Manejo del sustrato en dientes con amelogénesis imperfecta y fluorosis para carillas en disilicato: Revisión exploratoria

Abstract

Background. Dental enamel abnormalities have features such as changes of the shape, color and texture that affect the aesthetic and psychological aspects of patients. It can occur for different reasons, due to genetic factors such as amelogenesis imperfecta, or acquired factors such as intoxication due to fluoride intake known as dental fluorosis. One of the treatments for these pathologies is lithium disilicate veneers. These veneers require an adequate cementation technique, especially since the substrate is clearly affected. Substrate management protocols for cementation of lithium disilicate veneers in teeth affected by fluorosis or amelogenesis imperfecta have not currently been reported. Objective: To analyze the existing literature published in the last 20 years on the management of enamel in teeth with amelogenesis imperfecta and dental fluorosis for the cementation of Lithium Disilicate veneers. Methods. An exploratory review of articles was carried out in the PubMed and EBSCO databases in English and Spanish that responded to the stated objective. Results. There were 545 articles in the first phase, these were reviewed, and 169 duplicates were excluded. In the second phase, the 317 were excluded because they did not meet the selection criteria. For the third phase, 59 articles remained for full text analysis, of which 19 fulfilled the purpose of this study for qualitative analysis. Conclusions: Disilicate veneers are the ones with the best survival rates compared to other treatments. Microabrasión with aluminum oxide (50μm) prior to chemical preparation is recommended in fluorosis cases. Etching is mainly carried out with 37% phosphoric acid with times of 45 seconds for amelogenesis imperfect, and 30 seconds for fluorosis. The most widely used adhesive technique is the two-step technique for cementing lithium disilicate veneers in teeth with amelogenesis imperfecta or fluorosis. It is not recommended to use auto-etching for these cases.