Eficácia de diferentes agentes de ligação cruzada no tecido dentinário: estudo In vitro e revisão sistemática com meta-análise

Abstract

Dentin biomodification through natural agents containing polyphenols as collagen cross-linking agents (CCLAs) has shown promising results in modifying the collagen structure. The present thesis aimed to evaluate the efficacy of CCLAs in dentin biomodification through a systematic review with meta-analysis and a laboratory study. This study consists of two chapters, where the first chapter aimed to evaluate, through a systematic review and meta-analysis with randomized clinical trials, the efficacy of CCLAs associated with adhesive techniques in restorative procedures. An individualized search was conducted in the following databases: PubMed, Scopus, Web of Science, Cochrane, LILACS, and DOSS, in addition to grey literature. A total of 838 articles were found, and after applying the PRISMA checklist, three articles were selected. It was concluded that there is no clinical efficacy to justify the use of CCLAs in the performed protocols; however, due to the short evaluation period and the low number of studies, despite presenting high certainty of evidence, this outcome may be altered in the long term. The second chapter aimed to evaluate the influence of extracts from native or cultivated plants in the Northeastern flora (Libidibia ferrea, Spondias mombin, Matricaria chamomilla, and Cocos nucifera), as well as an extract from Vitis vinifera originating from a US company, as dentin biomodifiers and relate these effects to the total polyphenol content (TPC). All extracts were evaluated at concentrations of 6.5% and 13% (n=15). The specimens were immersed in these solutions for 1 hour. The tests performed were TPC using the Folin-Ciocalteu method, modulus of elasticity, mass variation, and biodegradation rate. All extracts increased the elasticity modulus of demineralized dentin; however, the mass gain and biodegradation rate varied among the extracts and evaluated concentrations. A positive relationship was only observed between high TPC and mass gain. Thus, it can be inferred that (1) the clinical studies conducted so far have not demonstrated the benefits of including these agents in the clinical performance of restorations and (2) the different extracts used were effective as dentin biomodification agents in vitro.