The influence&nbsp; of dental fluorosis on shear bond strength: a systematic review protocol

Rim Kallala; Yosra Gassara; Yasmine Dhraief; Soumaya Touzi; Belhassen Harzallah

doi:10.12688/f1000research.155925.2

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Study Protocol

Revised

The influence of dental fluorosis on shear bond strength: a systematic review protocol

[version 2; peer review: 1 approved, 1 not approved]

Rim Kallala ¹, Yosra Gassara ¹, Yasmine Dhraief¹, Soumaya Touzi¹, Belhassen Harzallah¹

Rim Kallala ¹, Yosra Gassara ¹, [...] Yasmine Dhraief¹, Soumaya Touzi¹, Belhassen Harzallah¹

PUBLISHED 05 Sep 2025

Author details Author details

¹ University of Monastir, faculty of dental medecine, Research laboratory of Occlusodontics and Ceramic Prostheses LR16ES15, University of Monastir, Monastir, 5000, Tunisia

Rim Kallala
Roles: Conceptualization, Data Curation, Formal Analysis, Writing – Review & Editing

Yosra Gassara
Roles: Data Curation, Formal Analysis, Investigation, Resources, Supervision

Yasmine Dhraief
Roles: Conceptualization, Methodology

Soumaya Touzi
Roles: Conceptualization, Validation, Visualization

Belhassen Harzallah
Roles: Supervision, Validation

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Introduction: Dental fluorosis, a developmental condition resulting from excessive fluoride intake, is characterized by enamel hypomineralization that may compromise the integrity of the tooth surface. This systematic review aims to investigate the influence of dental fluorosis on the shear bond strength of dental adhesive systems. The findings will inform clinical recommendations for treating fluorosis-affected teeth.

Methods: A comprehensive search of electronic databases will be conducted, including PubMed, Scopus, Web of Science, and the Cochrane Library. The search strategy will be designed to identify all relevant in vitro studies published on this topic. Two independent reviewers will screen titles and abstracts, followed by a full-text review of potentially eligible articles. We will include studies that evaluate the shear bond strength of dental materials on teeth with varying degrees of dental fluorosis. The risk of bias of the included studies will be assessed using a validated tool, and a pre-defined data extraction form will be used to collect key information. A narrative synthesis of the findings will be performed, and if sufficient data and homogeneity are present, a meta-analysis will be conducted to pool the results.

Discussion: The results of this systematic review will synthesize the current evidence regarding the effect of dental fluorosis on shear bond strength. This protocol follows the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The findings are expected to provide valuable insights for clinicians on the selection of appropriate bonding techniques and materials for fluorosis-affected teeth.

Keywords

Dental fluorosis, shear bond strength , esthetic, adhesive, bonding

Corresponding authors: Rim Kallala, 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: © 2025 Kallala R 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. The author(s) is/are employees of the US Government and therefore domestic copyright protection in USA does not apply to this work. The work may be protected under the copyright laws of other jurisdictions when used in those jurisdictions.

How to cite: Kallala R, Gassara Y, Dhraief Y et al. The influence of dental fluorosis on shear bond strength: a systematic review protocol [version 2; peer review: 1 approved, 1 not approved]. F1000Research 2025, 13:1349 (https://doi.org/10.12688/f1000research.155925.2) First published: 11 Nov 2024, 13:1349 (https://doi.org/10.12688/f1000research.155925.1) Latest published: 05 Sep 2025, 13:1349 (https://doi.org/10.12688/f1000research.155925.2)

Revised Amendments from Version 1

This revised manuscript incorporates significant changes in response to reviewer feedback, aiming to enhance the clarity and scientific rigor of our work.
The key modifications are as follows:

Title and Abstract: The title has been adjusted to more accurately reflect the study's focus. The abstract has been updated to summarize the revised conclusions and methodological adjustments.
Author List: The author list has been finalized following a comprehensive review of all contributions.
Text: The main text has undergone a thorough review to correct tense inconsistencies and improve overall clarity. The introduction now includes more current bibliographic references, while the discussion has been synthesized and supported by relevant citations. We have also revised the methods section to clarify the inclusion criteria (limited to in vitro studies), justify our focus on a single mechanical property (shear bond strength), and detail our more comprehensive search strategy.
Tables and Figures: A new table (Table 2) has been added to detail the data extraction plan, which ensures greater transparency and reproducibility of our approach.
Data: The core data have not been changed, but the methodology for their collection and potential analysis has been specified more precisely.

To read any peer review reports and author responses for this article, follow the "read" links in the Open Peer Review table.

Introduction

Dental fluorosis (DF) is defined as the hypomineralization of tooth enamel during its development.¹ It is an acquired dental disease that is caused by excessive fluoride intake. During the maturation stage of amylogenesis,¹ excessive fluoride decreases the free calcium ion concentration.¹

This alteration may negatively affect the adhesion of various dental materials to teeth with dental fluorosis, which requires precautions or specific materials.² A systematic review by Savovic et al.³ reported that bonding procedures can be performed reliably on most fluorosed teeth, provided that the severity of fluorosis is carefully considered, and appropriate bond-enhancing measures are implemented for severely affected teeth.

In vitro studies are useful for evaluating the behavior of different materials to create guidelines for clinical practice.⁴ The shear bond strength (SBS) is commonly used to assess bond strength.⁵ It presents the maximum force applied to the adhesive area between the two materials, tolerated before fracture.⁶

The present systematic review aimed to assess the SBS of teeth with dental fluorosis in in vitro studies available in the literature. It aims to establish guidelines to enhance bonding to fluorescent teeth.

Protocol

Methods

The review protocol was registered with PROSPERO (CRD42024516157) dated 3/3/24. It adheres to PRISMA-P guidelines and provides a structured approach for conducting systematic reviews.^7,8 To guarantee reliability and uniformity, the F1000 journal’s methodology will was implemented in our review.

Two independent reviewers will conduct the assessments to minimize bias and ensure reliability. Any disagreements were resolved through discussion or by consulting with a third reviewer (ST) to reach a consensus. Rigorous methodology and assessment of bias will help guarantee that the conclusions of the review are based on high-quality evidence.

The phrasing of the research question

Is the shear bond strength similar between the fluorosed and non-fluorosed teeth?

Objectives

Primary objective: To compare the mean shear bond strength (measured in Megapascals, MPa) between fluorosed teeth and non-fluorosed teeth.

Secondary objectives: To determine the factors that could enhance or decrease the bonding quality of fluorosed teeth.

The PICO model

In this systematic review, the PICO format was used to formulate an evidence question resulting in the following:

• Types of participants: This systematic review will focus on fluorosed teeth
• Intervention types: This systematic review will focus on the assessment of shear bond strength.
• The comparators: This systematic review will with non fluorosed teeth
• Types of outcomes: This systematic review will be conducted using quantitative assessments of shear bond strength.
• Study types: The included articles will mainly include in vitro studies that will be chosen for their substantial data and rigorous methodology to meet the research objectives effectively.

Eligiblity criteria

• Inclusion criteria: Original English-language articles describing in vitro studies were included.
• Exclusion criteria: Systematic reviews, meta-analyses, non-original articles, cohort studies, human studies, articles published in languages other than English, animal studies, case reports, and theses will be excluded. Additionally, case reports, case series, abstracts, discussions, interviews, editorials, opinion pieces, and studies with inadequate data or methodology were excluded to ensure the reliability and relevance of the review.

Search strategy

A combination of keywords relevant to the topic was used in the refined search strategy. Databases such as Web of Science, PubMed, Scopus, Cochrane, and Science Direct will be searched meticulously.

To ensure an accurate review, gray literature and ongoing clinical trials from sources such as dissertations, conference proceedings, and clinical trial registries will be reviewed. An expert panel assists in identifying relevant gray literature sources. Additionally, we will systematically examine the reference lists of the included studies to uncover supplementary articles that may not have been found through electronic database searches. This approach aimed to minimize publication bias and provide a thorough evaluation of the available evidence.

An electronic search was performed using a combination of the mesh terms listed in Table 1.

Table 1.

Search strategy in different databases.

Database	Search strategy
Pubmed	(“Dental Bonding”[Mesh] OR “Bonding”[tiab] OR “Shear Bond Strength”[tiab]) AND (“Fluorosis, Dental”[Mesh] OR “Dental Fluorosis”[tiab] OR “Fluoride Exposure”[tiab]) NOT (“Orthodontic”[tiab] OR “Bracket”[tiab] OR “Brackets”[tiab])
Scopus	TITLE-ABS-KEY (“dental fluorosis” OR “fluoride exposure”) AND TITLE-ABS-KEY (“shear bond strength” OR bonding) AND NOT TITLE-ABS-KEY (orthodontic OR brackets)
Cochrane	((MeSH descriptor: [Fluorosis, Dental] explode) OR “dental fluorosis” OR “fluoride exposure”) AND ((MeSH descriptor: [Dental Bonding] explode) OR “shear bond strength” OR “bonding”) NOT (“orthodontic” OR “bracket” OR “brackets”)
Web of Science	TS=((“dental fluorosis” OR “fluoride exposure”) AND (“shear bond strength” OR bonding) NOT (“orthodontic” OR bracket OR brackets))
Science Direct	“dental fluorosis” OR “fluoride exposure” AND “shear bond strength” OR bonding NOT “orthodontic” OR bracket

Selection process

All included articles will be exported to Mendeley^® software (https://www.mendeley.com/). Duplicates were then removed. Subsequently, both the operators reviewed the titles and abstracts of each article. Those containing relevant information according to the eligibility criteria were selected. Finally, a full-text analysis of the selected articles will be conducted to determine their suitability for inclusion in the systematic review.

Quality and bias risk assessment

The Cochrane Collaboration tool will be used to assess the methodological quality of the included studies using a software program (RevMan v5.4; The Cochrane Collaboration). The risk of bias will be evaluated for each domain, and the overall assessment will be categorized as low, unclear, or high risk.³

Data collection plan

Table 2 details the data collection process, specifying the data that will be extracted from studies.

Table 2.

details the data collection process, specifying the data that will be extracted from studies.

Characteristics of included studies	Methodology	Sample subgroups and divisions	Materials, compositions, and manufactures of resin and bonding systems	Main outcome
Study design Country Index of DF Studied Interface Sample size	Testing machine The fixation of the specimen to the testing machine Speed of the force Observation of mode of fracture		Materials Compositions Manufactures	Mean bond strength values Fracture mode observed of the different groups

Discussion

The results of this systematic review will contribute to the understanding of the effect of dental fluorosis on shear bond strength. Therefore, based on the study results, it will be discussed whether a fluorosis-affected tooth should be considered a healthy tooth, and clinical recommendations for improving material adhesion will be provided.

Furthermore, the findings of this review may inform future research on the mechanisms underlying the influence of dental fluorosis on the shear bond strength. This knowledge could lead to the development of strategies to mitigate the negative effects of fluorosis on the mechanical properties of the enamel.

Ethics and dissemination

Ethical approval was not required for this study. The conclusions of this research will be disseminated to the scientific community through conference presentations and publications in a peer-reviewed journal that adheres to open science principles.

Study Status - Data analysis phase.

Data availability

Underlying data

No data associated with this article.

Extended data

Reporting guidelines

Figshare: The influence of dental fluorosis on shear bond strength: a systematic review protocol, https://doi.org/10.6084/m9.figshare.27172677.v1.⁹

The project contains the following data:

• PRISMA-P checklist

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

References

1. Bhagavatula P, Levy SM, Broffitt B, et al.: Timing of fluoride intake and dental fluorosis on late-erupting permanent teeth. Community Dent. Oral Epidemiol. 2016; 44(1): 32–45. PubMed Abstract | Publisher Full Text | Free Full Text
2. Ermiş RB, Gokay N: Effect of fluorosis on dentine shear bond strength of a self-etching bonding system. J. Oral Rehabil. 2003; 30(11): 1090–1094. PubMed Abstract | Publisher Full Text
3. Savović J, Weeks L, Sterne JA, et al.: Evaluation of the Cochrane Collaboration’s tool for assessing the risk of bias in randomized trials: focus groups, online survey, proposed recommendations and their implementation. Syst. Rev. 2014; 3: 37. PubMed Abstract | Publisher Full Text | Free Full Text
4. Fernandes VVBOM Jr, Nogueira L Jr, Silva JMF: Araújo RM Analysis and Comparison of Different Bond Strength Tests. JSM Dent. 2016; 4(5): 6.
5. El Mourad AM: Assessment of Bonding Effectiveness of Adhesive Materials to Tooth Structure using Bond Strength Test Methods: A Review of Literature. Open Dent. J. 2018; 12: 664–678. PubMed Abstract | Publisher Full Text | Free Full Text
6. Ismail AM, Bourauel C, ElBanna A, et al.: Micro versus Macro Shear Bond Strength Testing of Dentin-Composite Interface Using Chisel and Wireloop Loading Techniques. Dent. J. 2021; 9(12). PubMed Abstract | Publisher Full Text | Free Full Text
7. Page MJ, McKenzie JE, Bossuyt PM, et al.: The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical Research ed). 2021; 372: n71. Publisher Full Text
8. Borges Migliavaca C, Stein C, Colpani V, et al.: How are systematic reviews of prevalence conducted? A methodological study. BMC Med. Res. Methodol. 2020; 20(1): 96. PubMed Abstract | Publisher Full Text | Free Full Text
9. Kallala R, Gassara Y, Touzi S, et al.: The influence of dental fluorosis on shear bond strength: a systematic review protocolPRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) 2015 checklist. figshare. Figure. 2024. Publisher Full Text

Comments on this article Comments (1)

Version 2

VERSION 2 PUBLISHED 05 Sep 2025

Revised

Comment

Version 1

VERSION 1 PUBLISHED 11 Nov 2024

Discussion is closed on this version, please comment on the latest version above.

Reader Comment 09 Aug 2025

raghad raad, preventive dentistry, University of Baghdad, Baghdad, Iraq

09 Aug 2025

Reader Comment

The protocol mentions the Cochrane Collaboration tool but doesn't specify which tool used to assess the methodological quality of the included studies
Competing Interests: None
The protocol mentions the Cochrane Collaboration tool but doesn't specify which tool used to assess the methodological quality of the included studies
The protocol mentions the Cochrane Collaboration tool but doesn't specify which tool used to assess the methodological quality of the included studies
Competing Interests: None Close
Report a concern
Discussion is closed on this version, please comment on the latest version above.

Author details Author details

¹ University of Monastir, faculty of dental medecine, Research laboratory of Occlusodontics and Ceramic Prostheses LR16ES15, University of Monastir, Monastir, 5000, Tunisia

Rim Kallala
Roles: Conceptualization, Data Curation, Formal Analysis, Writing – Review & Editing

Yosra Gassara
Roles: Data Curation, Formal Analysis, Investigation, Resources, Supervision

Yasmine Dhraief
Roles: Conceptualization, Methodology

Soumaya Touzi
Roles: Conceptualization, Validation, Visualization

Belhassen Harzallah
Roles: Supervision, Validation

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: 05 Sep 2025, 13:1349

https://doi.org/10.12688/f1000research.155925.2

version 1

Published: 11 Nov 2024, 13:1349

https://doi.org/10.12688/f1000research.155925.1

Copyright

© 2025 Kallala R 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. The author(s) is/are employees of the US Government and therefore domestic copyright protection in USA does not apply to this work. The work may be protected under the copyright laws of other jurisdictions when used in those jurisdictions.

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Kallala R, Gassara Y, Dhraief Y et al. The influence of dental fluorosis on shear bond strength: a systematic review protocol [version 2; peer review: 1 approved, 1 not approved]. F1000Research 2025, 13:1349 (https://doi.org/10.12688/f1000research.155925.2)

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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Reviewer Report 16 Sep 2025

Muna Saleem Khalaf, University of Baghdad, Baghdad, Iraq

Approved

https://doi.org/10.5256/f1000research.186565.r411907

I have read the revisions made to the article. ... Continue reading

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Reviewer Report 02 Jun 2025

Muna Saleem Khalaf, University of Baghdad, Baghdad, Iraq

Approved with Reservations

https://doi.org/

1- In Introduction section, at the end of the aim of the systematic review the description of fluorosed teeth by the use of "fluorescent teeth" is incorrect. Fluorescent teeth have a very different meaning. Please correct
2- In " ... Continue reading

1- In Introduction section, at the end of the aim of the systematic review the description of fluorosed teeth by the use of "fluorescent teeth" is incorrect. Fluorescent teeth have a very different meaning. Please correct
2- In " The comparators" I believe there is a missing word between will and with.
3- fluorosis in teeth has degrees of severity ranging from small opaque white lesions to severe enamel surface defects. Is this considered when assessing SBS of the in vitro studies?
4- It is mentioned in the "Quality and bias risk assessment " the use of the Cochrane Collaboration tool, but does not specify which tool to be used to assess the methodological quality of the included studies.

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?

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

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: pediatric dentistry, restorative materials, endodontics, behavior management

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.

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Reviewer Report 28 May 2025

Daniela Prócida Raggio, University of São Paulo, Sao Paulo, Brazil

Not Approved

https://doi.org/10.5256/f1000research.171159.r386554

The submitted protocol outlines a systematic review aiming to compare the shear bond strength between fluorosed and non-fluorosed teeth using in vitro data. Unfortunately, several methodological and structural issues indicate that the authors may not be fully familiar with best ... Continue reading

The submitted protocol outlines a systematic review aiming to compare the shear bond strength between fluorosed and non-fluorosed teeth using in vitro data. Unfortunately, several methodological and structural issues indicate that the authors may not be fully familiar with best practices in conducting and reporting systematic reviews. The following points detail the areas in need of attention and improvement.
1. Registration Platform Appropriateness:
The authors have registered their protocol on PROSPERO. However, PROSPERO explicitly states that it is intended for systematic reviews of human health and some preclinical studies. As this review is focused solely on in vitro studies, a more appropriate registry should be considered, such as the Open Science Framework (OSF) or protocols.io.
2. Clarity of Research Question and Outcomes:
The protocol does not clearly specify the primary outcome. While it is implied that the review aims to assess the shear bond strength between fluorosed and non-fluorosed teeth, the measurement metric (e.g., in MPa) and statistical descriptors (e.g., with standard deviation) are not clearly defined. This ambiguity could lead to inconsistencies during data extraction and synthesis.
3. Inconsistencies in Inclusion Criteria:
There is a discrepancy between the registered protocol and the manuscript text regarding inclusion criteria. In PROSPERO, the authors list several study types, including cross-sectional and clinical studies. In contrast, the protocol document only includes in vitro studies. The authors should clarify and reconcile these differences to avoid confusion during study selection.
4. Search Strategy:
The current search strategy requires significant revision. It is not sufficiently detailed, and the inclusion of time and language restrictions is a concern. Such limitations are discouraged by the Cochrane Handbook unless clearly justified. The authors are strongly advised to consult with a medical librarian or information specialist to develop a more comprehensive and reproducible search strategy.
5. Language and Tense Consistency:
The manuscript contains inconsistencies in verb tense usage. Some sections are written in the past tense (e.g., "Duplicates were then removed"), while others use the future tense (e.g., "All included articles will be exported..."). As this is a research protocol, it should consistently use future tense to describe planned methods.
6. Justification for Outcome Focus:
It is unclear why the review is limited to assessing only shear bond strength. The authors should justify this choice and clarify whether other mechanical properties (e.g., tensile strength, microtensile strength) were considered and why they were excluded.
7. Data Collection Plan:
The data collection process is not described in sufficient detail. The authors should specify what information they plan to extract from each included study (e.g., sample size, type of adhesive used, surface treatment, testing conditions, bond strength outcomes, statistical measures). This information is essential for ensuring transparency and reproducibility.

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

Yes
Is the study design appropriate for the research question?

No
Are sufficient details of the methods provided to allow replication by others?

No
Are the datasets clearly presented in a useable and accessible format?

No

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Pediatric Dentistry, Cariology, Meta-research

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Version 2

VERSION 2 PUBLISHED 05 Sep 2025

Revised

Comment

Version 1

VERSION 1 PUBLISHED 11 Nov 2024

Discussion is closed on this version, please comment on the latest version above.

Reader Comment 09 Aug 2025

raghad raad, preventive dentistry, University of Baghdad, Baghdad, Iraq

09 Aug 2025

Reader Comment

The protocol mentions the Cochrane Collaboration tool but doesn't specify which tool used to assess the methodological quality of the included studies
Competing Interests: None
The protocol mentions the Cochrane Collaboration tool but doesn't specify which tool used to assess the methodological quality of the included studies
The protocol mentions the Cochrane Collaboration tool but doesn't specify which tool used to assess the methodological quality of the included studies
Competing Interests: None Close
Report a concern
Discussion is closed on this version, please comment on the latest version above.

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Version 1 11 Nov 24	read	read

Daniela Prócida Raggio, University of São Paulo, Sao Paulo, Brazil
Muna Saleem Khalaf, University of Baghdad, Baghdad, Iraq

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Reviewer Report

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16 Sep 2025 | for Version 2

Muna Saleem Khalaf, University of Baghdad, Baghdad, Iraq

1 Views Cite this report Responses(0)

Approved

I have read the revisions made to the article. The revisions are appropriate, and I now approve the article.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

pediatric dentistry, restorative materials, endodontics, behavior management

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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02 Jun 2025 | for Version 1

Muna Saleem Khalaf, University of Baghdad, Baghdad, Iraq

12 Views Cite this report Responses(0)

Approved With Reservations

1- In Introduction section, at the end of the aim of the systematic review the description of fluorosed teeth by the use of "fluorescent teeth" is incorrect. Fluorescent teeth have a very different meaning. Please correct
2- In " The comparators" I believe there is a missing word between will and with.
3- fluorosis in teeth has degrees of severity ranging from small opaque white lesions to severe enamel surface defects. Is this considered when assessing SBS of the in vitro studies?
4- It is mentioned in the "Quality and bias risk assessment " the use of the Cochrane Collaboration tool, but does not specify which tool to be used to assess the methodological quality of the included studies.

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?

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

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

pediatric dentistry, restorative materials, endodontics, behavior management

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.

Respond to this report

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Reviewer Report

8 Views

28 May 2025 | for Version 1

Daniela Prócida Raggio, University of São Paulo, Sao Paulo, Brazil

8 Views Cite this report Responses(0)

Not Approved

The submitted protocol outlines a systematic review aiming to compare the shear bond strength between fluorosed and non-fluorosed teeth using in vitro data. Unfortunately, several methodological and structural issues indicate that the authors may not be fully familiar with best practices in conducting and reporting systematic reviews. The following points detail the areas in need of attention and improvement.
1. Registration Platform Appropriateness:
The authors have registered their protocol on PROSPERO. However, PROSPERO explicitly states that it is intended for systematic reviews of human health and some preclinical studies. As this review is focused solely on in vitro studies, a more appropriate registry should be considered, such as the Open Science Framework (OSF) or protocols.io.
2. Clarity of Research Question and Outcomes:
The protocol does not clearly specify the primary outcome. While it is implied that the review aims to assess the shear bond strength between fluorosed and non-fluorosed teeth, the measurement metric (e.g., in MPa) and statistical descriptors (e.g., with standard deviation) are not clearly defined. This ambiguity could lead to inconsistencies during data extraction and synthesis.
3. Inconsistencies in Inclusion Criteria:
There is a discrepancy between the registered protocol and the manuscript text regarding inclusion criteria. In PROSPERO, the authors list several study types, including cross-sectional and clinical studies. In contrast, the protocol document only includes in vitro studies. The authors should clarify and reconcile these differences to avoid confusion during study selection.
4. Search Strategy:
The current search strategy requires significant revision. It is not sufficiently detailed, and the inclusion of time and language restrictions is a concern. Such limitations are discouraged by the Cochrane Handbook unless clearly justified. The authors are strongly advised to consult with a medical librarian or information specialist to develop a more comprehensive and reproducible search strategy.
5. Language and Tense Consistency:
The manuscript contains inconsistencies in verb tense usage. Some sections are written in the past tense (e.g., "Duplicates were then removed"), while others use the future tense (e.g., "All included articles will be exported..."). As this is a research protocol, it should consistently use future tense to describe planned methods.
6. Justification for Outcome Focus:
It is unclear why the review is limited to assessing only shear bond strength. The authors should justify this choice and clarify whether other mechanical properties (e.g., tensile strength, microtensile strength) were considered and why they were excluded.
7. Data Collection Plan:
The data collection process is not described in sufficient detail. The authors should specify what information they plan to extract from each included study (e.g., sample size, type of adhesive used, surface treatment, testing conditions, bond strength outcomes, statistical measures). This information is essential for ensuring transparency and reproducibility.

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

Yes
Is the study design appropriate for the research question?

No
Are sufficient details of the methods provided to allow replication by others?

No
Are the datasets clearly presented in a useable and accessible format?

No

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Pediatric Dentistry, Cariology, Meta-research

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

Respond to this report

Responses (0)

[1] 1. Bhagavatula P, Levy SM, Broffitt B, et al.: Timing of fluoride intake and dental fluorosis on late-erupting permanent teeth. Community Dent. Oral Epidemiol. 2016; 44(1): 32–45. PubMed Abstract | Publisher Full Text | Free Full Text

[2] 2. Ermiş RB, Gokay N: Effect of fluorosis on dentine shear bond strength of a self-etching bonding system. J. Oral Rehabil. 2003; 30(11): 1090–1094. PubMed Abstract | Publisher Full Text

[3] 3. Savović J, Weeks L, Sterne JA, et al.: Evaluation of the Cochrane Collaboration’s tool for assessing the risk of bias in randomized trials: focus groups, online survey, proposed recommendations and their implementation. Syst. Rev. 2014; 3: 37. PubMed Abstract | Publisher Full Text | Free Full Text

[4] 4. Fernandes VVBOM Jr, Nogueira L Jr, Silva JMF: Araújo RM Analysis and Comparison of Different Bond Strength Tests. JSM Dent. 2016; 4(5): 6.

[5] 5. El Mourad AM: Assessment of Bonding Effectiveness of Adhesive Materials to Tooth Structure using Bond Strength Test Methods: A Review of Literature. Open Dent. J. 2018; 12: 664–678. PubMed Abstract | Publisher Full Text | Free Full Text

[6] 6. Ismail AM, Bourauel C, ElBanna A, et al.: Micro versus Macro Shear Bond Strength Testing of Dentin-Composite Interface Using Chisel and Wireloop Loading Techniques. Dent. J. 2021; 9(12). PubMed Abstract | Publisher Full Text | Free Full Text

[7] 7. Page MJ, McKenzie JE, Bossuyt PM, et al.: The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical Research ed). 2021; 372: n71. Publisher Full Text

[8] 8. Borges Migliavaca C, Stein C, Colpani V, et al.: How are systematic reviews of prevalence conducted? A methodological study. BMC Med. Res. Methodol. 2020; 20(1): 96. PubMed Abstract | Publisher Full Text | Free Full Text

[9] 9. Kallala R, Gassara Y, Touzi S, et al.: The influence of dental fluorosis on shear bond strength: a systematic review protocolPRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) 2015 checklist. figshare. Figure. 2024. Publisher Full Text

The influence of dental fluorosis on shear bond strength: a systematic review protocol

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Data availability

Underlying data

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