Palabras clave
Caries de dentina, tratamiento por etapas.
Cómo citar
Abordaje biológico de la caries profunda de dentina: el tratamiento por etapas. (2010). Odontoestomatología, 12(15), 4-12. https://www.odon.edu.uy/ojs/index.php/ode/article/view/221
Resumen
El objetivo de este trabajo es abordar el diagnóstico y el tratamiento de la lesión cariosa en la dentina profunda desde un enfoque biológico y conservador. Comprender la fisiología y la histopatología del complejo dentino pulpar, así como las condiciones que mantienen activa la lesión dentinaria son elementos determinantes que deben considerarse al momento de realizar tratamientos restauradores. Se realiza una revisión bibliografica orientada al estudio o análisis de la enfermedad caries en dentina, su diagnóstico y su tratamiento en situaciones clínicas que permitan una respuesta del complejo dentino pulpar. Se propone el tratamiento por etapas como alternativa a la remoción completa de la dentina cariada profunda. Se apuesta de esta manera a la capacidad reaccional pulpar con el objetivo de evitar exposiciones pulpares, brindando al paciente un tratamiento con enfoque preventivo e integral.
Referencias
1) FDI. Definición de Minimal Intervention Dental Restauration. J Minim Inter. Dent 2009;2 (2) p: 273-274
2) TJ, Anusavice KJ, Frencken JE, Mount GJ. Minimal Intervention Dentistry. A review. FDI Comission Project 1-97. Int dent J 2000 Feb 50 (1): 1-12.
3) Almaraz Cianni M.T, Carvallo Sena A.L. Valoración de la situación del 1er. Molar permanente en niños de 5 a 12 años (de la “Villa del Cerro”- Montevideo). Supl. Rev. Prismas. 1999 nov.; 29 (68): 1-5.
4) Endodoncia Clínica. Manual de apoyo a la Enseñanza Clínica en terapias Endodónticas. Cátedra de Endodoncia. UDelaR. 2008.
5) OgilvieA. Histology of the dental pulp. En: Ingle IJ, ed. Endodontics. Philadelphia : Ed. Lea & Feliger; 1965.p: 295-300.
6) Pashley D. Dinamics of the Pulpodentin Complex. Crit. Rev. In oral Biology and Medicine. 1996; 7: 104-133.
7) Cohen S. Vias de la pulpa. 9ª Edicion. 2007. Elsevier
8) Kuboki Y, Ohgushi K, Fusayama T. Collagen Biochemistry of the two layers of carious dentin. Journal Dent. Res. 1977; 56 (10): 1233-37.
9) Ohgushi K, Fusayama T. Electrón microscopic structure of the two layers of carious dentin. J. Dent. Res. 1975; 54 (5): 1019-75.
10) Stanley HR, Pereira JP, Spiegel E. The detection and prevalence of reactive and physiologic sclerotic dentin, reparative dentin and dead tracts beneath various types of dental lesions according to tooth surface and age. Journal of Pathology. 1983; 12: 257-89.
11) Mjör, Ivar A. Pulp-dentin biology in restorative dentistry. Quintessence Books. Chicago 2002. P. 1-22.
12) Kidd E. A. Microbiological validation of assessments of caries activity during cavity preparation. Caries Res. 1993; 27 (5):402-408.
13) Mc. Comb D., Caries detector dyes-How accurate and useful are they? J. Can. Dent. Assoc. 2000; 66(4): 195-98.
14) Yip HK, Stevenson AG, Beeley J A, The specificity of caries detector dyes in cavity preparation. Br. Dent. J. 1994; 176(11): 417-421.
15) Fusayama T, Okuse K, Hosoda H. Relationship between hardness, discoloration, and microbial invasion in carious dentin. Journal Dental Res. 1966; 45(4): 1033-46.
16) Anderson MH, Charbeneau GT. A comparison of digital and optical criteria for detecting carious dentin. The Journal of Pros. Dent. 1985; 53: 643-46.
17) Cadafalch J. Casanellas J. M., Cerda I., Alemany J., Caballero R. Estudio sobre la aplicación de un colorante detector de caries en cavidades preparadas. Revista Europea de Odontoestomatologia, 2001; 13(2): 67-72.
18) Turell, JC. Rehabilitaciones dentarias. Bs. As.: Mundi SAIC y F; 1976.
19) Fusayama, T. Two layers of caious dentin; diagnosis and treatment. Operative Dentistry, 1979, 4: 63-70.
20) Boston DW, Graver HT. Histological study of an acid red caries disclosing dye. Operative Dentistry. 1989;14: 186-92.
21) Kidd E A, Joyston-Bechal S, Beighton D, The use of a caries detector dye during cavity preparation. Br. Dent. J. 1993; 174 (7): 245-248.
22) Ansari G, Beeley J A. Reid J.S. Caries detector dyes: an in vitro assessment of some new compounds. J. Oral Rehab. 1999; 26: 453-58.
23) Chifflet G, Garchitorena M I. Métodos químicos en la detección de caries. Odontoestomatología del Uruguay. 2008; 10: 13- 8.
24) Fusayama T, Terashima. Differentiation of two layers of carious dentin by staining. J. Dent. Res. 1972; 51(3): 866.
25) Bjorndal L. Indirect Pulp Therapy and Stepwise Excavation. J of Endod 2008; 34: 29-33.
26) Bjorndal L, Thylstrup A. A practice based study on stepwise excavation of deep carious lesions in permanent teeth: a 1 year follow-up study. Community Dent Oral Epidemio 1998; 26: 122-8
27) Fejerskov O, Kidd E. Dental caries - The disease and its clinical management. 2nd ed. Oxford: Blackwell Munksgaard; 2008.
28) Mertz-Fairhurst EJ, Smith CD, Williams JE, Sherrer JD, Mackert Jr JR, Richards EE, et al. Ultraconservative and cariostatic sealed restorations: results at year 10. J Am Dent Assoc. 1998; 129 (1): 55-66.
29) de Souza Acosta C.A. Repercussoes dos Procedimentos operatorios e técnicas sobre o complexo dentino- pulpar. In: De Angelis Porto CL. Cariologia.Artes Medicas; 2008. P 151-195.
30) Fairbourn DR. Charbeneau GT. Loesche WJ. Effect of improved Dycal and IRM on bacteria in deep carious lesions. Journal of the American Dental Association. 1980; 100(4):547-52.
31) Bjorndal L, Larsen T. Changes in the Cultivable Flora in deep carious Lesions following a Stepwise Excavation Procedure. Caries Res. 2000; 34: 502-8
32) Bjorndal L. The Caries Process and Its Effect on the Pulp: The Science Is Changing and So Is Our Understanding. J of Endod. 2008; 34: S2-5
33) Griffin SO. The effectiveness of sealants in managing caries lesions. J of Dent Res. 2008, 87 (2): 169-174.
34) Zacharia-Munshi. Microbiological assessment of dentin stined with a caries detector dye. J Clin Pediatr Dent. 1995; 19 (2): 111-5.
35) Besic FC. The Fate of Bacteria Sealed in Dental Cavities. J Dent Res. 1943; 22: 349- 54.
36) Kidd EA, Fejerskov O. What constitutes dental caries? Histopathology of carious enamel and dentin related to the action of cariogenic biofilms. J Dent Res. 2004; 83 Spec No C:C35–C38
37) Kidd E A. How ‘Clean’ must a cavity be before restoration? Caries Res. 2004; 38: 305–13
38) Anderson M H, Loesche W J, Chabernau G T. Bacteriologic study of a basic fuchsin caries-disclosing dye. J. Prosthet. Dent. 1985; 54(1): 51-4.
39) Oong E M. The Effect of Dental Sealants on Bacteria Levels in Caries Lesions. J Am Dent Assoc. 2008; 139 (3): 271-8.
40) Pereira J P, Berbert A, Segala AD. Long Term Clinical and Radiographic Evaluation of Teeth Submitted to Indirect Pulp Capping. Dent Res ( IADR Abstracts) 1997; 179.
41) Bjorndal L, Reit C, Bruun G, Markvart M, Kjaldgaard M, Nasman P et al. Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Eur J Oral Sci. 2010; 118: 290-7.
2) TJ, Anusavice KJ, Frencken JE, Mount GJ. Minimal Intervention Dentistry. A review. FDI Comission Project 1-97. Int dent J 2000 Feb 50 (1): 1-12.
3) Almaraz Cianni M.T, Carvallo Sena A.L. Valoración de la situación del 1er. Molar permanente en niños de 5 a 12 años (de la “Villa del Cerro”- Montevideo). Supl. Rev. Prismas. 1999 nov.; 29 (68): 1-5.
4) Endodoncia Clínica. Manual de apoyo a la Enseñanza Clínica en terapias Endodónticas. Cátedra de Endodoncia. UDelaR. 2008.
5) OgilvieA. Histology of the dental pulp. En: Ingle IJ, ed. Endodontics. Philadelphia : Ed. Lea & Feliger; 1965.p: 295-300.
6) Pashley D. Dinamics of the Pulpodentin Complex. Crit. Rev. In oral Biology and Medicine. 1996; 7: 104-133.
7) Cohen S. Vias de la pulpa. 9ª Edicion. 2007. Elsevier
8) Kuboki Y, Ohgushi K, Fusayama T. Collagen Biochemistry of the two layers of carious dentin. Journal Dent. Res. 1977; 56 (10): 1233-37.
9) Ohgushi K, Fusayama T. Electrón microscopic structure of the two layers of carious dentin. J. Dent. Res. 1975; 54 (5): 1019-75.
10) Stanley HR, Pereira JP, Spiegel E. The detection and prevalence of reactive and physiologic sclerotic dentin, reparative dentin and dead tracts beneath various types of dental lesions according to tooth surface and age. Journal of Pathology. 1983; 12: 257-89.
11) Mjör, Ivar A. Pulp-dentin biology in restorative dentistry. Quintessence Books. Chicago 2002. P. 1-22.
12) Kidd E. A. Microbiological validation of assessments of caries activity during cavity preparation. Caries Res. 1993; 27 (5):402-408.
13) Mc. Comb D., Caries detector dyes-How accurate and useful are they? J. Can. Dent. Assoc. 2000; 66(4): 195-98.
14) Yip HK, Stevenson AG, Beeley J A, The specificity of caries detector dyes in cavity preparation. Br. Dent. J. 1994; 176(11): 417-421.
15) Fusayama T, Okuse K, Hosoda H. Relationship between hardness, discoloration, and microbial invasion in carious dentin. Journal Dental Res. 1966; 45(4): 1033-46.
16) Anderson MH, Charbeneau GT. A comparison of digital and optical criteria for detecting carious dentin. The Journal of Pros. Dent. 1985; 53: 643-46.
17) Cadafalch J. Casanellas J. M., Cerda I., Alemany J., Caballero R. Estudio sobre la aplicación de un colorante detector de caries en cavidades preparadas. Revista Europea de Odontoestomatologia, 2001; 13(2): 67-72.
18) Turell, JC. Rehabilitaciones dentarias. Bs. As.: Mundi SAIC y F; 1976.
19) Fusayama, T. Two layers of caious dentin; diagnosis and treatment. Operative Dentistry, 1979, 4: 63-70.
20) Boston DW, Graver HT. Histological study of an acid red caries disclosing dye. Operative Dentistry. 1989;14: 186-92.
21) Kidd E A, Joyston-Bechal S, Beighton D, The use of a caries detector dye during cavity preparation. Br. Dent. J. 1993; 174 (7): 245-248.
22) Ansari G, Beeley J A. Reid J.S. Caries detector dyes: an in vitro assessment of some new compounds. J. Oral Rehab. 1999; 26: 453-58.
23) Chifflet G, Garchitorena M I. Métodos químicos en la detección de caries. Odontoestomatología del Uruguay. 2008; 10: 13- 8.
24) Fusayama T, Terashima. Differentiation of two layers of carious dentin by staining. J. Dent. Res. 1972; 51(3): 866.
25) Bjorndal L. Indirect Pulp Therapy and Stepwise Excavation. J of Endod 2008; 34: 29-33.
26) Bjorndal L, Thylstrup A. A practice based study on stepwise excavation of deep carious lesions in permanent teeth: a 1 year follow-up study. Community Dent Oral Epidemio 1998; 26: 122-8
27) Fejerskov O, Kidd E. Dental caries - The disease and its clinical management. 2nd ed. Oxford: Blackwell Munksgaard; 2008.
28) Mertz-Fairhurst EJ, Smith CD, Williams JE, Sherrer JD, Mackert Jr JR, Richards EE, et al. Ultraconservative and cariostatic sealed restorations: results at year 10. J Am Dent Assoc. 1998; 129 (1): 55-66.
29) de Souza Acosta C.A. Repercussoes dos Procedimentos operatorios e técnicas sobre o complexo dentino- pulpar. In: De Angelis Porto CL. Cariologia.Artes Medicas; 2008. P 151-195.
30) Fairbourn DR. Charbeneau GT. Loesche WJ. Effect of improved Dycal and IRM on bacteria in deep carious lesions. Journal of the American Dental Association. 1980; 100(4):547-52.
31) Bjorndal L, Larsen T. Changes in the Cultivable Flora in deep carious Lesions following a Stepwise Excavation Procedure. Caries Res. 2000; 34: 502-8
32) Bjorndal L. The Caries Process and Its Effect on the Pulp: The Science Is Changing and So Is Our Understanding. J of Endod. 2008; 34: S2-5
33) Griffin SO. The effectiveness of sealants in managing caries lesions. J of Dent Res. 2008, 87 (2): 169-174.
34) Zacharia-Munshi. Microbiological assessment of dentin stined with a caries detector dye. J Clin Pediatr Dent. 1995; 19 (2): 111-5.
35) Besic FC. The Fate of Bacteria Sealed in Dental Cavities. J Dent Res. 1943; 22: 349- 54.
36) Kidd EA, Fejerskov O. What constitutes dental caries? Histopathology of carious enamel and dentin related to the action of cariogenic biofilms. J Dent Res. 2004; 83 Spec No C:C35–C38
37) Kidd E A. How ‘Clean’ must a cavity be before restoration? Caries Res. 2004; 38: 305–13
38) Anderson M H, Loesche W J, Chabernau G T. Bacteriologic study of a basic fuchsin caries-disclosing dye. J. Prosthet. Dent. 1985; 54(1): 51-4.
39) Oong E M. The Effect of Dental Sealants on Bacteria Levels in Caries Lesions. J Am Dent Assoc. 2008; 139 (3): 271-8.
40) Pereira J P, Berbert A, Segala AD. Long Term Clinical and Radiographic Evaluation of Teeth Submitted to Indirect Pulp Capping. Dent Res ( IADR Abstracts) 1997; 179.
41) Bjorndal L, Reit C, Bruun G, Markvart M, Kjaldgaard M, Nasman P et al. Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Eur J Oral Sci. 2010; 118: 290-7.