Abstract
This paper presents the results of a systematic review and meta-analysis on the efficacy of mussel-inspired primers on resin-dentin bond stability. This review was registered on the OSF platform (https://doi.org/10.17605/OSF.IO/QC7VU) and followed PRISMA guidelines. Databases included PubMed, SCOPUS, Web of Science, EMBASE, Lilacs, LIVIVO, and gray literature. Eligibility criteria included in vitro studies using human dentin, which assessed bond strength through microtensile tests after applying mussel-inspired primers. Exclusion criteria were studies evaluating bond strength to enamel, animal dentin, and ceramics, those not using the microtensile test, or those conducting immediate evaluation only. The RoBDEMAT tool was used for risk-of-bias analysis. Two independent reviewers screened 5522 articles, and seven were selected. The studies showed a similar risk of bias performance, with insufficient reporting of different parameters, while not presenting significant publication bias. Meta-analysis revealed significantly higher bond strength in specimens treated with mussel-inspired monomers after thermocycling. Across studies, no substantial reduction in heterogeneity was observed using the leave-one-out method. Mussel-inspired monomers incorporated into the dentin adhesive procedure can enhance bond strength, mainly through their catecholic groups, highlighting their potential in adhesive dentistry. However, drawbacks such as oxidative potential and effects on the degree of conversion may limit their widespread application.