Protocolos para la Fijación Adhesiva Predecible de Restauraciones Estéticas Indirectas. Consenso Facultad de Odontología Universidad de Buenos Aires.
DOI:
https://doi.org/10.62172/revfouba.n97.a304Palabras clave:
fijación, adhesión, tratamiento de superficies, consensoResumen
La incorporación de las técnicas adhesivas como standard of care al flujo de trabajo de la clínica odontológica ha modificado prácticamente todas las etapas del tratamiento dental, desde el diagnóstico hasta el mantenimiento de las restauraciones. En el caso de las restauraciones indirectas, la fijación adhesiva tiene como objetivo la integración del bloque restaurador con el remanente dentario y con los materiales que hayan sido necesarios para la conformación de la preparación. Los aspectos fundamentales para alcanzar el éxito clínico en restauraciones estéticas adheridas incluyen: la identificación de la magnitud de fijación requerida en el caso; el control del campo operatorio (incluido el vapor de agua del aire exhalado); la preparación del sustrato orientada para la máxima conservación de tejido dentario y la minimización de las tensiones de corte y flexión; la selección del medio de fijación o cemento (términos que serán considerados sinónimos) adecuado al espesor y transmitancia del material restaurador; el tratamiento de la superficie interna de la restauración y del sustrato dentario (y no dentario) para generar interacción mecánica y/o química con el cemento elegido, de acuerdo con el protocolo correspondiente; y el control de la oclusión. La diversidad de materiales disponibles, junto con la sensibilidad técnica del procedimiento, ha generado una considerable variabilidad en los protocolos clínicos de fijación. En este contexto, el presente consenso propone una sistematización de los pasos clínicos involucrados en la fijación adhesiva de restauraciones estéticas indirectas basada en la mejor evidencia científica disponible, con el objetivo de favorecer procedimientos más predecibles y reproducibles en la práctica odontológica.
Citas
Angkasith, P., Burgess, J. O., Bottino, M. C., y Lawson, N. C. (2016). Cleaning methods for zirconia following salivary contamination. Journal of Prosthodontics, 25(5), 375–379. https://doi.org/10.1111/jopr.12441
Arai, M., Takagaki, T., Takahashi, A., y Tagami, J. (2017). The role of functional phosphoric acid ester monomers in the surface treatment of yttria-stabilized tetragonal zirconia polycrystals. Dental Materials Journal, 36(2), 190–194. https://doi.org/10.4012/dmj.2016-060
Almiro, M., Marinho, B., Delgado, A. H. S., Rua, J., Monteiro, P., Santos, I. C., Proença, L., Mendes, J. J., y Gresnigt, M. M. M. (2022). Increasing acid concentration, time and using a two-part silane potentiates bond strength of lithium disilicate-reinforced glass ceramic to resin composite: an exploratory laboratory study. Materials (Basel, Switzerland), 15(6), 2045. https://doi.org/10.3390/ma15062045
Bora, P. V., Sayed Ahmed, A., Alford, A., Pitttman, K., Thomas, V., y Lawson, N. C. (2024). Characterization of materials used for 3D printing dental crowns and hybrid prostheses. Journal of Esthetic and Restorative Dentistry, 36(1), 220–230. https://doi.org/10.1111/jerd.13174
Breschi, L., Josic, U., Maravic, T., Mancuso, E., Del Bianco, F., Baldissara, P., Mazzoni, A., y Mazzitelli, C. (2023). Selective adhesive luting: A novel technique for improving adhesion achieved by universal resin cements. Journal of Esthetic and Restorative Dentistry, 35(7), 1030–1038. https://doi.org/10.1111/jerd.13037
Bresser, R. A., Gerdolle, D., van den Heijkant, I. A., Sluiter-Pouwels, L. M. A., Cune, M. S., y Gresnigt, M. M. M. (2019). Up to 12 years clinical evaluation of 197 partial indirect restorations with deep margin elevation in the posterior region. Journal of Dentistry, 91, 103227. https://doi.org/10.1016/j.jdent.2019.103227
Browet, S., y Gerdolle, D. (2017). Precision and security in restorative dentistry: the synergy of isolation and magnification. The International Journal of Esthetic Dentistry, 12(2), 172–185. https://www.quintessence-publishing.com/deu/en/article/852286
Da Rosa, L. S., Dapieve, K. S., Dalla-Nora, F., Rippe, M. P., Valandro, L. F., Sarkis-Onofre, R., y Pereira, G. K. R. (2022). Does adhesive luting reinforce the mechanical properties of dental ceramics used as restorative materials? A systematic review and meta-analysis. The Journal of Adhesive Dentistry, 24, 209–222. https://doi.org/10.3290/j.jad.b2916469
Da Silva, E. M., Poskus, L. T., y Guimarães, J. G. (2008). Influence of light-polymerization modes on the degree of conversion and mechanical properties of resin composites: a comparative analysis between a hybrid and a nanofilled composite. Operative Dentistry, 33(3), 287–293. https://doi.org/10.2341/07-81
Daher, R., Ardu, S., di Bella, E., Krejci, I., y Duc, O. (2024). Efficiency of 3D printed composite resin restorations compared with subtractive materials: Evaluation of fatigue behavior, cost, and time of production. The Journal of Prosthetic Dentistry, 131(5), 943–950. https://doi.org/10.1016/j.prosdent.2022.08.001
De Souza, G., Braga, R. R., Cesar, P. F., y Lopes, G. C. (2015). Correlation between clinical performance and degree of conversion of resin cements: a literature review. Journal of Applied Oral Science, 23(4), 358–368. https://doi.org/10.1590/1678-775720140524
Del Cisne Maldonado, K., Espinoza, J. A., Astudillo, D. A., Delgado, B. A., y Bravo, W. D. (2024). Resistance of CAD/CAM composite resin and ceramic occlusal veneers to fatigue and fracture in worn posterior teeth: a systematic review. Dental and Medical Problems, 61(3), 417–426. https://doi.org/10.17219/dmp/157347
Donmez, M. B., Okutan, Y., y Yucel, M. T. (2020). Effect of prolonged application of single-step self-etching primer and hydrofluoric acid on the surface roughness and shear bond strength of CAD/CAM materials. European Journal of Oral Sciences, 128(6), 542–549. https://doi.org/10.1111/eos.12747
Elkassas, D., y Arafa, A. (2016). Assessment of post-contamination treatments affecting different bonding stages to dentin. European Journal of Dentistry, 10(3), 327–332. https://doi.org/10.4103/1305-7456.184159
Falacho, R. I., Melo, E. A., Marques, J. A., Ramos, J. C., Guerra, F., y Blatz, M. B. (2023). Clinical in-situ evaluation of the effect of rubber dam isolation on bond strength to enamel. Journal of Esthetic and Restorative Dentistry, 35(1), 48–55. https://doi.org/10.1111/jerd.12979
García-Cuerva, M., Boaventura-Dubovik, A., y Iglesias, M. E. (2021). Transmittance of lithium disilicate ceramic of different thicknesses and opacities with different curing units. Transmitancia de cerámicas de disilicato de litio, de diferentes espesores y opacidades, con diferentes unidades de curado intrabucal. Acta Odontologica Latinoamericana : AOL, 34(2), 143–148. https://doi.org/10.54589/aol.34/2/143
Gerdolle, D., y Browet, S. (2019). Isolation et lésions cervicales. Stratégie et solutions cliniques [The secrets of isolation in the cervical area]. Swiss Dental Journal, 129(5), 371–379. https://doi.org/10.61872/sdj-2019-05-02
Guimaraes, I. R., Murillo Gómez, F., y De Goes, M. F. (2016). Effect of activation mode on flexural strength and elasticity modulus of dual cure resin cements. Odovtos - International Journal of Dental Sciences, 18(1), 61–71. https://doi.org/10.15517/ijds.v18i1.23556
Kelch, M., Stawarczyk, B., y Mayinger, F. (2022). Chemical and mechanical properties of dual-polymerizing core build-up materials. Clinical Oral Investigations, 26(7), 4885–4896. https://doi.org/10.1007/s00784-022-04455-4
Lawson, N. C., Jurado, C. A., Huang, C. T., Morris, G. P., Burgess, J. O., Liu, P. R., Kinderknecht, K. E., Lin, C. P., y Givan, D. A. (2019). Effect of surface treatment and cement on fracture load of traditional zirconia (3Y), translucent zirconia (5Y), and lithium disilicate crowns. Journal of Prosthodontics, 28(6), 659–665. https://doi.org/10.1111/jopr.13088
Lyann, S. K., Takagaki, T., Nikaido, T., Wada, T., Uo, M., Ikeda, M., Sadr, A., y Tagami, J. (2019). Efficacy of various surface treatments on the bonding performance of saliva-contaminated lithium-disilicate ceramics. The Journal of Adhesive Dentistry, 21(1), 51–58. https://doi.org/10.3290/j.jad.a41918
Mandurino, M., Cortili, S., Coccoluto, L., Greco, K., Cantatore, G., Gherlone, E. F., Vichi, A., y Paolone, G. (2025). Mechanical properties of 3D printed vs. subtractively manufactured composite resins for permanent restorations: a systematic review. Materials (Basel, Switzerland), 18(5), 985. https://doi.org/10.3390/ma18050985
Marchesi, G., Camurri Piloni, A., Nicolin, V., Turco, G., y Di Lenarda, R. (2021). Chairside CAD/CAM materials: current trends of clinical uses. Biology, 10(11), 1170. https://doi.org/10.3390/biology10111170
Marcondes, R. L., Lima, V. P., Barbon, F. J., Isolan, C. P., Carvalho, M. A., Salvador, M. V., Lima, A. F., y Moraes, R. R. (2020). Viscosity and thermal kinetics of 10 preheated restorative resin composites and effect of ultrasound energy on film thickness. Dental Materials, 36(10), 1356–1364. https://doi.org/10.1016/j.dental.2020.08.004
Mendes, L. C., Matos, I. C., Miranda, M. S., y Benzi, M. R. (2010). Dual-curing, self-adhesive resin cement: influence of the polymerization modes on the degree of conversion and microhardness. Materials Research, 13(2), 171–176. https://doi.org/10.1590/S1516-14392010000200009
Mokhtar, M. M., Farahat, D. S., Eldars, W., y Osman, M. F. (2022). Physico-mechanical properties and bacterial adhesion of resin composite CAD/CAM blocks: an in-vitro study. Journal of Clinical and Experimental Dentistry, 14(5), e413–e419. https://doi.org/10.4317/jced.59548
Moreira, P. M., Carvalho, G. L. M., de Castro Albuquerque, R., y André, C. B. (2024). Effect of hydrofluoric acid and self-etch ceramic primers on the flexural strength and fatigue resistance of glass ceramics: a systematic review and meta-analysis of in vitro studies. The Japanese Dental Science Review, 60, 198–210. https://doi.org/10.1016/j.jdsr.2024.06.001
Oliveros Astudillo, D. V., Tartacovsky, H., Agüero Romero, A., González Zannotto, C.A., y Iglesias, M. E. (2023). Efecto de la descontaminación del disilicato de litio en la resistencia adhesiva [resumen]. En Libro de la LVI Reunión Científica Anual. Sociedad Argentina de Investigaciónn Odontológica, del 9 al 11 de noviembre, Córdoba, Argentina. https://saio.org.ar/wp-content/uploads/2023/12/LibroRRAASAIO2023_v1.pdf
Omidi, B. R., Heidari, S., y Izadpanah, A. (2025). Bond strength of flowable dental composites in the cementation of indirect restorations: a systematic review and meta-analysis. Evidence-Based Dentistry, 26(4), 178–179. https://doi.org/10.1038/s41432-025-01187-8
Pameijer C. H. (2012). A review of luting agents. International Journal of Dentistry, 2012, 752861. https://doi.org/10.1155/2012/752861
Piguillem Brizuela, F. J., Capusotto, A. O., Abate, P. F., Cattaneo, S. P., Lombardo, N. P., Martucci, D. G., Picca, M., Garrofé, A. B., Rodríguez, P. A., Somoza, F., Rodríguez, A. N., González Zanotto, C. A., García Cuerva, J. M., y Alvarez Castro, M. (2024). Manejo de los sistemas adhesivos poliméricos en esmalte y dentina: consenso de la Facultad de Odontología de la Universidad de Buenos Aires. Revista de la Facultad de Odontología. Universidad de Buenos Aires, 39(93), 31–45. https://doi.org/10.62172/revfouba.n93.a233
Prasad, A. L., Cumberbatch, M., y Mohammadnezhad, M. (2018). Experience and practicality of rubber dam use among undergraduate dental students in Fiji. Journal of Oral Hygiene & Health, 6(2), 239. https://doi.org/10.4172/2332-0702.1000239
Pucci, C. R., Mafetano, A. P. V. P., Borges, A. L. S., de Andrade, G. S., Dal Piva, A. M. O., Kleverlaan, C. J., y Tribst, J. P. M. (2023). Substrate Rigidity Effect on CAD/CAM Restorations at Different Thicknesses. European Journal of Dentistry, 17(4), 1020–1028. https://doi.org/10.1055/s-0042-1757910
Ramos, R. Q., Mercelis, B., Ahmed, M. H., Peumans, M., Lopes, G. C., y Van Meerbeek, B. (2024). Bonding of composite cements containing 10-MDP to zirconia ceramics without dedicated ceramic primer. The Journal of Adhesive Dentistry, 26, 135–145. https://doi.org/10.3290/j.jad.b5362103
Riesgo, B. V. P., Rodrigues, C. da S., Nascimento, L. P., y May, L. G. (2023). Effect of hydrofluoric acid concentration and etching time on the adhesive and mechanical behavior of glass-ceramics: A systematic review and meta-analysis. International Journal of Adhesion and Adhesives, 121, 103303. https://doi.org/10.1016/j.ijadhadh.2022.103303
Rosa, R. S., Balbinot, C. E., Blando, E., Mota, E. G., Oshima, H. M., Hirakata, L., Pires, L. A., y Hübler, R. (2012). Evaluation of mechanical properties on three nanofilled composites. Stomatologija, 14(4), 126–130. http://sbdmj.lsmuni.lt/124/124-05.pdf
Sahin, Z., Ozer, N. E., Yιkιcι, C., y Kιlιçarslan, M. A. (2023). Mechanical characteristics of composite resins produced by additive and subtractive manufacturing. The European Journal of Prosthodontics and Restorative Dentistry, 31(3), 278–285. https://doi.org/10.1922/EJPRD_2478Sahin08
Santos, M., Fidalgo-Pereira, R., Torres, O., Carvalho, O., Henriques, B., Özcan, M., y Souza, J. C. M. (2024). The impact of inorganic fillers, organic content, and polymerization mode on the degree of conversion of monomers in resin-matrix cements for restorative dentistry: a scoping review. Clinical Oral Investigations, 28(8), 454. https://doi.org/10.1007/s00784-024-05829-6
Schlichting, L. H., Resende, T. H., Reis, K. R., Raybolt Dos Santos, A., Correa, I. C., y Magne, P. (2022). Ultrathin CAD-CAM glass-ceramic and composite resin occlusal veneers for the treatment of severe dental erosion: An up to 3-year randomized clinical trial. The Journal of Prosthetic Dentistry, 128(2), 158.e1–158.e12. https://doi.org/10.1016/j.prosdent.2022.02.009
Sharma, A., Shetty, P. P., Ali, A., Bhardwaj, M., Dubey, D., y Chhabra, S. (2021). Comparative evaluation of the compressive, tensile, and flexural strengths of paracore®, flourocore®2+, and multicore® resin-based core build-up materials - An in vitro study. Journal of Conservative Dentistry : JCD, 24(6), 576–579. https://pmc.ncbi.nlm.nih.gov/articles/PMC9089769/
Silva, N. R. D., Araújo, G. M., Vila-Nova, T. E. L., Bezerra, M. G. P. G., Calderon, P. D. S., Özcan, M., y Souza, R. O. A. E. (2022). Which zirconia surface-cleaning strategy improves adhesion of resin composite cement after saliva contamination? A systematic review and meta-analysis. The Journal of Adhesive Dentistry, 24, 175–186. https://doi.org/10.3290/j.jad.b2916437
Spinhayer, L., Bui, A. T. B., Leprince, J. G., y Hardy, C. M. F. (2020). Core build-up resin composites: an in-vitro comparative study. Biomaterial Investigations in Dentistry, 7(1), 159–166. https://doi.org/10.1080/26415275.2020.1838283
Sulaiman T. A. (2020). Materials in digital dentistry-A review. Journal of Esthetic and Restorative Dentistry, 32(2), 171–181. https://doi.org/10.1111/jerd.12566
Sulaiman, T. A., Altak, A., Abdulmajeed, A., Rodgers, B., y Lawson, N. (2022). Cleaning zirconia surface prior to bonding: a comparative study of different methods and solutions. Journal of Prosthodontics, 31(3), 239–244. https://doi.org/10.1111/jopr.13389
Teyagirwa, P. F., Aquin, C., Kharouf, N., Roman, T., Senger, B., Reitzer, F., y Etienne, O. (2023). Operator versus material influence on film thickness using adhesive resin cement or pre-heated resin composite. Journal of Esthetic and Restorative Dentistry, 35(3), 517–524. https://doi.org/10.1111/jerd.12988
Vaithiyalingam, A., Mathew, M., Jayakumar, S., Arumugam, K., Ponnusamy, P., y Narasimman, T. (2023). Evaluation of compressive and flexural strengths of two resin-based core materials with an alkasite material: an in vitro study. The Journal of Contemporary Dental Practice, 24(6), 385–389. https://doi.org/10.5005/jp-journals-10024-3520
Veríssimo, A. H., Moura, D. M. D., Tribst, J. P. M., Araújo, A. M. M., Leite, F. P. P., y Souza, R. O. A. E. (2019). Effect of hydrofluoric acid concentration and etching time on resin-bond strength to different glass ceramics. Brazilian Oral Research, 33, e041. https://doi.org/10.1590/1807-3107bor-2019.vol33.0041
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