2.1

Protocol and registration

We registered this study protocol at the PROSPERO database under the registration number CRD42015019560, and we followed the recommendations of the PRISMA statement for the report of this systematic review .

2.2

Information sources and search strategy

The controlled vocabulary (mesh terms) and free keywords in the search strategy were defined based on the PICOS question:

• 1.

  Population (P): adult patients with the non-carious cervical lesions.

• 2.

  Intervention (I): placement of composite restorations with self-etch adhesives after selective enamel etching.

• 3.

  Comparison (C): the intervention should be compared with composite restorations placed with self-etch adhesives without selective enamel etching.

• 4.

  The outcomes (O): retention rates, marginal discoloration and marginal adaptation.

• 5.

  Study design (S): randomized clinical trials.

To identify trials to be included for this review, we searched the MEDLINE electronic databases via PubMeb, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database (LILACS), Brazilian Library in Dentistry (BBO) and Cochrane Library ( Table 1 ). We hand-searched the reference lists of all primary studies for additional relevant publications and the related articles linked to each primary study in the PubMed database. No restrictions were placed on the publication date or languages.

Other sources were also used to identify possible articles. The abstracts of the annual conference of the International Association for Dental Research (IADR) and their regional divisions (1990–2014) were also searched, and authors of relevant abstracts were contacted for further information. The grey literature was explored using the database System for Information on Grey Literature in Europe (SIGLE). Dissertations and theses were searched using the ProQuest Dissertations and Theses Fulltext database and the Periódicos Capes Theses database.

To locate unpublished and ongoing trials, we searched the following clinical trials registries: Current Controlled Trials ( www.controlled-trials.com ), International Clinical trials registry platform ( http://apps.who.int/trialsearch ), the ClinicalTrials.gov ( www.clinicaltrials.gov ), Rebec ( www.rebec.gov.br ), and EU Clinical Trials Register ( https://www.clinicaltrialsregister.eu ).

2.3

Eligibility criteria

We included only randomized clinical trials (RCTs) that compared the clinical effectiveness of self-etch adhesives with and without selective enamel etching used for direct composite resin restorations in permanent dentition of adult patients of any age group ( Table 1 ). Non-controlled clinical trials, editorial letters, pilot studies, historical reviews, in vitro studies, cohort, and observational and descriptive studies, such as case reports and case series, were excluded. Additionally, RCT studies were excluded if (1) other types of cavity were treated other than non-carious cervical lesions; (2) bases or liners were always used before adhesive application; (3) silorane-based adhesives were employed; (4) chemically cured adhesives were used; (5) the restorations were placed in primary teeth; (6) resin cements were involved in the bonding protocol, such as for indirect restorations; (7) polyacid-based resins instead of composite resins were employed as restorative materials.

2.4

Study selection and data collection process

Initially, the articles were selected by title and abstracts according to the previously described search strategy. Articles that appeared in more than one database were considered only once. Full-text articles were also obtained when the title and abstract presented insufficient information to make a clear decision. Subsequently, two reviewers classified those that met the inclusion criteria. Relevant information about the study design, participants, interventions and outcomes were extracted using customized extraction forms by three authors (A.S., S.O. and A.R.). The collection form was pilot tested using a sample of study reports to ensure that the criteria were consistent with the research question.

Multiple reports of the same study data were extracted directly into a single data-collection form to avoid overlapping data. Because the study results were reported in several periods of follow-ups, we performed a different analysis by grouping the studies in the follow-up periods: 1 year; 18 months to 2 years; 3 years and 4–5 years. We did not conduct further long-term analysis because only two articles reported longer periods than 5 years .

When more than one adhesive was included in the study, their values were combined to make a single entry. In case data from marginal discoloration and marginal adaptation were provided for dentin and enamel margins, we collected data from the worst scenario. When inconsistencies of data were observed between the different follow-ups of the same study, we collected data from the most recent article.

In case data were provided in the World Dental Federation (FDI) and in the original or slightly modified United States Public Health Service (USPHS) criteria, we collected data from the USPHS criteria, as most of the RCTs selected for this study employed the later approach for evaluation of the restorations.

2.5

Risk of bias in individual studies

Quality assessments of the included trials were evaluated by two independent reviewers (A.S and S.P), using the Cochrane Collaboration’s tool for assessing risk of bias in randomized trials . The assessment criteria contained six items: sequence generation, allocation concealment, blinding of the outcome assessors, incomplete outcome data, selective outcome reporting, and other possible sources of bias. During data extraction and quality assessment, any disagreements between the reviewers were resolved through discussion, and if needed, by consulting a third reviewer (A.L.).

For each aspect of the quality assessment, the risk of bias was scored following recommendations as described in the Cochrane Handbook for Systematic reviews of Interventions 5.1.0 ( ). At the domain level, the judgment for each entry involved recording ‘yes’ indicating low risk of bias, ‘no’ indicating high risk of bias and ‘unclear’ indicating either lack of information or uncertainty over the potential for bias.

At the study level, the study was considered to be at “low” risk of bias if all key domains (sequence generation, allocation concealment and blinding of the outcome assessors) for each outcome (retention, marginal discoloration and marginal adaptation) were at “low” risk of bias. If one or more key domains were judged as at “unclear” or at “high” risk of bias, the study as a whole was considered at “high” risk of bias. When the study was judged as “unclear” in its key domains, we tried to contact the authors to obtain more information and allow a definitive “yes” or “no” judgment of each domain.

2.6

Summary measures and synthesis of the results

Dichotomized data were collected and a meta-analysis for paired data was performed to obtain a pooled estimate of the overall odds ratios (ORs) with a 95% confidence interval. Due to the matched nature of the data (split-mouth design), we imputed an external correlation of 0.5 for groups from the same study (as this information was not available in any of the studies). Only studies classified at “low” risk of bias in the key domains were used in the meta-analysis. The random-effects models were employed. Heterogeneity was assessed using the Cochran Q test and I ² statistics.

In the presence of substantial heterogeneity (p < 0.1, I2 > 75%), sensitivity analysis was conducted to determine whether excluding one or more studies would reduce the heterogeneity or not. Sensitivity analyses using lower (0.1) and higher (0.9) external correlations were performed to check the impact of such imputation in all meta-analysis. The impact of excluding studies at “high” risk of bias was also assessed through a sensitivity analysis. All analyses were conducted using the software Comprehensive Meta-Analysis (CMA, Biostat, NJ, USA). No subgroup analyses were performed.

2.1

Protocol and registration

We registered this study protocol at the PROSPERO database under the registration number CRD42015019560, and we followed the recommendations of the PRISMA statement for the report of this systematic review .

2.2

Information sources and search strategy

The controlled vocabulary (mesh terms) and free keywords in the search strategy were defined based on the PICOS question:

• 1.

  Population (P): adult patients with the non-carious cervical lesions.

• 2.

  Intervention (I): placement of composite restorations with self-etch adhesives after selective enamel etching.

• 3.

  Comparison (C): the intervention should be compared with composite restorations placed with self-etch adhesives without selective enamel etching.

• 4.

  The outcomes (O): retention rates, marginal discoloration and marginal adaptation.

• 5.

  Study design (S): randomized clinical trials.

To identify trials to be included for this review, we searched the MEDLINE electronic databases via PubMeb, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database (LILACS), Brazilian Library in Dentistry (BBO) and Cochrane Library ( Table 1 ). We hand-searched the reference lists of all primary studies for additional relevant publications and the related articles linked to each primary study in the PubMed database. No restrictions were placed on the publication date or languages.

Table 1

Electronic database and search strategy (15/04/2016).

Pubmed
#1 dental caries[MeSH Terms]) OR dentin sensitivity[MeSH Terms]) OR tooth abrasion[MeSH Terms]) OR tooth erosion[MeSH Terms]) OR tooth wear[MeSH Terms]) OR tooth cervix[MeSH Terms]) OR dental restoration, permanent[MeSH Terms]”cervical lesions”[Title/Abstract]) OR ”cervical lesion”[Title/Abstract]) OR ”non-carious cervical lesions”[Title/Abstract]) OR ”non-carious cervical lesion”[Title/Abstract]) OR ”noncarious cervical lesions” [Title/Abstract]) OR ”noncarious cervical lesion” OR ”cervical lesion”[MeSH Terms]) OR ”cervical sclerotic dentine”[Title/Abstract]) OR ”class V” [Title/Abstract]) OR ”class 5′’[Title/Abstract]) OR ”abfraction”[Title/Abstract]	#2 dental etching[MeSH Terms]) OR phosphoric acids[MeSH Terms]) OR ”phosphoric acids”[Title/Abstract]) OR ”phosphoric acid”[Title/Abstract]) OR ”dental etching”[Title/Abstract]) OR ”acid etching”[Title/Abstract]) OR ”selective etching”[Title/Abstract]) OR ”selective enamel etching”[Title/Abstract]	#3 dentin bonding agents[MeSH Terms] OR composite resins[MeSH Terms]) OR ”composite resin”[Title/Abstract]) OR ”resin composite”[Title/Abstract]) OR ”resin composites”[Title/Abstract]) OR ”resin restoration”[Title/Abstract]) OR ”resin restorations”[Title/Abstract]) OR ”composite restoration”[Title/Abstract]) OR ”composite restorations”[Title/Abstract]) OR ”self-etching adhesive”[Title/Abstract]) OR ”self-etching adhesives”[Title/Abstract]) OR ”self-etch adhesive”[Title/Abstract]) OR ”self-etch adhesives”[Title/Abstract]) OR ”all-in-one adhesive”[Title/Abstract]) OR ”all-in-one adhesives”[Title/Abstract]) OR ”one-bottle adhesive”[Title/Abstract]) OR ”one-bottle adhesives”[Title/Abstract]	#4 (randomized controlled trial[pt] OR controlled clinical trial[pt] OR randomized controlled trials[mh] OR random allocation[mh] OR double-blind method[mh] OR single-blind method[mh] OR clinical trial[pt] OR clinical trials[mh] OR (“clinical trial”[tw]) OR ((singl*[tw] OR doubl*[tw] OR trebl*[tw] OR tripl*[tw]) AND (mask*[tw] OR blind*[tw])) OR random*[tw] OR research design[mh:noexp] OR comparative study[pt] OR evaluation studies as topic[mh] OR follow-up studies[mh] OR prospective studies[mh] OR control*[tw] OR prospective*[tw] OR volunteer*[tw]) NOT (animals[mh] NOT humans[mh])
#1 AND #2 AND #3 AND #4
Scopus
#1 TITLE-ABS-KEY (“dental caries”) OR TITLE-ABS-KEY (“dentin sensitivity”) OR TITLE-ABS-KEY (“tooh abrasion”) OR TITLE-ABS-KEY (“tooth erosion”) OR TITLE-ABS-KEY (“tooth wear”) OR TITLE-ABS-KEY (“tooth cervix”) OR TITLE-ABS-KEY (“cervical lesion”) OR TITLE-ABS-KEY (“non-carious cervical lesion”) OR TITLE-ABS-KEY (“noncarious cervical lesion”) OR TITLE-ABS-KEY (“cervical lesion”) OR TITLE-ABS-KEY (“cervical sclerotic lesion”) OR TITLE-ABS-KEY (“class V”) OR TITLE-ABS-KEY (“class 5”) OR TITLE-ABS-KEY (“dental restoration”)		#2 TITLE-ABS-KEY (“dental etching”) OR TITLE-ABS-KEY (“phosphoric acid”) OR TITLE-ABS-KEY (“enamel etching”) OR TITLE-ABS-KEY (“dental etching”) OR TITLE-ABS-KEY (“acid etching”) OR TITLE-ABS-KEY (“selective etching”) OR TITLE-ABS-KEY (“selective enamel etching”)	#3 TITLE-ABS-KEY (“composite resin”) OR TITLE-ABS-KEY (“resin composite”) OR TITLE-ABS-KEY (“resin restoration”) OR TITLE-ABS-KEY (“composite restoration”) OR TITLE-ABS-KEY (“self-etching adhesive”) OR TITLE-ABS-KEY (“self-etch adhesive”) OR TITLE-ABS-KEY (“all-in-one adhesive”) OR TITLE-ABS-KEY (“one-bottle adhesive”) OR TITLE-ABS-KEY (“dentin bonding agent”)
#1 AND #2 AND #3
Web of Science
#1 Topic:(“dental caries”) OR Topic:(“dentin sensitivity”) OR Topic:(“t??th abrasion”) OR Topic: (“t??th erosion”) OR Topic: (“t??th wear”)OR Topic: (“t??th cervix”) OR Topic: (“cervical lesion*”) OR Topic: (“non carious cervical lesion*”) OR Topic: (“noncarious cervical lesion*”)OR Topic: (“cervical lesion*”) OR Topic: (“cervical sclerotic dentine”) OR Topic:(‘class V’) OR Topic:(“class 5”)OR Topic: (‘abfraction’) OR Topic:(“dental restoration*”)		#2 Topic: (“dental etching”) OR Topic: (“phosphoric acid*”) OR Topic:(‘enamel etching’) OR Topic: (“acid etching”) OR Topic: (“selective etching”) OR Topic: (“selective enamel etching”)	#3 Topic:(“composite resin*”) OR Topic:(“resin composite*”) OR Topic:(“resin restoration*”) OR Topic:(“composite restoration*”) OR Topic: (“self-etch* adhesive*”) OR Topic: (“all in one adhesive*”) OR Topic: (“one bottle adhesive*”)OR Topic: (“dentin bonding agents*”)
#1 AND #2 AND #3
Lilacs and BBO
#1 (MH: “dental caries‘OR MH:“cárie dentária” OR MH: ‘caries dentales’ MH:“dentin sensitivity” OR MH:“tooth abrasion” MH:“abrasão dentária” OR MH:“tooth erosion” OR MH:“erosão dentária” OR MH:“tooth wear” OR MH:“tooth cervix” OR “sensibilidade dentinária” OR “sensibilidad dentinaria” OR “abrasión dental” OR “erosión dental” OR “desgaste dentário” OR “desgaste dental” OR “cuello del diente” OR “colo do dente” OR “cervical lesions” OR “cervical lesion” OR “lesão cervical” OR “lesión cervical” OR “noncarious cervical lesions” OR “non-carious cervical lesions” OR “lesão não cariosa” OR “class V” OR “classe V” OR “classe 5” OR “class 5” OR “clase 5” OR “clase V”)		#2 (MH:“dental etching” OR “condicionamento dental” OR MH:“grabado dental” OR MH:“phosphoric acids” OR “phosphoric acids” OR “ácido fosfórico” OR “enamel etching” OR “condicionamento do esmalte” OR “grabado del esmalte” OR “dental etching” OR “grabado dental” OR “condicionamento dental” OR “acid etching” OR “condicionamento ácido” OR “grabado ácido” OR “selective etching” OR “condicionamento ácido seletivo” OR “condicionamento seletivo do esmalte” OR “condicionamento ácido seletivo do esmalte”)	#3 (MH:“resinas compostas” OR “resin composite” OR “resin composites” OR “resina composta” OR “resinas compostas” OR “resina compuesta” OR “resinas compuestas” OR “composite resin” OR “composite resins” OR “compósito” OR “compósitos” OR “resin restoration” OR “resin restorations” OR “restauração de resina” OR “restauração de resinas” OR “restauración de resina” OR “restauraciones de resina” OR “composite restoration” OR “composite restorations” OR “restauração de compósito” OR “restaurações de compósitos” OR “restauração de resina composta” OR “restaurações de resinas compostas” OR “self-etch adhesive” OR “adesivo auto-condicionante” OR “adesivo autocondicionante” OR “adhesivo de autograbado” OR “self-etching adhesive” OR “all-in-one adhesive” OR “all-in-one adhesives” OR “adesivo de passo único” OR “adesivos de passo único” OR “adhesivo de paso unico” OR “adhesivos de passo unico” OR “one-bottle adhesive” OR “one-bottle adhesives”)
#1 AND #2 AND #3
Cochrane Library
#1 MeSH descriptor: [Dental Caries] explode all trees #2 MeSH descriptor: [Dentin Sensitivity] explode all trees #3 MeSH descriptor: [Tooth Abrasion] explode all trees #4 MeSH descriptor: [Tooth Erosion] explode all trees #5 MeSH descriptor: [Tooth Wear] explode all trees #6 MeSH descriptor: [Tooth Cervix] explode all trees #7 MeSH descriptor: [Dental Restoration, Permanent] explode all trees #8 “cervical lesion”:ti,ab,kw (Word variations have been searched) #9 “noncarious cervical lesions”:ti,ab,kw (Word variations have been searched) #10 “non carious cervical lesion”:ti,ab,kw (Word variations have been searched) #11 “class V”:ti,ab,kw (Word variations have been searched) #12 “class 5”:ti,ab,kw (Word variations have been searched) #13 “abfraction”:ti,ab,kw (Word variations have been searched) #14 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13		#15 MeSH descriptor: [Dental Etching] explode all trees #16 MeSH descriptor: [Phosphoric Acids] explode all trees #17 “phosphoric acids”:ti,ab,kw (Word variations have been searched) #18 “dental etching”:ti,ab,kw (Word variations have been searched) #19 “acid etching”:ti,ab,kw (Word variations have been searched) #20 “selective etching”:ti,ab,kw (Word variations have been searched) #21 “selective enamel etching”:ti,ab,kw (Word variations have been searched) #22 #15 or #16 or #17 or #18 or #19 or #20 or #21	#23 MeSH descriptor: [Dentin-Bonding Agents] explode all trees #24 MeSH descriptor: [Composite Resins] explode all trees #25 “composite resin”:ti,ab,kw (Word variations have been searched) #26 “resin composite”:ti,ab,kw (Word variations have been searched) #27 “resin restoration”:ti,ab,kw (Word variations have been searched) #28 “composite restoration”:ti,ab,kw (Word variations have been searched) #29 “self-etching adhesive”:ti,ab,kw (Word variations have been searched) #30 “all-in-one adhesive”:ti,ab,kw (Word variations have been searched) #31 “one-bottle adhesive”:ti,ab,kw (Word variations have been searched) #32 #23 or #24 #25 or #26 or #27 or #28 or #29 or #30 or #31 #33 #14 and #22 and #32

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