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Avaliação clínica das microinfiltrações das restaurações em compósito, uma revisão sistemática
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| Projeto de pós-graduação_40886 | 2.08 MB | Adobe PDF |
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Resumo(s)
A microinfiltração marginal nas restaurações em compósito constitui um desafio relevante em medicina dentária, dado o seu papel na etiologia de cáries secundárias, sensibilidade pósoperatória e falhas restauradoras. A inexistência de um método clínico universalmente aceite para a sua deteção reforça a necessidade de uma análise sistemática das abordagens disponíveis. O presente estudo teve como objetivo identificar e comparar os métodos de avaliação clínica da microinfiltração em restaurações de compósito. Foi realizada uma revisão sistemática, registada no PROSPERO (CRD420251012767), baseada em pesquisas nas bases PubMed, Science Direct, Google Scholar e Cochrane, abrangendo publicações entre 2000 e 2024. Foram incluídos 23 estudos clínicos randomizados e observacionais, totalizando 1.826 pacientes e 6.019 restaurações iniciais, das quais 4.816 foram efetivamente avaliadas após follow-ups médios de 75,7 ± 74,6 meses (mínimo 6; máximo 254). A média ponderada de idades dos participantes foi de 43 anos. Os métodos de avaliação mais frequentemente utilizados foram os critérios FDI e USPHS (sonda exploradora), a observação direta/fotográfica e a tomografia de coerência ótica (SS-OCT). A meta-regressão demonstrou que métodos subjetivos, como observação direta e fotografias, apresentaram odds ratios mais elevados de sucesso clínico em relação ao critério FDI, sugerindo risco de sobrestimação. Em contrapartida, o SS-OCT apresentou maior sensibilidade na deteção de falhas marginais, embora com uso limitado. Variáveis metodológicas, como número de avaliadores (p = 0,0076), diferença entre amostra inicial e número de restaurações avaliadas (p = 0,0013), tempo de follow-up (p = 0,0148) e utilização de coloração marginal (p = 0,0045), influenciaram significativamente os resultados. A heterogeneidade global foi elevada (I² > 85% na maioria dos métodos), refletindo ausência de padronização e diferenças substanciais entre estudos. O risco de viés foi considerado moderado em 19 trabalhos, alto em 3 e baixo em apenas 1, em grande parte devido à falta de calibração entre avaliadores e operadores. Conclui-se que, apesar da utilização generalizada de métodos subjetivos, estes carecem de fiabilidade, sendo recomendável a integração de técnicas mais objetivas como o SS-OCT. Os resultados reforçam a necessidade de padronização metodológica, treino prévio de avaliadores e desenvolvimento de novos protocolos clínicos que assegurem maior sensibilidade, reprodutibilidade e aplicabilidade prática na deteção de microinfiltrações em restaurações de compósito.
Marginal microleakage in composite restorations remains a significant concern in dentistry, as it contributes to secondary caries, postoperative sensitivity, and restoration failure. The lack of a universally accepted clinical detection method underscores the need for a systematic evaluation of available approaches. This study aimed to identify and compare clinical methods for assessing microleakage in composite restorations. A systematic review, registered in PROSPERO (CRD420251012767), was conducted by searching PubMed, Science Direct, Google Scholar, and Cochrane databases for publications between 2000 and 2024. A total of 23 randomized clinical trials and observational studies were included, encompassing 1,826 patients and 6,019 initial restorations. Of these, 4,816 restorations were effectively evaluated after a mean follow-up period of 75.7 ± 74.6 months (range: 6–254 months). The weighted mean age of participants was 43 years. The most frequently used evaluation methods were the FDI and USPHS criteria (using an explorer probe), direct or photographic observation, and swept-source optical coherence tomography (SS-OCT). Meta-regression indicated that subjective methods, such as direct and photographic observation, showed higher odds ratios for clinical success compared to the FDI criterion, suggesting a potential risk of overestimation. In contrast, SS-OCT demonstrated greater sensitivity in detecting marginal defects, though it was applied less frequently. Methodological variables such as the number of evaluators (p = 0.0076), discrepancy between initial and evaluated samples (p = 0.0013), follow-up duration (p = 0.0148), and the use of marginal staining (p = 0.0045)—significantly influenced the outcomes. Overall heterogeneity was high (I² > 85% for most methods), reflecting a lack of standardization and considerable variation across studies. Risk of bias was moderate in 19 studies, high in 3, and low in only 1, primarily due to insufficient calibration among evaluators and operators. In conclusion, while subjective methods are widely used, they lack reliability. The integration of more objective techniques such as SS-OCT is recommended. These findings emphasize the urgent need for methodological standardization, structured evaluator training, and the development of new clinical protocols to improve sensitivity, reproducibility, and practical applicability in detecting microleakage in composite restorations.
Marginal microleakage in composite restorations remains a significant concern in dentistry, as it contributes to secondary caries, postoperative sensitivity, and restoration failure. The lack of a universally accepted clinical detection method underscores the need for a systematic evaluation of available approaches. This study aimed to identify and compare clinical methods for assessing microleakage in composite restorations. A systematic review, registered in PROSPERO (CRD420251012767), was conducted by searching PubMed, Science Direct, Google Scholar, and Cochrane databases for publications between 2000 and 2024. A total of 23 randomized clinical trials and observational studies were included, encompassing 1,826 patients and 6,019 initial restorations. Of these, 4,816 restorations were effectively evaluated after a mean follow-up period of 75.7 ± 74.6 months (range: 6–254 months). The weighted mean age of participants was 43 years. The most frequently used evaluation methods were the FDI and USPHS criteria (using an explorer probe), direct or photographic observation, and swept-source optical coherence tomography (SS-OCT). Meta-regression indicated that subjective methods, such as direct and photographic observation, showed higher odds ratios for clinical success compared to the FDI criterion, suggesting a potential risk of overestimation. In contrast, SS-OCT demonstrated greater sensitivity in detecting marginal defects, though it was applied less frequently. Methodological variables such as the number of evaluators (p = 0.0076), discrepancy between initial and evaluated samples (p = 0.0013), follow-up duration (p = 0.0148), and the use of marginal staining (p = 0.0045)—significantly influenced the outcomes. Overall heterogeneity was high (I² > 85% for most methods), reflecting a lack of standardization and considerable variation across studies. Risk of bias was moderate in 19 studies, high in 3, and low in only 1, primarily due to insufficient calibration among evaluators and operators. In conclusion, while subjective methods are widely used, they lack reliability. The integration of more objective techniques such as SS-OCT is recommended. These findings emphasize the urgent need for methodological standardization, structured evaluator training, and the development of new clinical protocols to improve sensitivity, reproducibility, and practical applicability in detecting microleakage in composite restorations.
Descrição
Palavras-chave
Microinfiltração marginal Controlo Restauração dentária Resina composta Avaliação clínica Cárie secundária Marginal microleakage Control Dental restoration Composite resin Clinical evaluation Secondary caires