Clinical reliability of self-adhesive luting resins compared to other adhesive procedures: A systematic review and meta-analysis

•Postoperative sensitivity might not be affected by the tooth surface pretreatment.•To avoid extreme postoperative sensitivity, etching should be confined to enamel. Dentin contamination with acid should be avoided.•The main low survival rate event of self-adhesive luting resin is debonding of the restorations.•Selective etching with dentin adhesives is preferred over selective-etch without dentin adhesive, when using self-adhesive luting resin.•Enamel etching along with dentin adhesive is preferred to self-etch adhesives and self-adhesive luting resins. This systematic review aimed to collect and interpret the randomized clinical trials (RCTs) that investigated the outcome of the self-adhesive luting resins (SA) compared to total-etch (TE), selective etch with dentin adhesives (Sle), selective etch without dentin adhesives (SleSA) or self-etch adhesives (SE). A thorough search of Internet databases was conducted without language restrictions, and the search ran up to and including April 2022. The illegible records citations were checked for more relevant clinical studies. The inclusion criteria were randomized controlled trials (RCTs) that compared self-adhesive luting resins with total-etch, selective-etch, or self-etch adhesives regarding postoperative sensitivity, incidences of debonding, and survival rates of indirect restorations. From 1732 records, 9 RCTs met the eligibility criteria. Three RCTs compared total-etch adhesive to self-adhesive luting resin for intracoronal restorations, one RCT compared selective etch to self-adhesive luting resin for inlays, and 5 RCTs compared self-adhesive to other protocols for partial ceramic crowns. Postoperative sensitivity showed a non-statistically significant difference between SA and other adhesive protocols, SA revealed a non-statistically significant difference in debonding and survival to TE, but a lower statistically significant difference to Sle, SleSA, and SE. Postoperative sensitivity might not be affected by the adhesive protocol. In relatively short observation, TE revealed comparable survival to SA for intracoronal restorations. SE and Sle exhibited the best clinical outcomes, followed by SleSA. Selective etch, and self-etch adhesives are preferable to self-adhesive resins. The significance of enamel etching and the superiority of self-etching adhesives over self-adhesive luting resins for reliable and durable bonding and improved clinical outcomes. However, long-term RCTs, particularly for total-e