Asociación del efecto ferrule con la tasa de éxito de las rehabilitaciones bucales en dientes estructuralmente comprometidos: una revisión sistemática
Resumen
Introducción: Los dientes estructuralmente comprometidos representan un desafío en odontología restauradora. El efecto ferrule, collar de dentina coronal sana =1.5-2mm sobre el margen gingival, es factor crítico en el pronóstico. Existe controversia sobre altura mínima y configuración óptima. Objetivo: Analizar la evidencia científica sobre la asociación entre efecto ferrule y tasas de éxito de rehabilitaciones en dientes estructuralmente comprometidos. Métodos: Revisión sistemática en bases de datos (PubMed, Science Direct, SciELO, Cochrane) 2005-2025. Se incluyeron estudios clínicos, ensayos controlados y cohortes evaluando influencia del ferrule en supervivencia de dientes tratados endodónticamente. Se excluyeron estudios in vitro, observacionales descriptivos y en animales. Resultados: Se incluyeron 23 estudios con 1,338 pacientes y 1,691 dientes, seguimiento promedio 6.4 años. Dientes con ferrule =2mm mostraron tasas superiores (91.4-97.8% a 5 años vs 53.2-59.8% sin ferrule). Se observó relación dosis-respuesta entre altura del ferrule y supervivencia. Ferrules circunferenciales completos superaron a parciales, aunque estos últimos fueron superiores a su ausencia. El efecto ferrule fue más determinante que tipo de poste o material coronario. Conclusiones: Ferrule adecuado (=2mm circunferencial) se relaciona directamente con mayores tasas de éxito a largo plazo. Incluso ferrules parciales ofrecen beneficios significativos. Las intervenciones para obtener ferrule adecuado deben considerarse prioritarias antes de optar por extracción.
Recibo: 28-04-25 / Aceptado: 15-05-25
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