Envíe este artículo por correo electrónico Estrategias para el tratamiento de la dentina afectada por caries. Revisión narrativa
Resumen
La mayoría de los estudios en esta área se han centrado en la dentina sana como sustrato para la unión; sin embargo, en entornos clínicos, es común encontrar dentina afectada por caries. que presenta características morfológicas, químicas y físicas distintas. El objetivo de esta revisión narrativa es indagar sobre mejoras en la resistencia y durabilidad de esta unión, en un enfoque integral que considere las características de las superficies expuestas durante la preparación, como las propiedades de los adhesivos utilizados, facilitando decisiones informadas y promoviendo el impulso de materiales dentales eficaces y seguros. Se realizaron búsquedas en bases de datos electrónicas hasta julio de 2025 para localizar artículos relevantes, evaluando la calidad y solidez de la evidencia. La hibridación de la dentina afectada por caries se ve comprometida por enzimas colagenolíticas endógenas, lo que afecta la durabilidad y reduce propiedades mecánicas como el módulo elástico y la nanodureza. Se han sugerido nanomateriales que pueden inducir y regular la mineralización biomimética del tejido duro dental; sin embargo, su adición a adhesivos y resinas podría afectar las propiedades mecánicas. Se destacan los inhibidores de las MMP como la clorhexidina, un inhibidor confiable que podría mejorar la unión en DAC. Es fundamental un esfuerzo colaborativo entre clínicos, investigadores e industrias para entender la relación entre el comportamiento bioactivo, las limitaciones biomecánicas y la biomimética, con el fin de desarrollar materiales restauradores adecuados para la DAC.
RECIBIDO: 29/08/2025
ACEPTADO: 07/11/2025
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Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, Tagami J, Twetman S, Tsakos G, Ismail A. Dental caries. Nat Rev Dis Primers. 2017 May 25; 3: 17030.
Featherstone JD. Dental caries: a dynamic disease process. Aust Dent J. 2008 Sep; 53(3): 286-91.
Pasheley DH, Tay FR, Yiu C, Hashimoto M, Breshi L Carvallo RM, Ito, S. Collagen degradation by host-derived enzymes during aging J Dent Res 2004: 83(3): 216-21
Ferracane JL, Hilton TJ. Polymerization stress--is it clinically meaningful? Dent Mater. 2016 Jan; 32(1): 1-10.
Isolan CP, Sarkis-Onofre R, Lima GS, Moraes RR. Bonding to Sound and Caries-Affected Dentin: A Systematic Review and Meta-Analysis. J Adhes Dent. 2018; 20(1): 7-18.
Meraji N, Nekoofar MH, Yazdi KA, Sharifian MR, Fakhari N, Camilleri J. Bonding to caries affected dentine. Dent Mater. 2018 Sep; 34(9): e236-e245
Liu Y, Mai S, Li N, Yiu CK, Mao J, Pashley DH, Tay FR. Differences between top-down and bottom-up approaches in mineralizing thick, partially demineralized collagen scaffolds. Acta Biomater. 2011 Apr; 7(4): 1742-51.
Mazzoni A, Tjäderhane L, Checchi V, Di Lenarda R, Salo T, Tay FR, Pashley DH, Breschi L. Role of dentin MMPs in caries progression and bond stability. J Dent Res. 2015 Feb; 94(2): 241-51.
Madhubala MM, Nayantara GS, Jayasree R, Locs J, Mahalaxmi S. Biogenic amorphous calcium phosphate: a sustainable alternative for dentin remineralization. BMC Oral Health. 2025 Jul 11; 25(1): 1149.
Carvalho RM, Manso AP, Geraldeli S, Tay FR, Pashley DH. Durability of bonds and clinical success of adhesive restorations. Dental Materials. 2012; 28: 72-86.
Cao CY, Mei ML, Li QL, Lo EC, Chu CH. Methods for biomimetic remineralization of human dentine: a systematic review. Int J Mol Sci. 2015 Mar 2; 16(3): 4615-27.
Calatrava O Luis Alonso En el ámbito de la invasión mínima. Dentina afectada e infectada Acta Odont Venez 2013. 51(4):
Kumari RV, Siddaraju K, Nagraj H, Poluri RK. Evaluation of shear bond strength of newer bonding systems on superficial and deep dentin. J. Int. Oral. Health. 2015; 7: 31-35.
Niu LN, Zhang W, Pashley DH, Breschi L, Mao J, Chen JH, Tay FR. Biomimetic remineralization of dentin. Dent Mater. 2014 Jan; 30(1): 77-96.
Zhang Q, Guo J, Huang Z, Mai S. Promotion Effect of Carboxymethyl Chitosan on Dental Caries via Intrafibrillar Mineralization of Collagen and Dentin Remineralization. Materials (Basel). 2022 Jul 12; 15(14): 4835.
Yang Q, Zheng W, Zhao Y, Shi Y, Wang Y, Sun H, Xu X. Advancing dentin remineralization: Exploring amorphous calcium phosphate and its stabilizers in biomimetic approaches. Dent Mater. 2024 Aug; 40(8): 1282-1295.
Kuru E, Eronat N, Türkün M, Çogulu D. Comparison of remineralization ability of tricalcium silicate and of glass ionomer cement on residual dentin: an in vitro study. BMC Oral Health. 2024 Jun 26; 24(1): 732.
Schweikle M, Bjørnøy SH, van Helvoort ATJ, Haugen HJ, Sikorski P, Tiainen H. Stabilisation of amorphous calcium phosphate in polyethylene glycol hydrogels. Acta Biomater. 2019 May; 90: 132-145
Ye Q, Spencer P, Yuca E, Tamerler C. Engineered Peptide Repairs Defective Adhesive–Dentin Interface. Macromol. Mater. Eng. 2017; 302: 1600487.
Cloyd AK, Boone K, Ye Q, Snead ML, Spencer P, Tamerler C. Engineered Peptides Enable Biomimetic Route for Collagen Intrafibrillar Mineralization. Int J Mol Sci. 2023 Mar 28; 24(7):6355.
Lewis NV, Aggarwal S, Dhatavkar P. Comparative evaluation of the degree of conversion of an 8th-generation bonding agent when applied to normal dentin or caries-affected dentin, pre- treated with MMP inhibitors - An in vitro study. J Oral Biol Craniofac Res. 2024 Nov-Dec; 14(6): 808-814.
Pinna R, Maioli M, Eramo S, Mura I, Milia E. Carious affected dentine: its behaviour in adhesive bonding. Aust Dent J. 2015 Sep; 60(3): 276-93.
Lewis NV, Aggarwal S, Borse NN, Sonawane S, Dhatavkar P, Digholkar R, Agarwal D. The Effect of Matrix Metalloproteinase Inhibitors on the Microtensile Bond Strength of Dentin Bonding Agents in Caries Affected Dentin: A Systematic Review. J Int Soc Prev Community Dent. 2023 Jun 29; 13(3): 173-184.
Dai D, Li D, Zhang C. Unraveling Nanomaterials in Biomimetic Mineralization of Dental Hard Tissue: Focusing on Advantages, Mechanisms, and Prospects. Adv Sci (Weinh). 2024 Oct; 11(40): e2405763
Attik N, Richert R, Garoushi S. Biomechanics, Bioactive and Biomimetic philosophy in restorative dentistry ? Quo vadis? J Dent. 2024 Sep; 148: 105036.
Kiuru O, Sinervo J, Vähänikkilä H, Anttonen V, Tjäderhane L. MMP Inhibitors and Dentin Bonding: Systematic Review and Meta-Analysis. Int J Dent. 2021 May 27; 2021: 9949699.
Sarikaya R, Song L, Yuca E, Xie SX, Boone K, Misra A, Spencer P, Tamerler C. Bioinspired multifunctional adhesive system for next generation bio-additively designed dental restorations. J Mech Behav Biomed Mater. 2021 Jan; 113: 104135
Fu Y, Ekambaram M, Li KC, Zhang Y, Cooper PR, Mei ML. In Vitro Models Used in Cariology Mineralisation Research-A Review of the Literature. Dent J (Basel). 2024 Oct 8; 12(10): 323.
Scaffa P, Logan MG, Icimoto MY, Fugolin A, Tsuzuki FM, Lewis SH, Pfeifer CS. Mechanistic study of the stabilization of dentin-bonded restorative interfaces via collagen reinforcement by multi-acrylamides. Dent Mater. 2024 Aug; 40(8): 1128-1137.
Mobarak EH. Effect of chlorhexidine pretreatment on bond strength durability of cariesaffected dentin over 2-year aging in artificial saliva and under simulated intrapulpal pressure. Oper Dent. 2011 Nov-Dec; 36(6): 649-60.
Garcia, A; Lopez Jordi, M; Fabruccini, AY Liberman, J. Efecto del pretratamiento con clorhexidina en la resistencia de unión a dentina desmineralizada. Odontoestomatología. 2023; 25(42).
Almutairi B. Aloe-Emodin activated by Photodynamic therapy and diode laser on carious affected dentin and survival of S. mutans. An-invitro SEM assessment. Photodiagnosis Photodyn Ther. 2025 Jun; 53: 104611.
Jamal H, Yaghmoor R, Abed H, Young A, Ashley P. Impact of Dentine Pretreatment with Matrix Metalloproteinase Inhibitors on Bond Strength of Coronal Composite Restorations: A Systematic Review and Meta-analysis of In Vitro Studies. Eur J Dent. 2023 Oct; 17(4): 974-999.
Breschi L, Maravic T, Comba A, Cunha SR, Loguercio AD, Reis A, Hass V, Cadenaro M, Mancuso E, Mayer-Santos E, Niu L, Pashley DH, Tay FR, Mazzoni A. Chlorhexidine preserves the hybrid layer in vitro after 10-years aging. Dent Mater. 2020 May; 36(5): 672-680.
Matos AB, Trevelin LT, Silva BTFD, Francisconi-Dos-Rios LF, Siriani LK, Cardoso MV. Bonding efficiency and durability: current possibilities. Braz Oral Res. 2017 Aug 28; 31(suppl 1): e57.
Zheng P, Zaruba M, Attin T, Wiegand A. Effect of different matrix metalloproteinase inhibitors on microtensile bond strength of an etch-and-rinse and a self-etching adhesive to dentin. Oper Dent. 2015 Jan-Feb; 40(1): 80-6.
Atalay C, Ozgunaltay G, Yazici AR. Thirty-six-month clinical evaluation of different adhesive strategies of a universal adhesive. Clin Oral Investig. 2020 Apr; 24(4): 1569-1578.
Altintop H, Kuru HE, Ertugrul F, Türkün M, Küçükyilmaz E. A prospective randomized clinical trial and an in vitro evaluation of the microtensile bond strength of a chlorhexidine-containing dentin bonding agent and a bulk fill composite material in primary teeth. BMC Oral Health. 2025 Apr 13; 25(1): 566.
Breschi L, Maravic T, Mazzitelli C, Josic U, Mancuso E, Cadenaro M, Pfeifer CS, Mazzoni A. The evolution of adhesive dentistry: From etch-and-rinse to universal bonding systems. Dent Mater. 2025 Feb; 41(2): 141-158.
Batu Eken Z, Ilie N. A Critical Review on the Factors Affecting the Bond Strength of Direct Restorative Material Alternatives to Amalgam. Materials (Basel). 2024 Oct 1; 17(19): 4853.
Depósito Legal Electrónico: PPI 201202ME4105
ISSN Electrónico: 2244-8861
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