this combination might improve the antimicrobial effects for short time, inhibiting the microorganisms compared with conventional GIC, without interfering with the survival of the restoration.