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O efeito dos materiais de silicato de cálcio na descoloração dentária: revisão integrativa
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A descoloração dentária é uma alteração cromática que pode comprometer a estética do sorriso e impactar negativamente na qualidade de vida dos pacientes. Diversos fatores podem contribuir para este fenómeno, incluindo a utilização de materiais odontológicos, como os cimentos à base de silicato de cálcio. Estes biomateriais, amplamente utilizados em procedimentos endodônticos e de recobrimento pulpar, destacam-se pelas suas propriedades biológicas favoráveis, como a biocompatibilidade, o potencial regenerativo e a atividade antibacteriana. No entanto, a sua aplicação clínica pode induzir descoloração dentária, sobretudo em dentes anteriores ou em zonas de elevada exigência estética. Esta revisão integrativa teve como objetivo avaliar, com base na literatura científica recente, o potencial de descoloração dentária causado por diferentes tipos de cimentos de silicato de cálcio, como o Mineral Trioxide Aggregate (MTA), o Biodentine e o TheraCal. A metodologia seguiu a estratégia PICO, tendo sido incluídos apenas estudos in vitro realizados em dentes humanos, que avaliaram alterações de cor utilizando espectrofotometria segundo os parâmetros CIE Lab*. Foram selecionados os estudos cuja metodologia englobava avaliação da aplicação coronária dos cimentos de silicato de cálcio, e de aplicação simultânea na zona coronária e radicular, sem objetivo de comparar cimentos que apenas serviam o propósito de obturação endodôntica. Dos 349 artigos inicialmente identificados, 11 foram selecionados para análise detalhada. Os resultados indicam que materiais como o ProRoot MTA (cinzento ou branco), que contêm óxido de bismuto como agente radiopacificante, são os principais responsáveis por descolorações clinicamente perceptíveis e progressivas ao longo do tempo. Em contraste, materiais como o Biodentine e o TheraCal PT, que substituem o óxido de bismuto por compostos como óxido de zircónio e fluoreto de itérbio, apresentaram maior estabilidade cromática, sobretudo na ausência de sangue. A presença de sangue durante os procedimentos mostrou-se um fator agravante para a discromia, independentemente do material utilizado. Além disso, o tempo de acompanhamento revelou-se relevante, uma vez que a descoloração tende a agravar-se ao longo do tempo. Conclui-se que, para além da eficácia clínica, a escolha do material a usar deve ter em conta o seu impacto estético. Os biomateriais mais recentes como o Biodentine e o TheraCal representam alternativas promissoras para minimizar a descoloração dentária, especialmente em contextos de elevada exigência estética.
Tooth discoloration is a chromatic change that can compromise the aesthetics of the smile and negatively impact the quality of life of patients. Several factors may contribute to this phenomenon, including the use of dental materials such as calcium silicate cements. These biomaterials, widely used in endodontic and pulp coating procedures, stand out for their favorable biological properties, such as biocompatibility, regenerative potential and antibacterial activity. However, its clinical application can induce tooth discoloration, especially in anterior teeth or areas of high aesthetic demand. This integrative review aimed to evaluate, based on recent scientific literature, the potential of tooth discoloration caused by different types of calcium silicate cements, such as Mineral Trioxide Aggregate (MTA), Biodentine and TheraCal. The methodology followed the PICO strategy, having been included only in vitro studies performed on human teeth, which evaluated color changes using spectrophotometry according to the parameters of CIE Lab*. Studies whose methodology included evaluation of the coronal application of calcium silicate cements and simultaneous application in the coronal and root zones were selected, without the aim of comparing cements that only served the purpose of endodontic obturation. From the 349 articles initially identified, 11 were selected for detailed analysis. The results indicate that materials such as ProRoot MTA (grey or white), which contain bismuth oxide as a radiopacifying agent, are mainly responsible for clinically noticeable and progressive discolorations over time. In contrast, materials such as Biodentine and TheraCal PT, which replace bismuth oxide with compounds such as zirconium oxide and ytterbium fluoride, showed greater chromatic stability, especially in the absence of blood. The presence of blood during the procedures was an aggravating factor for dyschromia, regardless of the material used. In addition, the follow-up time was relevant, since discoloration tends to worsen over time. It is concluded that, in addition to the clinical efficacy, the materials’ choice should take into account its aesthetic impact. More recent biomaterials such as Biodentine and TheraCal represent promising alternatives to minimize tooth discoloration, especially in contexts of high aesthetic demands.
Tooth discoloration is a chromatic change that can compromise the aesthetics of the smile and negatively impact the quality of life of patients. Several factors may contribute to this phenomenon, including the use of dental materials such as calcium silicate cements. These biomaterials, widely used in endodontic and pulp coating procedures, stand out for their favorable biological properties, such as biocompatibility, regenerative potential and antibacterial activity. However, its clinical application can induce tooth discoloration, especially in anterior teeth or areas of high aesthetic demand. This integrative review aimed to evaluate, based on recent scientific literature, the potential of tooth discoloration caused by different types of calcium silicate cements, such as Mineral Trioxide Aggregate (MTA), Biodentine and TheraCal. The methodology followed the PICO strategy, having been included only in vitro studies performed on human teeth, which evaluated color changes using spectrophotometry according to the parameters of CIE Lab*. Studies whose methodology included evaluation of the coronal application of calcium silicate cements and simultaneous application in the coronal and root zones were selected, without the aim of comparing cements that only served the purpose of endodontic obturation. From the 349 articles initially identified, 11 were selected for detailed analysis. The results indicate that materials such as ProRoot MTA (grey or white), which contain bismuth oxide as a radiopacifying agent, are mainly responsible for clinically noticeable and progressive discolorations over time. In contrast, materials such as Biodentine and TheraCal PT, which replace bismuth oxide with compounds such as zirconium oxide and ytterbium fluoride, showed greater chromatic stability, especially in the absence of blood. The presence of blood during the procedures was an aggravating factor for dyschromia, regardless of the material used. In addition, the follow-up time was relevant, since discoloration tends to worsen over time. It is concluded that, in addition to the clinical efficacy, the materials’ choice should take into account its aesthetic impact. More recent biomaterials such as Biodentine and TheraCal represent promising alternatives to minimize tooth discoloration, especially in contexts of high aesthetic demands.
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Palavras-chave
Cimentos de silicato de cálcio Descoloração dentária MTA Biodentine TheraCal Estética dentária Calcium silicate cements Tooth discoloration Dental aesthetics