Abstract

Introduction: Cervical lesions often demand specialized approaches due to their anatomical position, and the effectiveness of these techniques may vary among clinicians. Objectives: To assess the clinical effectiveness of various adhesive strategies combined with different restorative materials for managing cavitated cervical carious lesions in adults, with a specific focus on restoration retention. The study also aimed to rank these combinations through network meta-analysis. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO. Randomized controlled trials comparing at least two restorative protocols in adult populations were included. Pairwise and network meta-analyses were performed using random-effects models. The certainty of the evidence was evaluated using the CINeMA framework. Results: Seventeen RCTs met the inclusion criteria. Conventional composites applied with two-step etch and rinse adhesives and compomers demonstrated the highest retention rates in pairwise comparisons. Glass ionomer cement showed the most stable long-term performance. However, the network meta-analysis revealed no statistically significant differences among treatments. Notably, compomers ranked highest in overall performance but were supported by studies with substantial heterogeneity and a high risk of bias. Conclusions: Although compomers achieved the highest retention rates in direct comparisons, the underlying evidence is limited by methodological concerns, reducing confidence in their clinical reliability. In contrast, conventional composites bonded with two-step etch-and-rinse adhesives emerged as the most robust and evidence-based option for restoring cervical carious lesions. The optimization of adhesive protocols, particularly the incorporation of selective enamel etching, remains a key determinant for long-term restoration success. Clinical Significance: This systematic review and network meta-analysis provides robust, evidence-based guidance for the restoration of cavitated cervical carious lesions in adults. Optimizing adhesive protocols, especially with selective enamel etching, significantly enhances the longevity of cervical carious lesion restorations. Evidence supports two-step etch-and-rinse adhesives with conventional composites as a dependable choice, ensuring durable retention, favorable esthetic integration, and long-term performance in this highly visible and esthetically sensitive region of the dentition. PROSPERO: Registration number: CRD420251083691. © 2025 Wiley Periodicals LLC.