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Adesão a dentina afetada decídua: uma revisão da literatura
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Os procedimentos restauradores em dentes decíduos destinam-se à manutenção dos mesmos em função na cavidade oral, até à sua esfoliação. Cada vez mais, tende-se para abordagens ultraconservadoras no tratamento de lesões dentinárias cavitadas. A dentina cariada possui duas camadas. A camada mais superficial, dentina infetada, é a zona de destruição e é removida aquando do tratamento. Por outro lado, a camada mais profunda, a dentina afetada, é um tecido passível de ser remineralizado. Este é o substrato maioritariamente encontrado após a remoção da lesão de cárie. A dentina afetada é diferente da dentina saudável, contendo os seus túbulos preenchidos com minerais resistentes a ácidos. Contudo, encontra-se parcialmente desmineralizada devido ao processo cariogénico e apresenta uma maior porosidade do que a dentina saudável devido à perda de mineral. Estas diferenças podem ter implicações na adesão à dentina afetada e comprometer a eficácia das restaurações adesivas. Desta forma, é essencial o uso de um sistema adesivo que se mostre eficaz neste substrato. O objetivo desta revisão narrativa sobre adesão a dentina afetada na dentição decídua é descrever, através da literatura existente, as estratégias adesivas a aplicar para uma melhor adesão a este substrato. Estão disponíveis dois sistemas adesivos que podem ser classificados de acordo com a sua interação com o substrato: o etch-and-rinse e o self-etch. Quanto à estratégia mais adequada à dentina afetada, os resultados obtidos pelos diversos estudos são controversos. Apesar dos sistemas self-etch terem sido propostos como uma escolha atrativa devido à menor sensibilidade da técnica e menor tempo clínico, foram obtidos maioritariamente melhores resultados quando utilizados sistemas etch-and-rinse. As explicações propostas divergem entre autores, existindo também aqueles que afirmam que ambos os sistemas produzem resultados semelhantes. Serão necessários mais estudos, principalmente clínicos, com protocolos uniformizados para se poder aferir a melhor estratégia adesiva para a dentina afetada.
The restorative procedures in deciduous teeth are intended to keep them in function in the oral cavity until exfoliation. Increasingly, there is a trend towards ultraconservative approaches in the treatment of cavitated dentinal lesions. Carious dentin has two layers. The most superficial layer, infected dentin, is the destruction zone and is removed at treatment. On the other hand, the deeper layer, the affected dentin, is a tissue that can be remineralized. This is the substrate mostly found after removal of the caries lesion. The affected dentin is different from healthy dentin, containing its tubules filled with acid-resistant minerals. However, it is partially demineralized due to the cariogenic process and has a higher porosity than healthy dentin due to mineral loss. These differences may have implications for the adhesion to the affected dentin and compromise the effectiveness of adhesive restorations. Therefore, the use of an adhesive system that is effective on this substrate is essential. The objective of this narrative review on adhesion to affected dentin in the deciduous teeth is to describe, based on the existing literature, the adhesive strategies to be applied for a better adhesion to this substrate. Two adhesive systems are available which can be classified according to their interaction with the substrate: etch-and-rinse and self-etch. Regarding the strategy most appropriate to the affected dentin, the results obtained by the several studies are controversial. Although self-etch systems were proposed as an attractive choice due to the lower sensitivity of the technique and shorter clinical time, better results were obtained when using etch-and-rinse systems. The proposed explanations differ between authors, and there are those who claim that both systems produce similar results. Further studies, mainly clinical ones, with standardized protocols will be needed to assess the best adhesive strategy for the affected dentin.
The restorative procedures in deciduous teeth are intended to keep them in function in the oral cavity until exfoliation. Increasingly, there is a trend towards ultraconservative approaches in the treatment of cavitated dentinal lesions. Carious dentin has two layers. The most superficial layer, infected dentin, is the destruction zone and is removed at treatment. On the other hand, the deeper layer, the affected dentin, is a tissue that can be remineralized. This is the substrate mostly found after removal of the caries lesion. The affected dentin is different from healthy dentin, containing its tubules filled with acid-resistant minerals. However, it is partially demineralized due to the cariogenic process and has a higher porosity than healthy dentin due to mineral loss. These differences may have implications for the adhesion to the affected dentin and compromise the effectiveness of adhesive restorations. Therefore, the use of an adhesive system that is effective on this substrate is essential. The objective of this narrative review on adhesion to affected dentin in the deciduous teeth is to describe, based on the existing literature, the adhesive strategies to be applied for a better adhesion to this substrate. Two adhesive systems are available which can be classified according to their interaction with the substrate: etch-and-rinse and self-etch. Regarding the strategy most appropriate to the affected dentin, the results obtained by the several studies are controversial. Although self-etch systems were proposed as an attractive choice due to the lower sensitivity of the technique and shorter clinical time, better results were obtained when using etch-and-rinse systems. The proposed explanations differ between authors, and there are those who claim that both systems produce similar results. Further studies, mainly clinical ones, with standardized protocols will be needed to assess the best adhesive strategy for the affected dentin.
Descrição
Tese de mestrado, Medicina Dentária, Universidade de Lisboa, Faculdade de Medicina Dentária, 2017
Palavras-chave
Adesivos - dentina Teses de mestrado - 2017