Eficiência de retentores utilizados para restauração de dentes tratados endodonticamente e sua obtenção por meio do escaneamento intraoral. Uma revisão sistemática e de escopo

Abstract

Teeth that receive endodontic treatment most often exhibit extensive coronal destruction, whether due to endodontic access, trauma, carious processes, among others, making their reconstruction challenging and restoring their function in the stomatognathic system. The aim of this systematic and scoping review was to provide support to dental students and professionals regarding the decision to use intraradicular retainers in teeth with endodontic treatment (ETT), and in cases where their use is indicated, how new CAD/CAM systems and intraoral scanners (IOS) can provide better-fitted retainers for the root canal, ensuring greater retention and longevity for these elements. The use of intraradicular retainers was once seen as reinforcement for the remaining dental structure, but over time and with the publication of randomized clinical trials, it has been proven that they provide support and retention solely to the restorative material, rather than reinforcing the dental structure. On the contrary, they can be responsible for failures such as displacement, decementation, and even irreparable fractures resulting in the loss of the dental element. The decision not to use intraradicular retainers should be based on a careful clinical evaluation of the remaining coronal structure and the bonding area for the restorative material. The use of IOS for the fabrication of intraradicular retainers is not yet well-established, as the available devices vary greatly in scanning quality, scanning technique, ease of use, and the shape of the tip, among other factors. These characteristics can influence the accuracy of IOS and their ability to scan in the intraoral environment. The first in vitro study on root canal scanning was only conducted in 2019; before that, techniques combining laboratory scanners for mold scanning with the scanning of a fiber post inside the canal using IOS were used to produce milled core fillings that ensured better marginal adaptation and reduced the risk of decementation. Therefore, it can be concluded that IOS still have a long way to go in the scanning of root canals, which could offer better possibilities for the reconstruction of teeth with extensive destruction. Adhesive system technology is also constantly evolving, and when the choice is to rehabilitate teeth with endodontic treatment without using intraradicular retainers, these new restorative systems may provide increased fracture resistance for teeth with endodontic treatment and the potential to reduce irreparable or reparable failures.