ELEVAÇÃO DE MARGEM GENGIVAL E RESTAURAÇÃO INDIRETA EM RESINA COMPOSTA FRESADA EM DENTE COM MARGEM SUBGENGIVAL: RELATO DE CASO
##plugins.themes.bootstrap3.article.sidebar##
Publicado:
Out 29, 2024
Palavras-chave:
Resina composta, CAD-CAM, adaptação marginal dentária, onlay dental, biomimética
##plugins.themes.bootstrap3.article.main##
Resumo
A Odontologia atual almeja ser conservadora, preservando o tecido dental. O uso de restaurações diretas e parciais indiretas em resina composta, associado aos protocolos biomiméticos, são exemplos de procedimentos minimamente invasivos. Dentes com cavidades extensas e términos marginais subgengivais são desafios para a prática clínica, e na busca por protocolos mais conservadores, a elevação de margem gengival (DME) pode ser indicada. O objetivo deste trabalho é demonstrar, através de um caso clínico, a importância da DME associada à restauração indireta fresada em resina composta, utilizando o sistema CAD-CAM, em um dente com margem localizada além da junção cemento esmalte (JCE). O presente relato de caso descreveu o tratamento restaurador do segundo pré-molar superior esquerdo, que inicialmente apresentava cárie extensa sob uma restauração em resina composta nas faces oclusal e mesial; e, após sua remoção, teve a margem cervical da face mesial alocada subgengivalmente. A opção de tratamento foi a DME em resina composta, seguida do tratamento endodôntico, selamento da entrada dos condutos, núcleo de preenchimento de resina composta, e restauração final tipo onlay, também em resina composta, produzida através do sistema de design e fabricação assistida digitalmente (CAD-CAM). O tratamento proposto demonstrou que a DME possibilita a perfeita adaptação da restauração diretamente ao dente, eliminando a necessidade de aumento de coroa clínica (ACC). Assim, viabilizou-se um tratamento efetivo, rápido, de menor comorbidade e custo financeiro reduzido ao paciente. Após quatro meses, a avaliação clínica e radiográfica da restauração evidenciou boa adaptação marginal, estética agradável, bom polimento e saúde gengival, sem sinal inflamatório.
##plugins.themes.bootstrap3.article.details##
Como Citar
Griebeler Carvalho Drebel, D. T., & Pizzini Montenegro, S. (2024). ELEVAÇÃO DE MARGEM GENGIVAL E RESTAURAÇÃO INDIRETA EM RESINA COMPOSTA FRESADA EM DENTE COM MARGEM SUBGENGIVAL: RELATO DE CASO. Revista Naval De Odontologia, 51(2), 33-42. https://doi.org/10.69909/1983-7550-dme-4
Seção
Relatos de caso
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Referências
1. Singer L, Fouda A, Bourauel C. Biomimetic approaches and materials in restorative and regenerative dentistry: review article. BMC Oral Health. 16 de fevereiro de 2023;23(1):105.
2. Suksawat N, Angwaravong O, Angwarawong T. Fracture resistance and fracture modes in endodontically treated maxillary premolars restored using different CAD-CAM onlays. J Prosthodont Res. 8 de abril de 2024;68(2):290–8.
3. Langoni A; Almeida G, Mota I, Dietrich L, Nascimento F, Viana H. Deep Margin Elevation: a restorative possibility to be considered. Research, Society and Development, [S. l.], v. 9, n. 11, p. e3799119863, 2020.
4. Aldakheel, M.; Aldosary, K.; Alnafissah, S.; Alaamer, R.; Alqahtani, A.; Almuhtab, N. Deep Margin Elevation: Current Concepts and Clinical Considerations: A Review. Medicina 2022, 58, 1482. https://doi.org/10.3390/medicina58101482.
5. Mugri, M.H.; Sayed, M.E.; Nedumgottil, B.M.; Bhandi, S.; Raj,A.T.; Testarelli, L.; Khurshid, Z.; Jain, S.; Patil, S. Treatment Prognosis of Restored Teeth with Crown Lengthening vs. Deep Margin Elevation: A Systematic Review. Materials 2021, 14, 6733. https:// doi.org/10.3390/ma14216733.
6. Samartzi, T.K.; Papalexopoulos, D.; Ntovas, P.; Rahiotis, C.; Blatz, M.B. Deep Margin Elevation: A Literature Review. Dent. J. 2022, 10, 48. https://doi.org/10.3390/dj10030048.
7. Felemban MF, Khattak O, Alsharari T, Alzahrani AH, Ganji KK, Iqbal A. Relationship between Deep Marginal Elevation and Periodontal Parameters: A Systematic Review. Medicina (Kaunas). 3 de novembro de 2023;59(11):1948.
8. El-Ma’aita AM, Radwan H, Al-Rabab’ah MA. Deep Margin Elevation - A Retrospective Clinical Study. J Adhes Dent. 15 de janeiro de 2024;26(1):117–24.
9. Dietschi D, Spreafico R. Current clinical concepts for adhesive cementation of tooth-colored posterior restorations. Pract Periodontics Aesthet Dent. 1998 Jan-Feb;10(1):47-54; quiz 56. PMID: 9582662.
10. Muscholl C, Zamorska N, Schoilew K, Sekundo C, Meller C, Büsch C, et al. Retrospective Clinical Evaluation of Subgingival Composite Resin Restorations with Deep-Margin Elevation. J Adhes Dent. 19 de agosto de 2022;24(1):335–44.
11. Bresser RA, Gerdolle D, van den Heijkant IA, Sluiter-Pouwels LMA, Cune MS, Gresnigt MMM. Up to 12 years clinical evaluation of 197 partial indirect restorations with deep margin elevation in the posterior region. J Dent. dezembro de 2019;91:103227.
12. Sarfati A, Tirlet G. Deep margin elevation versus crown lengthening: biologic width revisited. Int J Esthet Dent. 2018;13(3):334–56.
13. Forster A, Braunitzer G, Tóth M, Szabó BP, Fráter M. In Vitro Fracture Resistance of Adhesively Restored Molar Teeth with Different MOD Cavity Dimensions. J Prosthodont. janeiro de 2019;28(1):e325–31.
14. Ismail HS, Ali AI, Mehesen RE, Juloski J, Garcia-Godoy F, Mahmoud SH. Deep proximal margin rebuilding with direct esthetic restorations: a systematic review of marginal adaptation and bond strength. Restor Dent Endod. 2022 Mar 4;47(2):e15. doi: 10.5395/rde.2022.47.e15. PMID: 35692223; PMCID: PMC9160765.
15. Sinjari B, Santilli M, D’Addazio G, Rexhepi I, Gigante A, Caputi S, et al. Influence of Dentine Pre-Treatment by Sandblasting with Aluminum Oxide in Adhesive Restorations. An In Vitro Study. Materials (Basel). 7 de julho de 2020;13(13):3026.
16. Magne P. Immediate dentin sealing: a fundamental procedure for indirect bonded restorations. J Esthet Restor Dent. 2005;17(3):144–54; discussion 155.
17. Magne P, Kim TH, Cascione D, Donovan TE. Immediate dentin sealing improves bond strength of indirect restorations. Journal of Prosthetic Dentistry. 1o de dezembro de 2005;94(6):511–9.
18. de Carvalho MA, Lazari-Carvalho PC, Polonial IF, de Souza JB, Magne P. Significance of immediate dentin sealing and flowable resin coating reinforcement for unfilled/lightly filled adhesive systems. Journal of Esthetic and Restorative Dentistry. 2021;33(1):88–98.
19. Magne P, So WS, Cascione D. Immediate dentin sealing supports delayed restoration placement. J Prosthet Dent. setembro de 2007;98(3):166–74.
20. Murata T, Maseki T, Nara Y. Effect of immediate dentin sealing applications on bonding of CAD/CAM ceramic onlay restoration. Dent Mater J. 30 de novembro de 2018;37(6):928–39.
21. Bresser RA, Carvalho MA, Naves LZ, Melma H, Cune MS, Gresnigt MMM. Biomechanical behavior of molars restored with direct and indirect restorations in combination with deep margin elevation. J Mech Behav Biomed Mater. 2024 Apr;152:106459. doi: 10.1016/j.jmbbm.2024.106459. Epub 2024 Feb 12. PMID: 38394767.
22. Ferraris F. Posterior indirect adhesive restorations (PIAR): preparation designs and adhesthetics clinical protocol. Int J Esthet Dent. 2017;12(4):482–502.
23. Veneziani M. Adhesive restorations in the posterior area with subgingival cervical margins: new classification and differentiated treatment approach. Eur J Esthet Dent. 2010;5(1):50–76.
24. Ghezzi C, Brambilla G, Conti A, Dosoli R, Ceroni F, Ferrantino L. Cervical margin relocation: case series and new classification system.
25. 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.
26. Milicich G, Rainey JT. Clinical presentations of stress distribution in teeth and the significance in operative dentistry. Pract Periodontics Aesthet Dent. setembro de 2000;12(7):695–700; quiz 702.
27. Urabe I, Nakajima S, Sano H, Tagami J. Physical properties of the dentin-enamel junction region. Am J Dent. junho de 2000;13(3):129–35.
28. Milicich G. The compression dome concept: the restorative implications. Gen Dent. 2017;65(5):55–60.
29. Macêdo B, Sousa V, Verde G, Martins I, Lima L. Influência de substâncias irrigadoras endodônticas na microdureza da dentina radicular - revisão integrativa. OCC. 2021;20(2). Disponível em: https://www.cro-pe.org.br/site/adm_syscomm/publicacao/foto/9eab4908c2ee625e1311b7a941b65edc.pdf
30. Saber SEDM, El-Askary FS. The Outcome of Immediate or Delayed Application of a Single-Step Self-Etch Adhesive to Coronal Dentin Following the Application of Different Endodontic Irrigants. Eur J Dent. abril de 2009;3(2):83–9.
31. Moghaddas MJ, Moosavi H, Ghavamnasiri M. Microleakage Evaluation of Adhesive Systems Following Pulp Chamber Irrigation with Sodium Hypochlorite. J Dent Res Dent Clin Dent Prospects. 2014;8(1):21–6.
32. Haralur SB, Alqahtani MM, Alqahtani RA, Shabab RM, Hummadi KA. Effect of Dentin-Disinfection Chemicals on Shear Bond Strength and Microhardness of Resin-Infiltrated Human Dentin in Different Adhesive Protocols. Medicina. setembro de 2022;58(9):1244.
33. Bresser RA, van de Geer L, Gerdolle D, Schepke U, Cune MS, Gresnigt MMM. Influence of Deep Margin Elevation and preparation design on the fracture strength of indirectly restored molars. J Mech Behav Biomed Mater. 2020 Oct;110:103950. doi: 10.1016/j.jmbbm.2020.103950. Epub 2020 Jul 6. PMID: 32957242.
34. Ozer F, Batu Eken Z, Hao J, Tuloglu N, Blatz MB. Effect of Immediate Dentin Sealing on the Bonding Performance of Indirect Restorations: A Systematic Review. Biomimetics (Basel). 17 de março de 2024;9(3):182.
35. Spreafico R, Marchesi G, Turco G, Frassetto A, Di Lenarda R, Mazzoni A, et al. Evaluation of the In Vitro Effects of Cervical Marginal Relocation Using Composite Resins on the Marginal Quality of CAD/CAM Crowns. J Adhes Dent. 2016;18(4):355–62.
36. Souza J, Fuentes MV, Baena E, Ceballos L. One-year clinical performance of lithium disilicate versus resin composite CAD/CAM onlays. Odontology. 1o de janeiro de 2021;109(1):259–70.
37. Elmoselhy HAS, Hassanien OES, Haridy MF, Salam El Baz MAE, Saber S. Two‑year clinical performance of indirect restorations fabricated from CAD/CAM nano hybrid composite versus lithium disilicate in mutilated vital teeth. A randomized controlled trial. BMC Oral Health. 17 de janeiro de 2024;24(1):101.
2. Suksawat N, Angwaravong O, Angwarawong T. Fracture resistance and fracture modes in endodontically treated maxillary premolars restored using different CAD-CAM onlays. J Prosthodont Res. 8 de abril de 2024;68(2):290–8.
3. Langoni A; Almeida G, Mota I, Dietrich L, Nascimento F, Viana H. Deep Margin Elevation: a restorative possibility to be considered. Research, Society and Development, [S. l.], v. 9, n. 11, p. e3799119863, 2020.
4. Aldakheel, M.; Aldosary, K.; Alnafissah, S.; Alaamer, R.; Alqahtani, A.; Almuhtab, N. Deep Margin Elevation: Current Concepts and Clinical Considerations: A Review. Medicina 2022, 58, 1482. https://doi.org/10.3390/medicina58101482.
5. Mugri, M.H.; Sayed, M.E.; Nedumgottil, B.M.; Bhandi, S.; Raj,A.T.; Testarelli, L.; Khurshid, Z.; Jain, S.; Patil, S. Treatment Prognosis of Restored Teeth with Crown Lengthening vs. Deep Margin Elevation: A Systematic Review. Materials 2021, 14, 6733. https:// doi.org/10.3390/ma14216733.
6. Samartzi, T.K.; Papalexopoulos, D.; Ntovas, P.; Rahiotis, C.; Blatz, M.B. Deep Margin Elevation: A Literature Review. Dent. J. 2022, 10, 48. https://doi.org/10.3390/dj10030048.
7. Felemban MF, Khattak O, Alsharari T, Alzahrani AH, Ganji KK, Iqbal A. Relationship between Deep Marginal Elevation and Periodontal Parameters: A Systematic Review. Medicina (Kaunas). 3 de novembro de 2023;59(11):1948.
8. El-Ma’aita AM, Radwan H, Al-Rabab’ah MA. Deep Margin Elevation - A Retrospective Clinical Study. J Adhes Dent. 15 de janeiro de 2024;26(1):117–24.
9. Dietschi D, Spreafico R. Current clinical concepts for adhesive cementation of tooth-colored posterior restorations. Pract Periodontics Aesthet Dent. 1998 Jan-Feb;10(1):47-54; quiz 56. PMID: 9582662.
10. Muscholl C, Zamorska N, Schoilew K, Sekundo C, Meller C, Büsch C, et al. Retrospective Clinical Evaluation of Subgingival Composite Resin Restorations with Deep-Margin Elevation. J Adhes Dent. 19 de agosto de 2022;24(1):335–44.
11. Bresser RA, Gerdolle D, van den Heijkant IA, Sluiter-Pouwels LMA, Cune MS, Gresnigt MMM. Up to 12 years clinical evaluation of 197 partial indirect restorations with deep margin elevation in the posterior region. J Dent. dezembro de 2019;91:103227.
12. Sarfati A, Tirlet G. Deep margin elevation versus crown lengthening: biologic width revisited. Int J Esthet Dent. 2018;13(3):334–56.
13. Forster A, Braunitzer G, Tóth M, Szabó BP, Fráter M. In Vitro Fracture Resistance of Adhesively Restored Molar Teeth with Different MOD Cavity Dimensions. J Prosthodont. janeiro de 2019;28(1):e325–31.
14. Ismail HS, Ali AI, Mehesen RE, Juloski J, Garcia-Godoy F, Mahmoud SH. Deep proximal margin rebuilding with direct esthetic restorations: a systematic review of marginal adaptation and bond strength. Restor Dent Endod. 2022 Mar 4;47(2):e15. doi: 10.5395/rde.2022.47.e15. PMID: 35692223; PMCID: PMC9160765.
15. Sinjari B, Santilli M, D’Addazio G, Rexhepi I, Gigante A, Caputi S, et al. Influence of Dentine Pre-Treatment by Sandblasting with Aluminum Oxide in Adhesive Restorations. An In Vitro Study. Materials (Basel). 7 de julho de 2020;13(13):3026.
16. Magne P. Immediate dentin sealing: a fundamental procedure for indirect bonded restorations. J Esthet Restor Dent. 2005;17(3):144–54; discussion 155.
17. Magne P, Kim TH, Cascione D, Donovan TE. Immediate dentin sealing improves bond strength of indirect restorations. Journal of Prosthetic Dentistry. 1o de dezembro de 2005;94(6):511–9.
18. de Carvalho MA, Lazari-Carvalho PC, Polonial IF, de Souza JB, Magne P. Significance of immediate dentin sealing and flowable resin coating reinforcement for unfilled/lightly filled adhesive systems. Journal of Esthetic and Restorative Dentistry. 2021;33(1):88–98.
19. Magne P, So WS, Cascione D. Immediate dentin sealing supports delayed restoration placement. J Prosthet Dent. setembro de 2007;98(3):166–74.
20. Murata T, Maseki T, Nara Y. Effect of immediate dentin sealing applications on bonding of CAD/CAM ceramic onlay restoration. Dent Mater J. 30 de novembro de 2018;37(6):928–39.
21. Bresser RA, Carvalho MA, Naves LZ, Melma H, Cune MS, Gresnigt MMM. Biomechanical behavior of molars restored with direct and indirect restorations in combination with deep margin elevation. J Mech Behav Biomed Mater. 2024 Apr;152:106459. doi: 10.1016/j.jmbbm.2024.106459. Epub 2024 Feb 12. PMID: 38394767.
22. Ferraris F. Posterior indirect adhesive restorations (PIAR): preparation designs and adhesthetics clinical protocol. Int J Esthet Dent. 2017;12(4):482–502.
23. Veneziani M. Adhesive restorations in the posterior area with subgingival cervical margins: new classification and differentiated treatment approach. Eur J Esthet Dent. 2010;5(1):50–76.
24. Ghezzi C, Brambilla G, Conti A, Dosoli R, Ceroni F, Ferrantino L. Cervical margin relocation: case series and new classification system.
25. 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.
26. Milicich G, Rainey JT. Clinical presentations of stress distribution in teeth and the significance in operative dentistry. Pract Periodontics Aesthet Dent. setembro de 2000;12(7):695–700; quiz 702.
27. Urabe I, Nakajima S, Sano H, Tagami J. Physical properties of the dentin-enamel junction region. Am J Dent. junho de 2000;13(3):129–35.
28. Milicich G. The compression dome concept: the restorative implications. Gen Dent. 2017;65(5):55–60.
29. Macêdo B, Sousa V, Verde G, Martins I, Lima L. Influência de substâncias irrigadoras endodônticas na microdureza da dentina radicular - revisão integrativa. OCC. 2021;20(2). Disponível em: https://www.cro-pe.org.br/site/adm_syscomm/publicacao/foto/9eab4908c2ee625e1311b7a941b65edc.pdf
30. Saber SEDM, El-Askary FS. The Outcome of Immediate or Delayed Application of a Single-Step Self-Etch Adhesive to Coronal Dentin Following the Application of Different Endodontic Irrigants. Eur J Dent. abril de 2009;3(2):83–9.
31. Moghaddas MJ, Moosavi H, Ghavamnasiri M. Microleakage Evaluation of Adhesive Systems Following Pulp Chamber Irrigation with Sodium Hypochlorite. J Dent Res Dent Clin Dent Prospects. 2014;8(1):21–6.
32. Haralur SB, Alqahtani MM, Alqahtani RA, Shabab RM, Hummadi KA. Effect of Dentin-Disinfection Chemicals on Shear Bond Strength and Microhardness of Resin-Infiltrated Human Dentin in Different Adhesive Protocols. Medicina. setembro de 2022;58(9):1244.
33. Bresser RA, van de Geer L, Gerdolle D, Schepke U, Cune MS, Gresnigt MMM. Influence of Deep Margin Elevation and preparation design on the fracture strength of indirectly restored molars. J Mech Behav Biomed Mater. 2020 Oct;110:103950. doi: 10.1016/j.jmbbm.2020.103950. Epub 2020 Jul 6. PMID: 32957242.
34. Ozer F, Batu Eken Z, Hao J, Tuloglu N, Blatz MB. Effect of Immediate Dentin Sealing on the Bonding Performance of Indirect Restorations: A Systematic Review. Biomimetics (Basel). 17 de março de 2024;9(3):182.
35. Spreafico R, Marchesi G, Turco G, Frassetto A, Di Lenarda R, Mazzoni A, et al. Evaluation of the In Vitro Effects of Cervical Marginal Relocation Using Composite Resins on the Marginal Quality of CAD/CAM Crowns. J Adhes Dent. 2016;18(4):355–62.
36. Souza J, Fuentes MV, Baena E, Ceballos L. One-year clinical performance of lithium disilicate versus resin composite CAD/CAM onlays. Odontology. 1o de janeiro de 2021;109(1):259–70.
37. Elmoselhy HAS, Hassanien OES, Haridy MF, Salam El Baz MAE, Saber S. Two‑year clinical performance of indirect restorations fabricated from CAD/CAM nano hybrid composite versus lithium disilicate in mutilated vital teeth. A randomized controlled trial. BMC Oral Health. 17 de janeiro de 2024;24(1):101.