Estudio colorimétrico de las tinciones ocasionadas por las técnicas de revascularización pulpar y su tratamiento
- Autores: Juan Luis Jiménez Padilla
- Directores de la Tesis: Santiago González López (dir. tes.), Valentín Viqueira Pérez (dir. tes.)
- Lectura: En la Universitat d'Alacant / Universidad de Alicante ( España ) en 2019
- Idioma: español
- Tribunal Calificador de la Tesis: Manuel Bravo Pérez (presid.), Esther Perales Romero (secret.), María Victoria Bolaños Carmona (voc.)
- Programa de doctorado: Programa de Doctorado en Física Aplicada a las Ciencias y las Tecnologías por la Universidad de Alicante
- Materias:
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- Resumen
INTRODUCCION:
Hoy en día, la estética dental se ha convertido en un área de gran repercusión, debido a la importancia que los individuos atribuyen a su sonrisa. Por eso, realizar tratamientos que causen el mínimo impacto sobre la estética del paciente es esencial para dar por exitoso un tratamiento odontológico.
La endodoncia regenerativa es uno de los desarrollos más interesantes en la odontología actual constituyendo una nueva frontera en la especialidad de la endodoncia. Mediante ella, se pretende reponer tejidos perdidos aplicando principios de ingeniería tisular, siendo la “revascularización pulpar” la técnica más usada. Ésta, que se realiza en piezas dentales que han sufrido necrosis y aún no han completado su formación, consiste en revascularizar el conducto con sangre procedente de la papila dental apical para que las células madre recolonicen el conducto, regeneren la pulpa y, con ello, completen la maduración de la raíz.
El principal problema recae en que ciertos materiales usados durante esta técnica pueden generar tinción en el diente. Por un lado, están los preparados antibióticos inyectados dentro del conducto para controlar la infección y, por otro, los cementos utilizados como barrera cervical que permanecen en contacto con la dentina y la sangre.
Atendiendo a estas dos situaciones, el principal objetivo de la presente investigación es evaluar la capacidad de tinción, sobre dientes anteriores, que tiene, por un lado, el preparado de pasta triantibiótica (TAP) más utilizado para esta técnica (compuesto principalmente de Ciprofloxacino, Metronidazol y Minociclina) y, por otro lado, el Biodentine (un cemento a base de silicato de calcio de reciente aparición) utilizado como barrera cervical en contacto con sangre. Como objetivo secundario se propuso la aplicación de un agente blanqueador con el fin de evaluar el efecto de recuperación del color según la procedencia de la tinción.
DESARROLLO TEORICO:
Para realizar los experimentos, se utilizaron treinta dientes intactos de origen humano a los cuales se les cortaron los ápices y se les ensanchó el conducto, para reproducir dientes inmaduros con ápice abierto. Tras realizar la preparación, éstos se dividieron en 3 grupos, de diez especímenes cada uno y se conservaron hasta el inicio de los ensayos en cámara de humedad 100% y 37ºC, para simular el entorno bucal.
Los experimentos se dividieron en dos fases: la primera de ellas comprendió la etapa en la que los especímenes recibieron tratamientos de revascularización pulpar, y la segunda, la etapa en la que los especímenes recibían blanqueamientos dentales.
Durante la fase l al grupo 1 se le inoculó sangre de origen humano, como grupo control, por un total de 3 semanas, durante las cuales se tomaron registros colorimétricos en la semana 1, 2 y 3. Al grupo 2 se le aplicó TAP durante 3 semanas para después removerla e inocular sangre hasta completar los 3 meses. En este grupo se tomaron registros colorimétricos en la semana 2, 3, 4, 6, 8 y 12. Al grupo 3 se le inoculó sangre y se realizó un sellado cervical con Biodentine durante 3 meses, durante los cuales se tomaron registros colorimétricos en la semana 2, 4, 8 y 12.
En la fase 2 se realizaron tres sesiones de blanqueamiento a los grupos 2 y 3, por un total de 3 semanas, durante las cuales se tomaron registros colorimétricos en la semana 1, 2 y 3.
Para las mediciones de color se utilizó un Telespectroradiómetro Konica Minolta (CS-2000) y los especímenes fueron colocados en una cabina de luz Verivide CAC 150 bajo luz fluorescente simuladora de luz diurna D65. El dispositivo registró los valores de reflectancia espectral de cada uno y, tras realizar la división entre el estímulo espectral correspondiente a la muestra por el estímulo espectral del blanco patrón, los datos se analizaron en CIE-L*a*b* y CIEDE2000.
Los resultados mostraron variación de color perceptible (∆E*> 3,7) durante la primera fase en todos los grupos, siendo el grupo 2 el que más tinción mostró (∆E* 26,12), seguido del grupo 1 (∆E* 15,49) y por último el grupo 3, con un valor dos veces menor que el alcanzado en el grupo 3 (∆E* 13,48). El atributo que más influyó al cambio de color fue el cambio de claridad (∆L* ) y después el del croma (∆Cab*), siendo la variación tonal (∆H*) prácticamente constante durante todo el proceso.
Durante la segunda fase, los grupos 2 y 3 lograron recuperar gran parte del color perdido (∆E* 8,31 y 7,26 respectivamente), siendo ligeramente mejores los resultados del grupo 3. Hay que reseñar que el grupo 2, partiendo con cierta desventaja frente al grupo 3 ya que al finalizar el tratamiento sus especímenes estaban más teñidos, consiguió reducir de forma considerable su tinción y acercarse a cifras parecidas a las del grupo 3. Con todo, algunos especímenes del grupo 2 conservaban un halo de tinción en la zona del tercio incisal más gingival.
CONCLUSIÓN:
De estos resultados se puede concluir que el uso de TAP produce tinción en la dentina, y que el empleo de Biodentine como material sellador, aunque en menor medida, no impide que exista tinción. Por otro lado, el uso de agentes blanqueadores a base de peróxido de hidrógeno al 50%, hidróxido amónico al 0,4% y perborato de sodio monohidratado al 15% puede ayudar a devolver gran parte del color perdido en revascularización pulpar, pero no su totalidad.
Por consiguiente, se requieren más estudios que investiguen sobre otras formas de controlar la infección sin que generen tinción en la dentina, al igual que otros donde se comprueben nuevos CSC para poder usar en revascularización pulpar y que sean estables en presencia de sangre.
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