Effect of immediate dentin sealing on the fracture strength of indirect posterior restorations:Systematic review and meta-analysis protocol.

Yosra Gassara; Rim Kallala; Rihab Dakhli; Sarra Nasri; Nourhen Klach; Belhassen Harzallah

doi:10.12688/f1000research.156876.1

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Effect of immediate dentin sealing on the fracture strength of indirect posterior restorations:Systematic review and meta-analysis protocol.

[version 1; peer review: 1 approved, 1 approved with reservations]

Yosra Gassara ¹, Rim Kallala¹, Rihab Dakhli¹, Sarra Nasri¹, Nourhen Klach¹, Belhassen Harzallah¹

Yosra Gassara ¹, Rim Kallala¹, [...] Rihab Dakhli¹, Sarra Nasri¹, Nourhen Klach¹, Belhassen Harzallah¹

PUBLISHED 15 Oct 2024

Author details Author details

¹ Fixed prosthodontics, University of Monastir Faculty of Dental Medicine of Monastir, Monastir, Monastir, 5000, Tunisia

Yosra Gassara
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation

Rim Kallala
Roles: Formal Analysis, Funding Acquisition, Resources, Software

Rihab Dakhli
Roles: Resources, Software, Supervision

Sarra Nasri
Roles: Investigation, Writing – Review & Editing

Nourhen Klach
Roles: Conceptualization, Formal Analysis, Methodology, Writing – Original Draft Preparation

Belhassen Harzallah
Roles: Supervision, Validation, Visualization

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

Immediate Dentin Sealing (IDS) is a technique that applies an adhesive layer immediately after tooth preparation, prior to the placement of indirect restorations. This method is gaining attention due to its potential to improve the bond strength and mechanical properties of restorations, particularly in the posterior region where restorations endure significant masticatory forces. The objectif of this systematic review and meta-analysis is to evaluate the effect of IDS on the fracture strength of indirect posterior restorations.

Methods

Following PRISMA guidelines, a comprehensive literature search was conducted in four databases: Web of Science, Scopus, Cochrane Library, and PubMed. Inclusion criteria focused on in vitro studies involving human teeth with indirect posterior restorations, published between 2014 and 2023. Studies using IDS were compared to those using conventional methods. The risk of bias was assessed using the Cochrane Collaboration’s tool, and a meta-analysis was performed with a random-effects model. The standard mean difference and 95% confidence intervals were calculated to compare fracture strength, with I² statistics assessing heterogeneity. Forest and funnel plots were employed to visualize results and publication bias, respectively.

Discussion

The results indicate that IDS generally enhances the fracture strength of indirect posterior restorations, particularly with ceramic materials like lithium disilicate. However, the effectiveness of IDS varies depending on the material and restoration type. While some studies demonstrated improved fracture resistance with IDS, others showed minimal benefit, especially with composite restorations. Additionally, IDS improved marginal adaptation and internal fit but increased the risk of severe failures, such as root fractures.

Systematic review registration

PROSPERO: CRD42024584545 (Registered on 08/09/2024).

Keywords

Fracture Strength, Endocrown, Overlay, occlusal veneer, Indirect restoration, Inlay, Onlay, immediate dentin sealing

Corresponding author: Yosra Gassara

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2024 Gassara Y et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Gassara Y, Kallala R, Dakhli R et al. Effect of immediate dentin sealing on the fracture strength of indirect posterior restorations:Systematic review and meta-analysis protocol. [version 1; peer review: 1 approved, 1 approved with reservations]. F1000Research 2024, 13:1234 (https://doi.org/10.12688/f1000research.156876.1) First published: 15 Oct 2024, 13:1234 (https://doi.org/10.12688/f1000research.156876.1) Latest published: 29 Aug 2025, 13:1234 (https://doi.org/10.12688/f1000research.156876.2)

Introduction

Immediate Dentin Sealing (IDS) has emerged as a highly influential technique in the field of restorative dentistry, particularly in the context of indirect posterior restorations.^1–4 This technique involves the application of an adhesive layer immediately after tooth preparation and before the final restoration is placed.^5,6 The primary goal of IDS is to optimize the bond strength between the tooth and restoration, while simultaneously preserving the vitality of the tooth by creating a durable seal. In contrast to delayed dentin sealing, which occurs after temporization, IDS is performed in the initial stages of the restorative process, leading to enhanced adhesion and improved long-term outcomes.⁷

The technique has gained significant attention for its potential to improve the mechanical properties of partial restorations, particularly those located in the posterior region of the mouth, where restorations are exposed to substantial masticatory forces.^8–11 These forces make the posterior region especially vulnerable to mechanical failure, making it critical for restorations in this area to exhibit both high durability and fracture resistance. For these reasons, it is important to investigate how IDS impacts the long-term success of indirect posterior restorations, especially in terms of their ability to withstand the stresses of everyday function.⁸

Despite its growing popularity, the effects of IDS on fracture strength remain a topic of debate. While several studies suggest that IDS enhances the fracture resistance of indirect restorations, discrepancies exist depending on factors such as the materials used, the specific restoration type, and the methods employed. Therefore, a systematic review and meta-analysis are necessary to consolidate the existing evidence and provide a clear understanding of IDS’s role in improving fracture strength.^12,13

This systematic review and meta-analysis aim to assess the effect of IDS on the fracture strength of indirect posterior restorations, offering a thorough evaluation of current evidence.

Protocol

Methods

This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist. It will also comply with the Methodological Expectations of Cochrane Intervention Reviews and the Cochrane Handbook for Systematic Reviews of Interventions. The review protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42024584545, as of September 8, 2024.

Objectives

Primary objectives

Specify the effect of immediate dentin sealing on the fracture strength of indirect posterior restorations.

Secondary objectives

Describe the benefits of IDS in posterior partial restorations

Present the mechanical properties of these restorations.

Specifying the impact of IDS on their fracture resistance.

Eligibility criteria

The PICOS framework (Participants, Intervention, Comparison, Outcome, Study Design) will be used to organize the eligibility criteria, which is intended to emphasize the key components of the research question.

The research question for this systematic review is:

The PICO question is: What is the effect of immediate dentin sealing (intervention) on the fracture strength (outcome) of indirect posterior restorations (population) compared to delayed dentin sealing (comparison)?

• Types of participants:

This systematic review will focus on teeth restored with indirect posterior restoration: Endocrown, Overlay, occlusal veneer, Inlay and Onlay.

• Types of interventions:

The intervention of interest is immediate dentin sealing (IDS). This technique involves sealing the dentin immediately after tooth preparation, before the indirect restoration is placed.

• Types of outcomes:

The primary outcome of interest is the fracture strength of the indirect posterior restorations.

• Measures of effect:

The main outcome, fracture strength, will be measured using either the risk ratio (relative risk) or odds ratio, depending on the type and availability of the data from the included studies. Meta-analysis will be performed if sufficient homogeneous data is available.

• Study types:

This review will include both in vivo and in vitro studies that assess the effect of immediate and delayed dentin sealing on fracture strength. Both randomized controlled trials (RCTs) and observational studies with a comparative design will be considered.

Exclusion criteria

Studies will be excluded if they meet any of the following criteria:

Studies involving indirect anterior restorations.

Studies with animal models.

Interventions on temporary teeth.

Search strategy

Two independent searchers, Y.G. and R.K. will search four different databases: Web of Science, Scopus, Cochrane library and PubMed.

They will perform a manual search and meticulously reviewed the reference lists of the studies included in this review to identify eligible ones. Additionally, electronic searches in databases will conduct using a combination of mesh terms (Table 1).

Table 1. The search strategy.

Database	Search strategy
PubMed	((“Fracture Strength” OR “Strength” OR “Force to fracture” OR “Fracture resistance”) AND (“Indirect posterior restorations” OR “Indirect restorations” OR “Endocrown” OR “Denture, Overlay” OR “occlusal veneer” OR “occlusal veneers” OR “Overlay” OR “Overlays” OR “Inlay” OR “Onlay”) AND immediate dentin sealing)
Web of science	(TS=(“Fracture Strength”) OR TS=(“Strength”) OR TS=(“Force to fracture”) OR TS=(“Fracture resistance”)) AND (TS=(“Indirect posterior restorations”) OR TS=(“Indirect restorations”) OR TS=(“Endocrown”) OR TS=(“Denture, Overlay”) OR TS=(“occlusal veneer”) OR TS=(“occlusal veneers”) OR TS=(“Overlay”) OR TS=(“Overlays”) OR TS=(“Inlay”) OR TS=(“Onlay”)) AND TS=(“immediate dentin sealing”)
Scopus	(TITLE-ABS(“Fracture Strength”) OR TITLE-ABS(“Strength”) OR TITLE-ABS(“Force to fracture”) OR TITLE-ABS(“Fracture resistance”)) AND (TITLE-ABS(“Indirect posterior restorations”) OR TITLE-ABS(“Indirect restorations”) OR TITLE-ABS(“Endocrown”) OR TITLE-ABS(“Denture, Overlay”) OR TITLE-ABS(“occlusal veneer”) OR TITLE-ABS(“occlusal veneers”) OR TITLE-ABS(“Overlay”) OR TITLE-ABS(“Overlays”) OR TITLE-ABS(“Inlay”) OR TITLE-ABS(“Onlay”)) AND TITLE-ABS(“immediate dentin sealing”)
Cochrane	"Fracture Strength” OR “Strength” OR “Force to Fracture” OR “Fracture Resistance” in Title Abstract Keyword AND ”Indirect posterior restorations” OR “Indirect restorations” OR “Endocrown” OR “Denture, Overlay” OR “occlusal veneer” OR “occlusal veneers” OR “Overlay” OR “Overlays” OR “Inlay” OR “Onlay” in Title Abstract Keyword AND ”immediate dentin sealing” in Title Abstract Keyword - (Word variations have been searched)

Study selection (screening process)

To select studies, duplicates will be removed. Titles and abstracts will be reviewed by the two investigators, and studies that do not meet the inclusion criteria will be excluded.

Assessment of methodological quality and risk of bias

The methodological quality of the included studies will be assessed using the Cochrane Collaboration’s risk of bias tool, a standard method for evaluating biases in clinical research. This assessment will be done using Review Manager software (RevMan, version 5.4). Each type of bias, such as selection, performance, and detection bias, will be evaluated individually. The risk of bias for each domain will be rated as “low,” “unclear,” or “high” according to Cochrane guidelines. An overall rating will then be assigned to summarize the risk of bias for each study.

Data extraction

Data from the included articles will be collected by one author (Y.G.), while a second researcher (R.K.) will review all the extracted data. The collected data will include: the first author, year, type of study, sample characteristics, IDS technique used in each study, and fracture strength values.

Data analysis and synthesis

The meta-analysis will evaluate the fracture strength of indirect posterior restorations (inlays, overlays, occlusal veneers) by comparing conventional methods to the immediate dentin sealing (IDS) method. Studies that contrast IDS with conventional methods will be included. Data analysis will be performed using RevMan software (version 5.4). The standard mean difference with a 95% confidence interval will be applied, andthe I² statistic will assess heterogeneity by measuring the percentage of variation across studies caused by true differences rather than chance. It helps determine if differences in study populations, methods, or interventions explain the variability. Due to the variability in immediate dentin sealing (IDS) techniques, types of restorations, and methodologies employed across the included studies, a random effects model will be used for the meta-analysis. This model is appropriate in this context as it accounts for the inherent differences among studies, allowing for a more accurate estimate of the overall effect size.

To visually represent the results of the meta-analysis, forest plots will be generated. These plots will display the individual study outcomes along with the overall pooled effect, providing a clear illustration of the results and the degree of consistency among the studies. Additionally, funnel plots will be employed to evaluate the potential for publication bias. By plotting the effect sizes of the studies against their standard errors, funnel plots can help identify any asymmetry that may suggest selective reporting or other biases affecting the literature.

Discussion

IDS generally enhances the fracture strength of indirect posterior restorations, especially with ceramic materials like lithium disilicate.¹² However, its effectiveness varies depending on the material and type of restoration.^14,15 While many studies report improved fracture resistance with IDS, others show only modest benefits, particularly in composite restorations.¹² Additionally, IDS contributes to superior marginal adaptation and internal fit but may also elevate the risk of severe failures, such as root fractures.^16,17

This review serves as a valuable resource for clinicians, offering guidance when restoring posterior teeth with indirect restorations.

Ethics and dissemination

Ethical approval is not required for this systematic review. The authors plan to present the results at relevant conferences and publish the findings in a peer-reviewed journal, following open science practices.

Study status

The protocol of this systematic review was submitted to PROSPERO registry on 08th September, 2024 (CRD42024584545).

Data availability

No data are associated with this article.

Reporting guidelines

Figshare. PRISMA-P checklist for Effect of immediate dentin sealing on the fracture strength of indirect posterior restorations: Systematic review and meta-analysis Protocol. DOI: https://doi.org/10.6084/m9.figshare.27143277.v1 ¹⁸

The project contains the following dataset:

• PRISMA-P-checklist.docx

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0)

References

1. Hofsteenge JW, Hogeveen F, Cune MS, et al.: Effect of immediate dentine sealing on the aging and fracture strength of lithium disilicate inlays and overlays.
2. Abdulsattar YH, Kadhim AJ: Effect of immediate dentin sealing on the fracture strength of indirect overlay restorations using different types of luting agents: A comparative in vitro study. J. Conserv. Dent. Endod. 2023; 26: 434–440. PubMed Abstract | Publisher Full Text
3. Magne P, Kim TH, Cascione D, et al.: Immediate dentin sealing improves bond strength of indirect restorations. J. Prosthet. Dent. 2005; 94: 511–519. PubMed Abstract | Publisher Full Text
4. Mueller B, Pilecco RO, Valandro LF, et al.: Effect of immediate dentin sealing on load-bearing capacity under accelerated fatigue of thin occlusal veneers made of CAD-CAM glass-ceramic and resin composite material. Dent. Mater. 2023; 39(4): 372–382. PubMed Abstract | Publisher Full Text
5. Oliveira EG, Mota GA, Borges LH, et al.: Influence of immediate dentin sealing techniques on cuspal deflection and fracture resistance of teeth restored with composite resin inlays. Oper. Dent. 2014; 39(1): 72–80. PubMed Abstract | Publisher Full Text
6. Magne P, Schlichting LH, Maia HP, et al.: In vitro fatigue resistance of CAD/CAM composite resin and ceramic posterior occlusal veneers. J. Prosthet. Dent. 2010; 104: 149–157. PubMed Abstract | Publisher Full Text
7. Ozer F, Batu Eken Z, Hao J, et al.: Effect of immediate dentin sealing on the bonding performance of indirect restorations: A systematic review. Biomimetics (Basel). 2024; 9(3): 182. PubMed Abstract | Publisher Full Text | Free Full Text
8. Oliveira DC, et al.: Influence of glycerin coating on the bond strength of resin-dentin interfaces. J. Adhes. Dent. 2003; 5(4): 309–315.
9. Saadeddin N, Al-Khalil MA, Al-Adel O: Effect of immediate dentin sealing on the fracture strength of lithium disilicate ceramic onlays. Swiss Dent. J. 2022; 132: 482–489. PubMed Abstract | Publisher Full Text
10. Schlichting LH, Maia HP, Baratieri LN, et al.: Novel-design ultra-thin CAD/CAM composite resin and ceramic occlusal veneers for the treatment of severe dental erosion. J. Prosthet. Dent. 2011; 105: 217–226. PubMed Abstract | Publisher Full Text
11. Teche FP, Valenzuela EBS, Tavares JG, et al.: Immediate dentin sealing influences the fracture strength of ultrathin occlusal veneers made of a polymer-infiltrated ceramic network. J. Mech. Behav. Biomed. Mater. 2022; 133: 105331. PubMed Abstract | Publisher Full Text
12. van den Breemer CRG , Özcan M, Cune MS, et al.: Effect of immediate dentine sealing on the fracture strength of lithium disilicate and multiphase resin composite inlay restorations. J. Mech. Behav. Biomed. Mater. 2017; 75: 92–99.
13. Shafiei F, Aghaei T, Jowkar Z: Effect of proanthocyanidin-mediated immediate and delayed dentin sealing on the strength of premolars restored with composite resin inlay. J Clin Exp Dent. 2020; 12(3): e235–e241. Publisher Full Text
14. Signore A, Benedicenti S, Covani U, et al.: A 4- to 6-year retrospective clinical study of cracked teeth restored with bonded indirect resin composite onlays. Int. J. Prosthodont. 2007; 20: 609–616. PubMed Abstract
15. Andrade JP, Stona D, Bittencourt HR, et al.: Effect of different computer-aided design/computer-aided manufacturing (CAD/CAM) materials and thicknesses on the fracture resistance of occlusal veneers. Oper. Dent. 2018; 43: 539–548. PubMed Abstract | Publisher Full Text
16. Ashy LM, Marghalani H, Silikas N: In vitro evaluation of marginal and internal adaptations of ceramic inlay restorations associated with immediate vs delayed dentin sealing techniques. Int. J. Prosthodont. 2020; 33: 48–55. PubMed Abstract | Publisher Full Text
17. Schenke F, Hiller K, Schmalz G, et al.: Marginal integrity of partial ceramic crowns within dentin with different luting techniques and materials. Oper. Dent. 2008; 33: 516–525. PubMed Abstract | Publisher Full Text
18. Gassara Y: PRISMA-P checklist for Effect of immediate dentin sealing on the fracture strength of indirect posterior restorations: Systematic review and meta-analysis Protocol. Dataset. figshare. 2024. Publisher Full Text

Comments on this article Comments (0)

Version 2

VERSION 2 PUBLISHED 15 Oct 2024

Author details Author details

¹ Fixed prosthodontics, University of Monastir Faculty of Dental Medicine of Monastir, Monastir, Monastir, 5000, Tunisia

Yosra Gassara
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation

Rim Kallala
Roles: Formal Analysis, Funding Acquisition, Resources, Software

Rihab Dakhli
Roles: Resources, Software, Supervision

Sarra Nasri
Roles: Investigation, Writing – Review & Editing

Nourhen Klach
Roles: Conceptualization, Formal Analysis, Methodology, Writing – Original Draft Preparation

Belhassen Harzallah
Roles: Supervision, Validation, Visualization

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (2)

version 2

Revised

Published: 29 Aug 2025, 13:1234

https://doi.org/10.12688/f1000research.156876.2

version 1

Published: 15 Oct 2024, 13:1234

https://doi.org/10.12688/f1000research.156876.1

© 2024 Gassara Y et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Gassara Y, Kallala R, Dakhli R et al. Effect of immediate dentin sealing on the fracture strength of indirect posterior restorations:Systematic review and meta-analysis protocol. [version 1; peer review: 1 approved, 1 approved with reservations]. F1000Research 2024, 13:1234 (https://doi.org/10.12688/f1000research.156876.1)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

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Open Peer Review

Version 1

VERSION 1

PUBLISHED 15 Oct 2024

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Reviewer Report 11 Aug 2025

Sanpreet Singh Sachdev, Oral Pathology and Microbiology,, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Munbai, India

Approved with Reservations

https://doi.org/10.5256/f1000research.172252.r401655

PICOS criteria needs to be properly defined. Include a table of PICOS framework with specific inclusion and exclusion criteria. The current PICOS is very vague.
Data extraction needs to have details of the agent applied and the restorative material used.
In meta-analysis, specify the effects model and define heterogeneity values for those models - random and fixed.
Include a section of subgroup analysis if the authors are including different restorative materials and adhesive agents, as these may differently influence the bonding process entirely.
Limitations of the protocol need to be acknowledged and wherever possible, addressed.
There are several spelling mistakes and grammatical errors in the manuscript such as 'objectif' or in the sentence stating the aim of the study. Similar errors are present sporadically in the manuscript.
The formatting of the manuscript is poor. The authors are suggested to write it in the form of paragraphs and use bullet points only when necessary for a neatly formatted protocol. The bullet points seem to be missing.
The risk of bias tool mentioned may not be appropriate for in vitro studies. Since the authors are focusing on in vitro studies, they are suggested to use more suitable tools such as the QUIN tool.

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Dentistry, Systematic Reviews

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

CITE

Report a concern

Author Response 10 Sep 2025

Yosra Gassara, Fixed prosthodontics, University of Monastir Faculty of Dental Medicine of Monastir, Monastir, 5000, Tunisia

10 Sep 2025

Author Response
Dear Reviewer,
We would like to thank you sincerely for your constructive feedback on our manuscript. Your comments have greatly contributed to improving the clarity, methodological rigor, and overall quality ... Continue reading
Dear Reviewer,
We would like to thank you sincerely for your constructive feedback on our manuscript. Your comments have greatly contributed to improving the clarity, methodological rigor, and overall quality of our work. Below, we provide a detailed response to each point, along with the corresponding revisions made in the manuscript.

Comment 1: PICOS criteria needs to be properly defined. Include a table of PICOS framework with specific inclusion and exclusion criteria. The current PICOS is very vague.
Response: We appreciate this suggestion. The eligibility criteria have been revised to provide a precise PICOS definition. A detailed PICOS framework table has been added (Table 1), specifying participants, interventions, comparisons, outcomes, and study designs, along with both inclusion and exclusion criteria. This improves methodological transparency.

Comment 2: Data extraction needs to have details of the agent applied and the restorative material used.
Response: We fully agree. The data extraction plan has been expanded to include details of:

The adhesive/agent applied (etch-and-rinse, self-etch, universal, protective liners, etc.),

The restorative material used (lithium disilicate, polymer-infiltrated ceramic, composite resin, glass-ceramic, etc.).
Information on the provisional phase, impression method, and storage conditions has also been included. These modifications ensure a comprehensive capture of all relevant variables influencing fracture strength.

Comment 3: In meta-analysis, specify the effects model and define heterogeneity values for those models – random and fixed.
Response: Thank you for pointing this out. We clarified that a random-effects model will be the primary model due to the anticipated variability in IDS protocols and restorative materials. For sensitivity analyses, results under a fixed-effects model will also be reported. Heterogeneity thresholds are now explicitly defined as:

I² < 25%: low heterogeneity,

25–50%: moderate heterogeneity,

>50%: substantial heterogeneity.

Comment 4: Include a section of subgroup analysis if the authors are including different restorative materials and adhesive agents, as these may differently influence the bonding process entirely.
Response: We agree. A subgroup analysis plan has been added to stratify studies by:

Type of restorative material (ceramic, resin composite, polymer-infiltrated ceramic),

Type of adhesive agent (etch-and-rinse, self-etch, universal adhesives, protective liners).
This will allow us to evaluate whether IDS effectiveness differs across materials and bonding protocols.

Comment 5: Limitations of the protocol need to be acknowledged and wherever possible, addressed.
Response: A limitations section has been added in the Discussion. It acknowledges:

Restriction to in vitro studies, limiting direct clinical applicability,

Variability in test setups, IDS techniques, and restorative materials,

Potential for publication bias, despite efforts to minimize it.
We also suggest that future well-designed clinical studies address these gaps.

Comment 6: There are several spelling mistakes and grammatical errors in the manuscript such as “objectif” or in the sentence stating the aim of the study. Similar errors are present sporadically in the manuscript.
Response: We apologize for these errors. The manuscript has undergone thorough proofreading and English language editing. Spelling (e.g., “objectif” → “objective”, “anlysis” → “analysis”)) and grammar have been corrected throughout.

Comment 7: The formatting of the manuscript is poor. The authors are suggested to write it in the form of paragraphs and use bullet points only when necessary for a neatly formatted protocol. The bullet points seem to be missing.
Response: Thank you for this feedback. The manuscript has been reformatted to improve readability. Paragraph structure has been refined, and bullet points are now used only when appropriate (e.g., inclusion/exclusion criteria, data extraction items). Tables have been harmonized for consistency with PRISMA guidelines.

Comment 8: The risk of bias tool mentioned may not be appropriate for in vitro studies. Since the authors are focusing on in vitro studies, they are suggested to use more suitable tools such as the QUIN tool.
Response: We appreciate this valuable suggestion. The Cochrane risk of bias tool has been replaced with the QUIN tool (Quality Assessment Tool for In Vitro Studies), which is specifically designed for laboratory studies. This improves the validity and reliability of our methodological assessment.

We are grateful for the reviewer’s constructive insights, which have allowed us to substantially strengthen the manuscript. We believe the revised version now addresses all concerns and meets the methodological standards expected.
Sincerely
Dear Reviewer,
We would like to thank you sincerely for your constructive feedback on our manuscript. Your comments have greatly contributed to improving the clarity, methodological rigor, and overall quality of our work. Below, we provide a detailed response to each point, along with the corresponding revisions made in the manuscript.

Comment 1: PICOS criteria needs to be properly defined. Include a table of PICOS framework with specific inclusion and exclusion criteria. The current PICOS is very vague.
Response: We appreciate this suggestion. The eligibility criteria have been revised to provide a precise PICOS definition. A detailed PICOS framework table has been added (Table 1), specifying participants, interventions, comparisons, outcomes, and study designs, along with both inclusion and exclusion criteria. This improves methodological transparency.

Comment 2: Data extraction needs to have details of the agent applied and the restorative material used.
Response: We fully agree. The data extraction plan has been expanded to include details of:

The adhesive/agent applied (etch-and-rinse, self-etch, universal, protective liners, etc.),

The restorative material used (lithium disilicate, polymer-infiltrated ceramic, composite resin, glass-ceramic, etc.).
Information on the provisional phase, impression method, and storage conditions has also been included. These modifications ensure a comprehensive capture of all relevant variables influencing fracture strength.

Comment 3: In meta-analysis, specify the effects model and define heterogeneity values for those models – random and fixed.
Response: Thank you for pointing this out. We clarified that a random-effects model will be the primary model due to the anticipated variability in IDS protocols and restorative materials. For sensitivity analyses, results under a fixed-effects model will also be reported. Heterogeneity thresholds are now explicitly defined as:

I² < 25%: low heterogeneity,

25–50%: moderate heterogeneity,

>50%: substantial heterogeneity.

Comment 4: Include a section of subgroup analysis if the authors are including different restorative materials and adhesive agents, as these may differently influence the bonding process entirely.
Response: We agree. A subgroup analysis plan has been added to stratify studies by:

Type of restorative material (ceramic, resin composite, polymer-infiltrated ceramic),

Type of adhesive agent (etch-and-rinse, self-etch, universal adhesives, protective liners).
This will allow us to evaluate whether IDS effectiveness differs across materials and bonding protocols.

Comment 5: Limitations of the protocol need to be acknowledged and wherever possible, addressed.
Response: A limitations section has been added in the Discussion. It acknowledges:

Restriction to in vitro studies, limiting direct clinical applicability,

Variability in test setups, IDS techniques, and restorative materials,

Potential for publication bias, despite efforts to minimize it.
We also suggest that future well-designed clinical studies address these gaps.

Comment 6: There are several spelling mistakes and grammatical errors in the manuscript such as “objectif” or in the sentence stating the aim of the study. Similar errors are present sporadically in the manuscript.
Response: We apologize for these errors. The manuscript has undergone thorough proofreading and English language editing. Spelling (e.g., “objectif” → “objective”, “anlysis” → “analysis”)) and grammar have been corrected throughout.

Comment 7: The formatting of the manuscript is poor. The authors are suggested to write it in the form of paragraphs and use bullet points only when necessary for a neatly formatted protocol. The bullet points seem to be missing.
Response: Thank you for this feedback. The manuscript has been reformatted to improve readability. Paragraph structure has been refined, and bullet points are now used only when appropriate (e.g., inclusion/exclusion criteria, data extraction items). Tables have been harmonized for consistency with PRISMA guidelines.

Comment 8: The risk of bias tool mentioned may not be appropriate for in vitro studies. Since the authors are focusing on in vitro studies, they are suggested to use more suitable tools such as the QUIN tool.
Response: We appreciate this valuable suggestion. The Cochrane risk of bias tool has been replaced with the QUIN tool (Quality Assessment Tool for In Vitro Studies), which is specifically designed for laboratory studies. This improves the validity and reliability of our methodological assessment.

We are grateful for the reviewer’s constructive insights, which have allowed us to substantially strengthen the manuscript. We believe the revised version now addresses all concerns and meets the methodological standards expected.
Sincerely
Competing Interests: No competing interests were disclosed. Close
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Author Response 10 Sep 2025

Yosra Gassara, Fixed prosthodontics, University of Monastir Faculty of Dental Medicine of Monastir, Monastir, 5000, Tunisia

10 Sep 2025

Author Response
Dear Reviewer,
We would like to thank you sincerely for your constructive feedback on our manuscript. Your comments have greatly contributed to improving the clarity, methodological rigor, and overall quality ... Continue reading
Dear Reviewer,
We would like to thank you sincerely for your constructive feedback on our manuscript. Your comments have greatly contributed to improving the clarity, methodological rigor, and overall quality of our work. Below, we provide a detailed response to each point, along with the corresponding revisions made in the manuscript.

Comment 1: PICOS criteria needs to be properly defined. Include a table of PICOS framework with specific inclusion and exclusion criteria. The current PICOS is very vague.
Response: We appreciate this suggestion. The eligibility criteria have been revised to provide a precise PICOS definition. A detailed PICOS framework table has been added (Table 1), specifying participants, interventions, comparisons, outcomes, and study designs, along with both inclusion and exclusion criteria. This improves methodological transparency.

Comment 2: Data extraction needs to have details of the agent applied and the restorative material used.
Response: We fully agree. The data extraction plan has been expanded to include details of:

The adhesive/agent applied (etch-and-rinse, self-etch, universal, protective liners, etc.),

The restorative material used (lithium disilicate, polymer-infiltrated ceramic, composite resin, glass-ceramic, etc.).
Information on the provisional phase, impression method, and storage conditions has also been included. These modifications ensure a comprehensive capture of all relevant variables influencing fracture strength.

Comment 3: In meta-analysis, specify the effects model and define heterogeneity values for those models – random and fixed.
Response: Thank you for pointing this out. We clarified that a random-effects model will be the primary model due to the anticipated variability in IDS protocols and restorative materials. For sensitivity analyses, results under a fixed-effects model will also be reported. Heterogeneity thresholds are now explicitly defined as:

I² < 25%: low heterogeneity,

25–50%: moderate heterogeneity,

>50%: substantial heterogeneity.

Comment 4: Include a section of subgroup analysis if the authors are including different restorative materials and adhesive agents, as these may differently influence the bonding process entirely.
Response: We agree. A subgroup analysis plan has been added to stratify studies by:

Type of restorative material (ceramic, resin composite, polymer-infiltrated ceramic),

Type of adhesive agent (etch-and-rinse, self-etch, universal adhesives, protective liners).
This will allow us to evaluate whether IDS effectiveness differs across materials and bonding protocols.

Comment 5: Limitations of the protocol need to be acknowledged and wherever possible, addressed.
Response: A limitations section has been added in the Discussion. It acknowledges:

Restriction to in vitro studies, limiting direct clinical applicability,

Variability in test setups, IDS techniques, and restorative materials,

Potential for publication bias, despite efforts to minimize it.
We also suggest that future well-designed clinical studies address these gaps.

Comment 6: There are several spelling mistakes and grammatical errors in the manuscript such as “objectif” or in the sentence stating the aim of the study. Similar errors are present sporadically in the manuscript.
Response: We apologize for these errors. The manuscript has undergone thorough proofreading and English language editing. Spelling (e.g., “objectif” → “objective”, “anlysis” → “analysis”)) and grammar have been corrected throughout.

Comment 7: The formatting of the manuscript is poor. The authors are suggested to write it in the form of paragraphs and use bullet points only when necessary for a neatly formatted protocol. The bullet points seem to be missing.
Response: Thank you for this feedback. The manuscript has been reformatted to improve readability. Paragraph structure has been refined, and bullet points are now used only when appropriate (e.g., inclusion/exclusion criteria, data extraction items). Tables have been harmonized for consistency with PRISMA guidelines.

Comment 8: The risk of bias tool mentioned may not be appropriate for in vitro studies. Since the authors are focusing on in vitro studies, they are suggested to use more suitable tools such as the QUIN tool.
Response: We appreciate this valuable suggestion. The Cochrane risk of bias tool has been replaced with the QUIN tool (Quality Assessment Tool for In Vitro Studies), which is specifically designed for laboratory studies. This improves the validity and reliability of our methodological assessment.

We are grateful for the reviewer’s constructive insights, which have allowed us to substantially strengthen the manuscript. We believe the revised version now addresses all concerns and meets the methodological standards expected.
Sincerely
Dear Reviewer,
We would like to thank you sincerely for your constructive feedback on our manuscript. Your comments have greatly contributed to improving the clarity, methodological rigor, and overall quality of our work. Below, we provide a detailed response to each point, along with the corresponding revisions made in the manuscript.

Comment 1: PICOS criteria needs to be properly defined. Include a table of PICOS framework with specific inclusion and exclusion criteria. The current PICOS is very vague.
Response: We appreciate this suggestion. The eligibility criteria have been revised to provide a precise PICOS definition. A detailed PICOS framework table has been added (Table 1), specifying participants, interventions, comparisons, outcomes, and study designs, along with both inclusion and exclusion criteria. This improves methodological transparency.

Comment 2: Data extraction needs to have details of the agent applied and the restorative material used.
Response: We fully agree. The data extraction plan has been expanded to include details of:

The adhesive/agent applied (etch-and-rinse, self-etch, universal, protective liners, etc.),

The restorative material used (lithium disilicate, polymer-infiltrated ceramic, composite resin, glass-ceramic, etc.).
Information on the provisional phase, impression method, and storage conditions has also been included. These modifications ensure a comprehensive capture of all relevant variables influencing fracture strength.

Comment 3: In meta-analysis, specify the effects model and define heterogeneity values for those models – random and fixed.
Response: Thank you for pointing this out. We clarified that a random-effects model will be the primary model due to the anticipated variability in IDS protocols and restorative materials. For sensitivity analyses, results under a fixed-effects model will also be reported. Heterogeneity thresholds are now explicitly defined as:

I² < 25%: low heterogeneity,

25–50%: moderate heterogeneity,

>50%: substantial heterogeneity.

Comment 4: Include a section of subgroup analysis if the authors are including different restorative materials and adhesive agents, as these may differently influence the bonding process entirely.
Response: We agree. A subgroup analysis plan has been added to stratify studies by:

Type of restorative material (ceramic, resin composite, polymer-infiltrated ceramic),

Type of adhesive agent (etch-and-rinse, self-etch, universal adhesives, protective liners).
This will allow us to evaluate whether IDS effectiveness differs across materials and bonding protocols.

Comment 5: Limitations of the protocol need to be acknowledged and wherever possible, addressed.
Response: A limitations section has been added in the Discussion. It acknowledges:

Restriction to in vitro studies, limiting direct clinical applicability,

Variability in test setups, IDS techniques, and restorative materials,

Potential for publication bias, despite efforts to minimize it.
We also suggest that future well-designed clinical studies address these gaps.

Comment 6: There are several spelling mistakes and grammatical errors in the manuscript such as “objectif” or in the sentence stating the aim of the study. Similar errors are present sporadically in the manuscript.
Response: We apologize for these errors. The manuscript has undergone thorough proofreading and English language editing. Spelling (e.g., “objectif” → “objective”, “anlysis” → “analysis”)) and grammar have been corrected throughout.

Comment 7: The formatting of the manuscript is poor. The authors are suggested to write it in the form of paragraphs and use bullet points only when necessary for a neatly formatted protocol. The bullet points seem to be missing.
Response: Thank you for this feedback. The manuscript has been reformatted to improve readability. Paragraph structure has been refined, and bullet points are now used only when appropriate (e.g., inclusion/exclusion criteria, data extraction items). Tables have been harmonized for consistency with PRISMA guidelines.

Comment 8: The risk of bias tool mentioned may not be appropriate for in vitro studies. Since the authors are focusing on in vitro studies, they are suggested to use more suitable tools such as the QUIN tool.
Response: We appreciate this valuable suggestion. The Cochrane risk of bias tool has been replaced with the QUIN tool (Quality Assessment Tool for In Vitro Studies), which is specifically designed for laboratory studies. This improves the validity and reliability of our methodological assessment.

We are grateful for the reviewer’s constructive insights, which have allowed us to substantially strengthen the manuscript. We believe the revised version now addresses all concerns and meets the methodological standards expected.
Sincerely
Competing Interests: No competing interests were disclosed. Close
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Reviewer Report 23 Jan 2025

Dinesh Rokaya, Ajman University, Ajman, United Arab Emirates

Approved

https://doi.org/10.5256/f1000research.172252.r344743

This is an interesting article done to evaluate the effect of IDS on the fracture strength of indirect posterior restorations.

Abstract:
The spelling of the Objective is a mistake. Please correct.
The Introduction presents the background and Method explains in detail.
PICOS framework (Participants, Intervention, Comparison, Outcome, Study Design is also clear.

Does the IDS affect the bonding of the ceramic?

More discussion is needed.
Discuss with similar previous studies.

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Dental Biomaterials, Prosthetic Dentistry

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

CITE

Report a concern

Author Response 10 Sep 2025

Yosra Gassara, Fixed prosthodontics, University of Monastir Faculty of Dental Medicine of Monastir, Monastir, 5000, Tunisia

10 Sep 2025

Author Response

Reviewer Comment 1: The spelling of the Objective is a mistake. Please correct.
Response: We thank the reviewer for pointing this out. The spelling error has been corrected from “objectif” ... Continue reading Reviewer Comment 1: The spelling of the Objective is a mistake. Please correct.
Response: We thank the reviewer for pointing this out. The spelling error has been corrected from “objectif” to “objective”. The manuscript has also undergone a careful proofreading to ensure consistency in language and grammar throughout.
Reviewer Comment 2: The Introduction presents the background and Method explains in detail. PICOS framework (Participants, Intervention, Comparison, Outcome, Study Design) is also clear.
Response: We are grateful for this positive feedback. We are pleased that the revised Introduction, Methods, and PICOS framework are now considered clear and appropriately detailed.
Reviewer Comment 3: Does the IDS affect the bonding of the ceramic?
Response: Thank you for raising this important point. We have expanded the Discussion section to address the effect of Immediate Dentin Sealing (IDS) on ceramic bonding. Evidence suggests that IDS improves adhesive infiltration and reduces the risk of contamination, thereby enhancing the bond strength between resin cement and ceramic restorations. This effect is particularly relevant for lithium disilicate ceramics, where improved adhesion contributes to increased fracture strength and long-term restoration stability. A paragraph discussing this relationship, supported by recent literature, has been added.
Reviewer Comment 4: More discussion is needed. Discuss with similar previous studies.
Response: We agree that the Discussion required further depth. We have now expanded it by comparing our findings with previous systematic reviews and experimental studies that investigated IDS protocols and their effect on indirect restorations. These comparisons highlight consistencies (e.g., improved fracture strength with IDS) as well as discrepancies (e.g., variations in results depending on adhesive system or restorative material). This addition provides stronger context and situates our findings within the broader body of evidence.
Reviewer Comment 1: The spelling of the Objective is a mistake. Please correct.
Response: We thank the reviewer for pointing this out. The spelling error has been corrected from “objectif” to “objective”. The manuscript has also undergone a careful proofreading to ensure consistency in language and grammar throughout.
Reviewer Comment 2: The Introduction presents the background and Method explains in detail. PICOS framework (Participants, Intervention, Comparison, Outcome, Study Design) is also clear.
Response: We are grateful for this positive feedback. We are pleased that the revised Introduction, Methods, and PICOS framework are now considered clear and appropriately detailed.
Reviewer Comment 3: Does the IDS affect the bonding of the ceramic?
Response: Thank you for raising this important point. We have expanded the Discussion section to address the effect of Immediate Dentin Sealing (IDS) on ceramic bonding. Evidence suggests that IDS improves adhesive infiltration and reduces the risk of contamination, thereby enhancing the bond strength between resin cement and ceramic restorations. This effect is particularly relevant for lithium disilicate ceramics, where improved adhesion contributes to increased fracture strength and long-term restoration stability. A paragraph discussing this relationship, supported by recent literature, has been added.
Reviewer Comment 4: More discussion is needed. Discuss with similar previous studies.
Response: We agree that the Discussion required further depth. We have now expanded it by comparing our findings with previous systematic reviews and experimental studies that investigated IDS protocols and their effect on indirect restorations. These comparisons highlight consistencies (e.g., improved fracture strength with IDS) as well as discrepancies (e.g., variations in results depending on adhesive system or restorative material). This addition provides stronger context and situates our findings within the broader body of evidence.
Competing Interests: No competing interests were disclosed. Close
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COMMENTS ON THIS REPORT

Author Response 10 Sep 2025

Yosra Gassara, Fixed prosthodontics, University of Monastir Faculty of Dental Medicine of Monastir, Monastir, 5000, Tunisia

10 Sep 2025

Author Response

Reviewer Comment 1: The spelling of the Objective is a mistake. Please correct.
Response: We thank the reviewer for pointing this out. The spelling error has been corrected from “objectif” ... Continue reading Reviewer Comment 1: The spelling of the Objective is a mistake. Please correct.
Response: We thank the reviewer for pointing this out. The spelling error has been corrected from “objectif” to “objective”. The manuscript has also undergone a careful proofreading to ensure consistency in language and grammar throughout.
Reviewer Comment 2: The Introduction presents the background and Method explains in detail. PICOS framework (Participants, Intervention, Comparison, Outcome, Study Design) is also clear.
Response: We are grateful for this positive feedback. We are pleased that the revised Introduction, Methods, and PICOS framework are now considered clear and appropriately detailed.
Reviewer Comment 3: Does the IDS affect the bonding of the ceramic?
Response: Thank you for raising this important point. We have expanded the Discussion section to address the effect of Immediate Dentin Sealing (IDS) on ceramic bonding. Evidence suggests that IDS improves adhesive infiltration and reduces the risk of contamination, thereby enhancing the bond strength between resin cement and ceramic restorations. This effect is particularly relevant for lithium disilicate ceramics, where improved adhesion contributes to increased fracture strength and long-term restoration stability. A paragraph discussing this relationship, supported by recent literature, has been added.
Reviewer Comment 4: More discussion is needed. Discuss with similar previous studies.
Response: We agree that the Discussion required further depth. We have now expanded it by comparing our findings with previous systematic reviews and experimental studies that investigated IDS protocols and their effect on indirect restorations. These comparisons highlight consistencies (e.g., improved fracture strength with IDS) as well as discrepancies (e.g., variations in results depending on adhesive system or restorative material). This addition provides stronger context and situates our findings within the broader body of evidence.
Reviewer Comment 1: The spelling of the Objective is a mistake. Please correct.
Response: We thank the reviewer for pointing this out. The spelling error has been corrected from “objectif” to “objective”. The manuscript has also undergone a careful proofreading to ensure consistency in language and grammar throughout.
Reviewer Comment 2: The Introduction presents the background and Method explains in detail. PICOS framework (Participants, Intervention, Comparison, Outcome, Study Design) is also clear.
Response: We are grateful for this positive feedback. We are pleased that the revised Introduction, Methods, and PICOS framework are now considered clear and appropriately detailed.
Reviewer Comment 3: Does the IDS affect the bonding of the ceramic?
Response: Thank you for raising this important point. We have expanded the Discussion section to address the effect of Immediate Dentin Sealing (IDS) on ceramic bonding. Evidence suggests that IDS improves adhesive infiltration and reduces the risk of contamination, thereby enhancing the bond strength between resin cement and ceramic restorations. This effect is particularly relevant for lithium disilicate ceramics, where improved adhesion contributes to increased fracture strength and long-term restoration stability. A paragraph discussing this relationship, supported by recent literature, has been added.
Reviewer Comment 4: More discussion is needed. Discuss with similar previous studies.
Response: We agree that the Discussion required further depth. We have now expanded it by comparing our findings with previous systematic reviews and experimental studies that investigated IDS protocols and their effect on indirect restorations. These comparisons highlight consistencies (e.g., improved fracture strength with IDS) as well as discrepancies (e.g., variations in results depending on adhesive system or restorative material). This addition provides stronger context and situates our findings within the broader body of evidence.
Competing Interests: No competing interests were disclosed. Close
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VERSION 2 PUBLISHED 15 Oct 2024

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Version 1 15 Oct 24	read	read

Dinesh Rokaya, Ajman University, Ajman, United Arab Emirates
Sanpreet Singh Sachdev, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Munbai, India
Cherif Adel Mohsen, Minia University, Minya, Egypt

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4 Views

19 Sep 2025 | for Version 2

Cherif Adel Mohsen, Faculty of Dentistry, Minia University, Minya, Egypt

4 Views Cite this report Responses(0)

Approved

Dear editorial board
I accept this manuscript with only one comment which is reference number 1 is not fully cited.
the topic entitled : effect of immediate dentin sealing on the fracture strength of indirect posterior restorations is nowadays.
the manuscript is well written and answer many issues about the topic.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Fixed Prosthodontics

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

11 Views

11 Aug 2025 | for Version 1

Sanpreet Singh Sachdev, Oral Pathology and Microbiology,, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Munbai, India

11 Views Cite this report Responses(1)

Approved With Reservations

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Dentistry, Systematic Reviews

Respond to this report

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Author Response

10 Sep 2025

Yosra Gassara, Fixed prosthodontics, University of Monastir Faculty of Dental Medicine of Monastir, Monastir, 5000, Tunisia

Dear Reviewer,
We would like to thank you sincerely for your constructive feedback on our manuscript. Your comments have greatly contributed to improving the clarity, methodological rigor, and overall quality of our work. Below, we provide a detailed response to each point, along with the corresponding revisions made in the manuscript.

Comment 1: PICOS criteria needs to be properly defined. Include a table of PICOS framework with specific inclusion and exclusion criteria. The current PICOS is very vague.
Response: We appreciate this suggestion. The eligibility criteria have been revised to provide a precise PICOS definition. A detailed PICOS framework table has been added (Table 1), specifying participants, interventions, comparisons, outcomes, and study designs, along with both inclusion and exclusion criteria. This improves methodological transparency.

Comment 2: Data extraction needs to have details of the agent applied and the restorative material used.
Response: We fully agree. The data extraction plan has been expanded to include details of:

The adhesive/agent applied (etch-and-rinse, self-etch, universal, protective liners, etc.),
The restorative material used (lithium disilicate, polymer-infiltrated ceramic, composite resin, glass-ceramic, etc.).
Information on the provisional phase, impression method, and storage conditions has also been included. These modifications ensure a comprehensive capture of all relevant variables influencing fracture strength.

Comment 3: In meta-analysis, specify the effects model and define heterogeneity values for those models – random and fixed.
Response: Thank you for pointing this out. We clarified that a random-effects model will be the primary model due to the anticipated variability in IDS protocols and restorative materials. For sensitivity analyses, results under a fixed-effects model will also be reported. Heterogeneity thresholds are now explicitly defined as:

I² < 25%: low heterogeneity,
25–50%: moderate heterogeneity,
>50%: substantial heterogeneity.

Comment 4: Include a section of subgroup analysis if the authors are including different restorative materials and adhesive agents, as these may differently influence the bonding process entirely.
Response: We agree. A subgroup analysis plan has been added to stratify studies by:

Type of restorative material (ceramic, resin composite, polymer-infiltrated ceramic),
Type of adhesive agent (etch-and-rinse, self-etch, universal adhesives, protective liners).
This will allow us to evaluate whether IDS effectiveness differs across materials and bonding protocols.

Comment 5: Limitations of the protocol need to be acknowledged and wherever possible, addressed.
Response: A limitations section has been added in the Discussion. It acknowledges:

Restriction to in vitro studies, limiting direct clinical applicability,
Variability in test setups, IDS techniques, and restorative materials,
Potential for publication bias, despite efforts to minimize it.
We also suggest that future well-designed clinical studies address these gaps.

Comment 6: There are several spelling mistakes and grammatical errors in the manuscript such as “objectif” or in the sentence stating the aim of the study. Similar errors are present sporadically in the manuscript.
Response: We apologize for these errors. The manuscript has undergone thorough proofreading and English language editing. Spelling (e.g., “objectif” → “objective”, “anlysis” → “analysis”)) and grammar have been corrected throughout.

Comment 7: The formatting of the manuscript is poor. The authors are suggested to write it in the form of paragraphs and use bullet points only when necessary for a neatly formatted protocol. The bullet points seem to be missing.
Response: Thank you for this feedback. The manuscript has been reformatted to improve readability. Paragraph structure has been refined, and bullet points are now used only when appropriate (e.g., inclusion/exclusion criteria, data extraction items). Tables have been harmonized for consistency with PRISMA guidelines.

Comment 8: The risk of bias tool mentioned may not be appropriate for in vitro studies. Since the authors are focusing on in vitro studies, they are suggested to use more suitable tools such as the QUIN tool.
Response: We appreciate this valuable suggestion. The Cochrane risk of bias tool has been replaced with the QUIN tool (Quality Assessment Tool for In Vitro Studies), which is specifically designed for laboratory studies. This improves the validity and reliability of our methodological assessment.

We are grateful for the reviewer’s constructive insights, which have allowed us to substantially strengthen the manuscript. We believe the revised version now addresses all concerns and meets the methodological standards expected.
Sincerely

View more View less

Competing Interests

No competing interests were disclosed.

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Reviewer Report

5 Views

23 Jan 2025 | for Version 1

Dinesh Rokaya, Ajman University, Ajman, United Arab Emirates

5 Views Cite this report Responses(1)

Approved

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Dental Biomaterials, Prosthetic Dentistry

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

Responses (1)

Author Response

10 Sep 2025

Yosra Gassara, Fixed prosthodontics, University of Monastir Faculty of Dental Medicine of Monastir, Monastir, 5000, Tunisia

Reviewer Comment 1: The spelling of the Objective is a mistake. Please correct.
Response: We thank the reviewer for pointing this out. The spelling error has been corrected from “objectif” to “objective”. The manuscript has also undergone a careful proofreading to ensure consistency in language and grammar throughout.
Reviewer Comment 2: The Introduction presents the background and Method explains in detail. PICOS framework (Participants, Intervention, Comparison, Outcome, Study Design) is also clear.
Response: We are grateful for this positive feedback. We are pleased that the revised Introduction, Methods, and PICOS framework are now considered clear and appropriately detailed.
Reviewer Comment 3: Does the IDS affect the bonding of the ceramic?
Response: Thank you for raising this important point. We have expanded the Discussion section to address the effect of Immediate Dentin Sealing (IDS) on ceramic bonding. Evidence suggests that IDS improves adhesive infiltration and reduces the risk of contamination, thereby enhancing the bond strength between resin cement and ceramic restorations. This effect is particularly relevant for lithium disilicate ceramics, where improved adhesion contributes to increased fracture strength and long-term restoration stability. A paragraph discussing this relationship, supported by recent literature, has been added.
Reviewer Comment 4: More discussion is needed. Discuss with similar previous studies.
Response: We agree that the Discussion required further depth. We have now expanded it by comparing our findings with previous systematic reviews and experimental studies that investigated IDS protocols and their effect on indirect restorations. These comparisons highlight consistencies (e.g., improved fracture strength with IDS) as well as discrepancies (e.g., variations in results depending on adhesive system or restorative material). This addition provides stronger context and situates our findings within the broader body of evidence.

View more View less

Competing Interests

No competing interests were disclosed.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

[1] 1. Hofsteenge JW, Hogeveen F, Cune MS, et al.: Effect of immediate dentine sealing on the aging and fracture strength of lithium disilicate inlays and overlays.

[2] 2. Abdulsattar YH, Kadhim AJ: Effect of immediate dentin sealing on the fracture strength of indirect overlay restorations using different types of luting agents: A comparative in vitro study. J. Conserv. Dent. Endod. 2023; 26: 434–440. PubMed Abstract | Publisher Full Text

[3] 3. Magne P, Kim TH, Cascione D, et al.: Immediate dentin sealing improves bond strength of indirect restorations. J. Prosthet. Dent. 2005; 94: 511–519. PubMed Abstract | Publisher Full Text

[4] 4. Mueller B, Pilecco RO, Valandro LF, et al.: Effect of immediate dentin sealing on load-bearing capacity under accelerated fatigue of thin occlusal veneers made of CAD-CAM glass-ceramic and resin composite material. Dent. Mater. 2023; 39(4): 372–382. PubMed Abstract | Publisher Full Text

[5] 5. Oliveira EG, Mota GA, Borges LH, et al.: Influence of immediate dentin sealing techniques on cuspal deflection and fracture resistance of teeth restored with composite resin inlays. Oper. Dent. 2014; 39(1): 72–80. PubMed Abstract | Publisher Full Text

[6] 6. Magne P, Schlichting LH, Maia HP, et al.: In vitro fatigue resistance of CAD/CAM composite resin and ceramic posterior occlusal veneers. J. Prosthet. Dent. 2010; 104: 149–157. PubMed Abstract | Publisher Full Text

[7] 7. Ozer F, Batu Eken Z, Hao J, et al.: Effect of immediate dentin sealing on the bonding performance of indirect restorations: A systematic review. Biomimetics (Basel). 2024; 9(3): 182. PubMed Abstract | Publisher Full Text | Free Full Text

[8] 8. Oliveira DC, et al.: Influence of glycerin coating on the bond strength of resin-dentin interfaces. J. Adhes. Dent. 2003; 5(4): 309–315.

[9] 9. Saadeddin N, Al-Khalil MA, Al-Adel O: Effect of immediate dentin sealing on the fracture strength of lithium disilicate ceramic onlays. Swiss Dent. J. 2022; 132: 482–489. PubMed Abstract | Publisher Full Text

[10] 10. Schlichting LH, Maia HP, Baratieri LN, et al.: Novel-design ultra-thin CAD/CAM composite resin and ceramic occlusal veneers for the treatment of severe dental erosion. J. Prosthet. Dent. 2011; 105: 217–226. PubMed Abstract | Publisher Full Text

[11] 11. Teche FP, Valenzuela EBS, Tavares JG, et al.: Immediate dentin sealing influences the fracture strength of ultrathin occlusal veneers made of a polymer-infiltrated ceramic network. J. Mech. Behav. Biomed. Mater. 2022; 133: 105331. PubMed Abstract | Publisher Full Text

[12] 12. van den Breemer CRG , Özcan M, Cune MS, et al.: Effect of immediate dentine sealing on the fracture strength of lithium disilicate and multiphase resin composite inlay restorations. J. Mech. Behav. Biomed. Mater. 2017; 75: 92–99.

[13] 13. Shafiei F, Aghaei T, Jowkar Z: Effect of proanthocyanidin-mediated immediate and delayed dentin sealing on the strength of premolars restored with composite resin inlay. J Clin Exp Dent. 2020; 12(3): e235–e241. Publisher Full Text

[14] 14. Signore A, Benedicenti S, Covani U, et al.: A 4- to 6-year retrospective clinical study of cracked teeth restored with bonded indirect resin composite onlays. Int. J. Prosthodont. 2007; 20: 609–616. PubMed Abstract

[15] 15. Andrade JP, Stona D, Bittencourt HR, et al.: Effect of different computer-aided design/computer-aided manufacturing (CAD/CAM) materials and thicknesses on the fracture resistance of occlusal veneers. Oper. Dent. 2018; 43: 539–548. PubMed Abstract | Publisher Full Text

[16] 16. Ashy LM, Marghalani H, Silikas N: In vitro evaluation of marginal and internal adaptations of ceramic inlay restorations associated with immediate vs delayed dentin sealing techniques. Int. J. Prosthodont. 2020; 33: 48–55. PubMed Abstract | Publisher Full Text

[17] 17. Schenke F, Hiller K, Schmalz G, et al.: Marginal integrity of partial ceramic crowns within dentin with different luting techniques and materials. Oper. Dent. 2008; 33: 516–525. PubMed Abstract | Publisher Full Text

[18] 18. Gassara Y: PRISMA-P checklist for Effect of immediate dentin sealing on the fracture strength of indirect posterior restorations: Systematic review and meta-analysis Protocol. Dataset. figshare. 2024. Publisher Full Text

Effect of immediate dentin sealing on the fracture strength of indirect posterior restorations:Systematic review and meta-analysis protocol.

Abstract

Background

Methods

Discussion

Systematic review registration

Keywords

Introduction

Protocol

Methods

Objectives

Eligibility criteria

Exclusion criteria

Search strategy

Table 1. The search strategy.

Study selection (screening process)

Assessment of methodological quality and risk of bias

Data extraction

Data analysis and synthesis

Discussion

Ethics and dissemination

Study status

Data availability

Reporting guidelines

References

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