Avaliação do uso de tecidos dentários animais como substitutos a dentes humanos em testes in vitro: revisão sistemática e metanálise

Abstract

Although many studies have evaluated the possibility of animal teeth being used as substitutes for human teeth in the literature, there is no clear answer as to which species, which type of tooth and for which types of animal substitutes can be used. systematic review of the in vitro literature to evaluate if there is evidence that supports the use of animal teeth as substitutes for human teeth in laboratory tests. The review was performed according to the guidelines of the Cochrane Handbook and reported based on the PRISMA Statement. Three international databases were used: MEDLINE / PubMed, ISI Web of Science and SciVerse Scopus. We included studies evaluating hard dental tissues (enamel and / or dentin) of animal teeth compared to human teeth, involving chemical, physical, structural or morphological analyzes in in vitro tests. After the screening of 2834 single titles, 57 articles were included in this systematic review, 57 of which were submitted to qualitative analysis and of these 15 studies included in the quantitative synthesis (meta-analysis). Considering that there was a great deal of heterogeneity among the studies, data extraction was performed according to factors considered relevant: animal dental substrate (different species), dentition (deciduous or permanent), animal and human tooth type, variable-response groups and treatments tested, among others. The quantitative analyzes were separated in bond strength, mechanical and surface properties and other properties and characteristics of the dental tissues, being reported for these mean outcomes, standard deviation and sample size (n). In addition, qualitative data were extracted separately from the studies. As most analyzes involved only bovine teeth, the meta-analysis was restricted to the bovine substrate as an animal substitute for human teeth. Statistical heterogeneity of substrate effects between studies was determined using Cochran's Q-test and inconsistency through the I2 test, where values greater than 50% were considered as indicative of substantial heterogeneity. At the end of the study, we find that there is no such comprehensive evidence in the literature that allows such specific conclusions, which are limited to bovine teeth, which accounted for 80.7% of all comparisons with human teeth; to the permanent dentition, whether of human or animal teeth, which corresponded to 89.5% of the comparisons in which the type of dentition was informed by the authors; to posterior human teeth, which corresponded to 83.6% of the sample, compared to previous animal teeth, which corresponded to 96.6% of all comparisons presented here. Considering these limitations, the results of the reviewed literature suggest that there is insufficient evidence to support the use of non-bovine animal dental tissues in laboratory tests in dental research; that bovine dentin seems to replace human dentin well, whereas bovine enamel has more limitations in the replacement of human enamel; the use of bovine teeth, especially dentin, appears to be well supported for laboratory tests involving adhesion and mechanical or tooth surface properties and that any laboratory analysis using animal 10 0 101 teeth as a substitute for human teeth should take into account structural and morphological differences between tissues.