Consideraciones clínicas para el análisis estructural en la restauración de dientes posteriores. Revisión
Resumen
Introducción: La rehabilitación de dientes posteriores estructuralmente comprometidos demanda una planificación y un análisis exhaustivo de la estructura dental remanente. Actualmente existen numerosas técnicas restauradoras, pero no se ha logrado un consenso sobre las directrices clínicas para la toma de decisiones terapéuticas. Por lo tanto, este artículo persigue identificar las consideraciones clínicas involucradas en el análisis estructural para la restauración de dientes posteriores con base a la literatura especializada disponible. Materiales y métodos: Se realizó una búsqueda electrónica de estudios en inglés y español en Science Direct, Medline y Google Académico. Se incluyeron 40 artículos publicados en un rango comprendido entre el 2020 y 2026. Resultados: se identificaron las siguientes consideraciones clínicas: cantidad de tejido sano remanente, relación entre la profundidad de la cavidad central y grosor de las paredes vestibulares y linguales/palatinas, presencia de crestas marginales, dentina interaxial, ausencia de cúspides, vitalidad del diente, efecto ferrule, profundidad de los márgenes, presencia de cracks, extensión de fracturas de coronales a la raíz, presencia de lesiones cervicales y viabilidad de aislamiento absoluto. Conclusiones: La evaluación de estos factores contribuyen en la toma de decisiones por parte del clínico. Las restauraciones de dientes estructuralmente comprometidos deben trascender la idea de la merareconstrucción deestos y se deben integrar criterios funcionales, biomecánicos y estéticos que favorezcan la estabilidad y conservación del diente a largo plazo
RECIBO:05-05-25
ACEPTADO: 26-04-26
Palabras clave
Texto completo:
PDFReferencias
Singh H, Kaur M, Dhillon J, Mann J, Kumar A. Evolution of restorative dentistry from past to present. Indian Journal of Dental Sciences. 2017;9(1):38–43. doi:10.4103/0976-4003.201634
Asaad YM, Alhudaithi MK, Alazraqi MS, Almugren SS, Alhumizi NA, Albesher FA, et al. The impact of occlusal forces on the longevity of restorations. Int J Community Med Public Health. 2023;10(10):3899–903. doi:10.18203/2394-6040.ijcmph20233129
Moussa C, Savard G, Rochefort G, Renaud M, Denis F, Daou MH. Fracture Resistance of Direct versus Indirect Restorations on Posterior Teeth: A Systematic Review and Meta-Analysis. Bioengineering [Internet]. Multidisciplinary Digital Publishing Institute (MDPI); 2024. Disponible en: https://pubmed.ncbi.nlm.nih.gov/38927772/ doi:10.3390/bioengineering11060536
Fichera G, Mazzitelli C, Picciariello V, Maravic T, Josic U, Mazzoni A, et al. Structurally compromised teeth. Part I: Clinical considerations and novel classification proposal. Journal of Esthetic and Restorative Dentistry. 2024;36(1):7–19. doi:10.1111/jerd.13117 PubMed PMID: 37615505.
Moghaddam AS, Radafshar G, Taramsari M, Darabi F. Long-term survival rate of teeth receiving multidisciplinary endodontic, periodontal and prosthodontic treatments. J Oral Rehabil. 2014;41(3):236–42. doi:10.1111/joor.12136 PubMed PMID: 24483819.
Cardoso JA, Almeida P, Negrão R, Oliveira JV, Venuti P, Taveira T, et al. Clinical guidelines for posterior restorations based on Coverage, Adhesion, Resistance, Esthetics, and Subgingival management. The CARES concept: Part I- partial adhesive restorations. The International Journal of Esthetic Dentistry | [Internet]. 2023;18(3). Disponible en: https://pubmed.ncbi.nlm.nih.gov/37462378/
d’Incau E, Zunzarren R. Evolution des formes de préparation pour inlays/onlayspostérieurs à la mandibule. RéalitésCliniques [Internet]. 2014;25(4):1–10. Disponible en: https://www.researchgate.net/publication/277141743
Jansen van Vuuren L, Broadbent JM, Duncan WJ, Waddell JN. Maximum voluntary bite force, occlusal contact points and associated stresses on posterior teeth. J R Soc N Z. el 2 de enero de 2020;50(1):132–43. doi:10.1080/03036758.2019.1691612
Rocha C. ModernOperative Dentistry [Internet]. Torres CRG, editor. Cham: Springer International Publishing; 2020. (Textbooks in Contemporary Dentistry). Disponible en: http://link.springer.com/10.1007/978-3-030-31772-0 doi:10.1007/978-3-030-31772-0
Ferraris F. Posterior indirect adhesive restorations (PIAR): preparation designs and adhesthetics clinical protocol. Int J Esthet Dent. 2017;12(4):482–502. PubMed PMID: 28983533.
Ammannato R, Ferraris F, Marchesi G. The “index technique” in worn dentition: a new and conservative approach. Int J Esthet Dent. 2015;10(1):68–99. PubMed PMID: 25625128.
Iglesia M. Restauraciones de recubrimiento parcial indirectas adheridas en sectores posteriores: indicaciones actuales. Clinica MAIP [Internet]. 2020;22:20–38. Disponible en: https://clinicamaip.com/wp-content/uploads/2020/09/2020-Iglesia-Puig-MA-Rev-Int-Protesis-Indicaciones-incrustaciones_compressed.pdf
Kotb S, Shaker A, Halim C. Fatigue resistance and 3D finite element analysis of machine-milled ceramic occlusal veneers with new preparation designs versus conventional design: an in vitro study. F1000Res. 2019;8:1–16. doi:10.12688/f1000research.19712.1
Eachempati P, Lambourn G, Harris A, Mccoll E. Top tips for treatment planning: tooth-by-tooth prognosis-Part 1: restorative prognosis. Br Dent J [Internet]. 2024;236(10):738–41. Disponible en: https://www.nature.com/articles/s41415-024-7472-y
Veneziani M. Posterior indirect adhesive restorations: updated indications and the Morphology Driven Preparation Technique. The International Journal of Esthetic Dentisry [Internet]. 2017;12:1–27. Disponible en: https://www.researchgate.net/publication/317022052
Cardoso JA, Venuti P, Almeida PJ, Costa R, Lapa HC, Afonso L. Clinical guidelines for posterior restorations based on Coverage, Adhesion, Resistance, Esthetics, and Subgingival management. The CAREs concept: Part II -full-contour resistive crowns with vertical preparation. Int J Esthet Dent [Internet]. 2023;18(4). Disponible en: https://pubmed.ncbi.nlm.nih.gov/37819563/
Sayed M, Jurado C, Tsujimoto A. Factors Affecting Clinical Decision-Making and Treatment Planning Strategies for Tooth Retention or Extraction: An Exploratory Review. Niger J Clin Pract. 2020;23(12):1629–38. doi:10.4103/njcp.njcp_649_19 PubMed PMID: 33355813.
Parirokh M, Zarifian A, Ghoddusi J. Choice of treatment plan based on root canal therapy versus extraction and implant placement: A mini-review. IranEndod J. 2015;10(3):152–5. doi:https://doi.org/10.7508/iej.2015.03.001
Dioguardi M, Alovisi M, Troiano G, Caponio C, Baldi A, Rocca GT, et al. Clinical outcome of bonded partial indirect posterior restorations on vital and non-vital teeth: a systematic review and meta-analysis. Clin Oral Investig. 2021;25:6597–621. doi:10.1007/s00784-021-04187-x PubMed PMID: 34628547.
Bhuva B, Giovarruscio M, Rahim N, Bitter K, Mannocci F. The restoration of root filled teeth: a review of the clinical literature. Int Endod J. 2021;54(4):509–35. doi:10.1111/iej.13438 PubMed PMID: 33128279.
Soliman M, Alshamrani L, Yahya B, Alajlan G, Aldegheishem A, Eldwakhly E. Monolithic Endocrown Vs. Hybrid Intraradicular Post/Core/Crown Restorations for Endodontically Treated Teeth; Cross-sectional Study. Saudi J Biol Sci. 2021;28(11):6523–31. doi:10.1016/j.sjbs.2021.07.020
Peumans M, Politano G, Meerbeek B Van. Effective protocol for daily high-quality direct posterior composite restorations. Cavity preparation and design [Internet]. Vol. 22. 2020;22(6):581–96. doi:10.3290/j.jad.a45515
Valizadeh S, Ranjbar Omrani L, Deliperi S, Sadeghi Mahounak F. Restoration of a Nonvital Tooth with Fiber Reinforce Composite (Wallpapering Technique). Case Rep Dent. 2020;2020:1–6. doi:10.1155/2020/9619787
Ardila C. Reducción del ciclo restaurador en dientes con perdida estructural: preparaciones mínimamente invasivas basadas en la naturaleza del diente (revisión de la literatura). Universidad CES [Internet]. 2024. Disponible en: https://repository.ces.edu.co/items/d88994e8-ab21-4748-b770-9eb82b42acca
Babaei B, Cella S, Farrar P, Prentice L, Prusty BG. The influence of dental restoration depth, internal cavity angle, and material properties on biomechanical resistance of a treated molar tooth. J Mech Behav Biomed Mater. 2022;133:105305. doi:10.1016/j.jmbbm.2022.105305 PubMed PMID: 35700676.
Abdelfattah RA, Nawar NN, Kataia EM, Saber SM. How loss of tooth structure impacts the biomechanical behavior of a single-rooted maxillary premolar: FEA. Odontology. 2024;112(1):279–86. doi:10.1007/s10266-023-00829-6 PubMed PMID: 37394683.
Shahmoradi M, Wan B, Zhang Z, Swain M, Li Q. Mechanical failure of posterior teeth due to caries and occlusal wear- A modelling study. J Mech Behav Biomed Mater. 2022;125:104942. doi:10.1016/J.JMBBM.2021.104942 PubMed PMID: 34800891.
Zotti F, Ferrari F, Paganelli C, Pilati F, Lanzaretti G, Arlacchi D, et al. Increasing the fracture strength of MOD restorations with Ribbond fibers. J Clin Exp Dent. 2024;16(6):707–13. doi:10.4317/jced.61608
Zotti F, Hu J, Zangani A, Albanese M, Paganelli C. Fracture strength and ribbond fibers: In vitro analysis of mod restorations. J Clin Exp Dent. 2023;15(4):318–23. doi:10.4317/jced.60334
Morimoto S, Lia WKC, Gonçalves F, Nagase DY, Gimenez T, Raggio DP, et al. Risk factors associated with cusp fractures in posterior permanent teeth—a cross-sectional study. Applied Sciences. el 1 de octubre de 2021;11(19). doi:10.3390/app11199299
Morimoto S, Lia WKC, Gonçalves F, Nagase DY, Gimenez T, Raggio DP, et al. Risk Factors Associated with Cusp Fractures in Posterior Permanent Teeth—A Cross-Sectional Study. Applied Sciences. 2021;11(19):9299. doi:10.3390/app11199299
Aksoy Yüksek M, Kedici Alp C, Sari C, Bala O. Influence of cusp reduction and fiber reinforcement on cusp deflection and fracture strength of restored endodontically treated molar teeth. Clin Oral Investig. 2025;29(4):1–11. doi:10.1007/s00784-025-06297-2
Koosha S, Jebelizadeh MS, Mostafavi AS. Effect of Ferrule Location on Fracture Resistance of Maxillary Premolars: An In Vitro Study. Int J Dent. 2023;1–7. doi:https://doi.org/10.1155/2023/9513804
Tribst JPM, Dal Piva AM de O, de Jager N, Bottino MA, de Kok P, Kleverlaan CJ. Full-Crown Versus Endocrown Approach: A 3D-Analysis of Both Restorations and the Effect of Ferrule and Restoration Material. Journal of Prosthodontics. 2021;30(4):335–44. doi:10.1111/jopr.13244 PubMed PMID: 32856743.
Caussin E, Izart M, Ceinos R, Attal JP, Beres F, François P. Advanced Material Strategy for Restoring Damaged Endodontically Treated Teeth: A Comprehensive Review. Materials. Multidisciplinary Digital Publishing Institute (MDPI); 2024. doi:10.3390/ma17153736
Eggmann F, Ayub JM, Conejo J, Blatz MB. Deep margin elevation—Present status and future directions. Journal of Esthetic and Restorative Dentistry. 2023;35(1):26–47. doi:10.1111/jerd.13008
Taylor A, Burns L. Deep margin elevation in restorative dentistry: A scoping review. J Dent. 2024;146:105066. doi:10.1016/j.jdent.2024.105066 PubMed PMID: 38740249.
Aldakheel M, Aldosary K, Alnafissah S, Alaamer R, Alqahtani A, Almuhtab N. Deep Margin Elevation: Current Concepts and Clinical Considerations: A Review. Medicina (B Aires). 2022;58:1482. doi:10.3390/medicina58101482 PubMed PMID: 36295642.
Samartzi TK, Papalexopoulos D, Ntovas P, Rahiotis C, Blatz MB. Deep Margin Elevation: A Literature Review. Dent J (Basel). 2022;10(48):1–17. doi:10.3390/dj10030048
Bhanderi S. Facts About Cracks in Teeth. Prim Dent J. 2021;10(1):20–7. doi:10.1177/2050168420980987 PubMed PMID: 33722131.
Liao WC, Chen CH, Pan YH, Chang MC, Jeng JH. Vertical Root Fracture in Non-Endodontically and Endodontically Treated Teeth: Current Understanding and Future Challenge. J Pers Med. 2021;11(12):1–20. doi:10.3390/jpm11121375
Kim JH, Eo SH, Shrestha R, Ihm JJ, Seo DG. Association between longitudinal tooth fractures and visual detection methods in diagnosis. J Dent. 2020;101:1–5. doi:10.1016/j.jdent.2020.103466 PubMed PMID: 32882335.
PradeepKumar A, Shemesh H, Nivedhitha M, Jubair M, Arockiam S, Uma T, et al. Diagnosis of Vertical Root Fractures by Cone-beam Computed Tomography in Root-filled Teeth with Confirmation by Direct Visualization: A Systematic Review and Meta-Analysis. J Endod. 2021;47(8):1198–214. doi:10.17605/OSF.IO/7JKE2
Patano A, Malcangi G, De Santis M, Morolla R, Settanni V, Piras F, et al. Conservative Treatment of Dental Non-Carious Cervical Lesions: A Scoping Review. Biomedicines. 2023;11(6):1530. doi:10.3390/biomedicines11061530
de Oliveira A, Bresciani E, Borges A, Pereira D, Maia L, Ferraz T. Do Tooth- and Cavity-related Aspects of Noncarious Cervical Lesions Affect the Retention of Resin Composite Restorations in Adults? A Systematic Review and Meta-analysis. Oper Dent. 2020;45(3):124–40. doi:10.2341/19-091-L PubMed PMID: 32053461.
Du JK, Wu JH, Chen PH, Ho PS, Chen KK. Influence of cavity depth and restoration of non-carious cervical root lesions on strain distribution from various loading sites. BMC Oral Health. 2020;20(1):1–10. doi:10.1186/s12903-020-01083-w PubMed PMID: 32264864.
Özcan M, Volpato CAM, D’Altoé LF. Adhesion to Intraradicular and Coronal Dentine. Endodontic Materials in Clinical Practice. 2021;(1):289–303. doi:10.1002/9781119513568.ch9
Falacho R, Melo EA, Marques J, Ramos JC, Guerra F, Blatz M. Clinical in-situ evaluation of the effect of rubber dam isolation on bond strength to enamel. Journal of Esthetic and Restorative Dentistry. 2023;35(1):48–55. doi:10.1111/jerd.12979 PubMed PMID: 36325593.
Miao C, Yang X, Wong MC, Zou J, Zhou X, Li C, et al. Rubber dam isolation for restorative treatment in dental patients. Cochrane Database of Systematic Reviews. 2021;2021(5):1–42. doi:10.1002/14651858.CD009858.pub3 PubMed PMID: 33998662.
Fichera G, Mazzitelli C, Picciariello V, Maravic T, Josic U, Mazzoni A, et al. Structurally compromised teeth. Part II: A novel approach to peripheral build up procedures. Journal of Esthetic and Restorative Dentistry. 2024;36(1):20–31. doi:10.1111/jerd.13118 PubMed PMID: 37565412.
Kostadinov K, Gerova-Vatsova T, Yotsova R. Rubber dam isolation for deep subgingival defects—practical guidelines. ScriptaScientificaMedicinaeDentalis [Internet]. 2025;1(1):1–9. Disponible en: https://journals.mu-varna.bg/index.php/ssmd/article/view/10020
Todos los documentos publicados en esta revista se distribuyen bajo una
Licencia Creative Commons Atribución -No Comercial- Compartir Igual 4.0 Internacional.
Por lo que el envío, procesamiento y publicación de artículos en la revista es totalmente gratuito.