Aims: This systematic review aimed to evaluate the influence of storage medium, moisture status, temperature, and duration on the in vitro outcomes of extracted human teeth, including bond strength, microleakage, fracture resistance, and imaging-detected artifacts. Methods: The study is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. In vitro and ex vivo comparative studies on extracted human teeth were eligible. Animal studies, simulations, and noncomparative reports were excluded. MEDLINE (PubMed), Embase, Scopus, Web of Science, Cochrane CENTRAL, ClinicalTrials.gov, and Google Scholar were searched from inception to October 15, 2025. Risk of bias was assessed using the Quality Assessment Tool for In vitro Studies in Dentistry (QUIN). Random-effects meta-analyses were performed where outcomes and contrasts were sufficiently comparable; otherwise, results were synthesized by contrast families. Continuous outcomes were expressed as mean differences (MDs) or standardized MDs and binary outcomes as odds ratios (ORs). Results: Fourteen studies met the inclusion criteria. Dehydration consistently increased the detection of crack-like artifacts compared with moist storage (pooled OR = 56.66). Microleakage was greater under less favorable storage conditions (pooled MD = 0.97). Limitations: The evidence base consisted of small laboratory studies with variable reporting. Conclusions: Preanalytical storage conditions substantially influence in vitro dental outcomes. Maintaining moisture prior to testing minimizes artifact formation, while formalin and prolonged aging protocols may bias bonding and leakage assessments. Registration: The protocol had been registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251179938).
Keswani et al. (Mon,) studied this question.