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Study Protocol

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

[version 1; peer review: 1 approved with reservations, 1 not approved]
PUBLISHED 11 Nov 2024
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Abstract

Dental fluorosis, a condition characterized by enamel hypoplasia caused by excessive fluoride intake, can potentially affect the adhesion of dental materials. This systematic review aimed to assess the influence of dental fluorosis on shear bond strength (SBS) and to provide clinical recommendations.

A comprehensive search of electronic databases was conducted, followed by a rigorous selection process to include relevant in vitro studies. The quality of the included studies was assessed and data were extracted for analysis.

Based on these findings, it is recommended to consider alternative bonding techniques or to use specific dental materials for fluorosis-affected teeth. Further research is needed to elucidate the mechanisms underlying the potential impact of dental fluorosis on shear bond strength and develop more targeted clinical strategies.

Keywords

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

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 assess the shear bond strength between fluorosed 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.

DatabaseSearch strategy
Pubmed((“Dental Bonding”[Mesh]) AND “Fluorosis, Dental"[Mesh]) NOT (orthodontic)) NOT (bracket)
ScopusTITLE-ABS-KEY (“dental fluorosis”) AND TITLE-ABS-KEY (“shear bond strength” OR “bonding”)AND NOT TITLE-ABS-KEY(“orthodontic”)AND NOT TITLE-ABS-KEY (“brackets”)
Cochrane((“dental fluorosis” OR “fluoride exposure”) AND (“shear bond strength” OR “bonding”)) NOT (“bracket” OR “orthodontic”)
Web of scienceAB=(“dental fluorosis”) AND AB=(“shear bond strength” OR “bonding”) Not AB=(“bracket” OR “orthodontic”)
Science direct(“dental fluorosis”) 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

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.

Comments on this article Comments (1)

Version 1
VERSION 1 PUBLISHED 11 Nov 2024
  • 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
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how to cite this article
Kallala R, Gassara Y, Dhraief Y et al. The influence  of dental fluorosis on shear bond strength: a systematic review protocol [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2024, 13:1349 (https://doi.org/10.12688/f1000research.155925.1)
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

Current Reviewer Status: ?
Key to Reviewer Statuses VIEW
ApprovedThe 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 approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 1
VERSION 1
PUBLISHED 11 Nov 2024
Views
4
Cite
Reviewer Report 02 Jun 2025
Muna Saleem Khalaf, University of Baghdad, Baghdad, Iraq 
Approved with Reservations
VIEWS 4
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
CITE
CITE
HOW TO CITE THIS REPORT
Khalaf MS. Reviewer Report For: The influence  of dental fluorosis on shear bond strength: a systematic review protocol [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2024, 13:1349 (https://doi.org/10.5256/f1000research.171159.r386555)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
Views
5
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Reviewer Report 28 May 2025
Daniela Prócida Raggio, University of São Paulo, Sao Paulo, Brazil 
Not Approved
VIEWS 5
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
CITE
CITE
HOW TO CITE THIS REPORT
Raggio DP. Reviewer Report For: The influence  of dental fluorosis on shear bond strength: a systematic review protocol [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2024, 13:1349 (https://doi.org/10.5256/f1000research.171159.r386554)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.

Comments on this article Comments (1)

Version 1
VERSION 1 PUBLISHED 11 Nov 2024
  • 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
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
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