RESUMO
This study evaluated the shaping ability of XP-endo Shaper and Mtwo systems in long-oval-shaped canals of extracted human mandibular molars using micro-computed tomography (micro-CT). Images recorded before and after preparation were evaluated for morphometric measures regarding increase in canal volume, dentin removed, surface area, untouched walls and structure model index (SMI). Data were statistically analysed using the Mann-Whitney test with 5% of significance. On both groups, the root canal preparation significantly increased all analysed parameters (P > 0.05). There was no statistical difference between XP-endo Shaper and Mtwo systems in the increase of the canal volume (30.50%-27.82%), in volume of dentin removed (2.77%-2.40%), in the increase of the canal surface area (11.30%-8.86%), in canal untouched surfaces (9.57%-8.51%) and in the SMI (2.59%-2.68%), respectively. XP-endo Shaper and Mtwo systems showed similar shaping efficiency and were not able to completely prepare the walls of long-oval-shaped canals of extracted human mandibular molars.
Assuntos
Cavidade Pulpar , Preparo de Canal Radicular , Cavidade Pulpar/diagnóstico por imagem , Humanos , Dente Molar/diagnóstico por imagem , Microtomografia por Raio-XRESUMO
RESUMEN: Introducción: El éxito del tratamiento endodóntico requiere de la desinfección completa del sistema de canales radiculares. Convencionalmente este procedimiento se realiza a través de maniobras de instrumentación rotatoria o manual e irrigación química. Dentro de las diferentes técnicas de instrumentación, la de tipo rotatoria ha surgido como una alternativa a la instrumentación manual, cuyos beneficios en comparación a ésta aún deben ser dilucidados. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos cinco revisiones sistemáticas que en conjunto incluyeron 15 estudios primarios, de los cuales, 10 corresponden a ensayos aleatorizados. Concluimos que el uso de instrumentación rotatoria en comparación a instrumentación manual probablemente disminuye la incidencia del dolor postoperatorio. Además, la instrumentación rotatoria podría disminuir el uso de analgésicos post tratamiento endodóntico. Sin embargo, podría resultar en poca o nula diferencia en la intensidad del dolor, pero la certeza de la evidencia es baja. Además, no es posible establecer con claridad si el uso de instrumentación rotatoria en comparación a la instrumentación manual aumenta la reparación apical debido a que la certeza de la evidencia existente ha sido evaluada como muy baja.
ABSTRACT: Introduction: Successful root canal therapy (endodontic treatment) requires complete disinfection of the root canal system. Traditionally, disinfection of the root canal system involves rotary or manual instrumentation and chemical irrigation. Various rotary instrumentation techniques have emerged as an alternative to manual instrumentation, but its benefits against manual techniques need to be clarified. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified five systematic reviews that together included 15 primary studies, of which 10 correspond to randomized trials. We conclude that the use of rotary instrumentation compared to manual instrumentation probably reduces the incidence of pain. Also, rotatory instrumentation may reduce the use of postoperative analgesics. However, it could result in little or no difference in pain intensity, but the certainty of the evidence is low. Furthermore, it is not possible to clearly establish whether the use of rotary instrumentation increases apical repair as the certainty of the evidence has been assessed as very low.
Assuntos
Humanos , Endodontia/instrumentação , Endodontia/métodos , Tratamento do Canal Radicular/instrumentação , Tratamento do Canal Radicular/métodos , Instrumentos OdontológicosRESUMO
O objetivo deste trabalho foi avaliar o resultado do preparo biomecânico da instrumentação endodôntica em protótipos de dentes decíduos intactos com sistemas mecanizados através de microtomografia computadorizada. Foram utilizados 50 protótipos de um incisivo central superior decíduo produzido através de impressão 3D. Os sistemas de limas empregados foram o manual (MN), WaveOne Gold (WOG), XP Endo Shaper (XPS), XP Endo Finisher (XPF) e XP Clean (XPC). Cada grupo contou com 10 dentes e foram instrumentados de acordo com as recomendações dos fabricantes. O escaneamento dos protótipos pelo micro-CT foi realizado antes e após a instrumentação e as reconstruções foram padronizadas para cada conjunto de imagens. O teste de Shapiro-Wilk foi utilizado para verificar a normalidade dos dados. O ANOVA seguido do teste de Tukey foi utilizado para comparar as médias de volume final do canal, formação de debris, volume de dentina removida e área não instrumentada das paredes do canal. O teste T de Student foi usado para comparar os volumes inicial e final do canal entre cada grupo de instrumentação. A presença de trincas e/ou perfurações ao longo do canal foi registrada e realizada uma descrição qualitativa da sua presença. Todos os grupos apresentaram uma diferença significativa no volume do canal após a instrumentação. O maior aumento de volume do canal foi com as limas manuais, que teve uma diferença estatística significativa quando comparado com os rotatórios, que não apresentaram diferença entre si. Em relação ao acumulo de debris e aréas não tocadas não houve diferença estatística entre os grupos. O maior volume de dentina removido foi quando utilizado as limas manuais. Apenas os grupos manual e WOG apresentaram trincas. Perfuração radicular foi observado apenas no grupo manual. Concluimos que o uso de sistemas rotatórios apresentou melhores resultados no preparo biomecânico do canal de incisivos superiores decíduos quando comparado à limas manuais. O sistema XP Clean combinou bons resultados, com pouco acumulo de debris e maior área tocada pelo instrumento no interior do canal. (AU)
The aim of this study was to evaluate the result of biomechanical preparation of endodontic instrumentation in prototypes of intact primary teeth with mechanized systems using computerized microtomography. 50 prototypes of a primary maxillary central incisor produced using 3D printing were used. The file systems used were hand files, WaveOne Gold (WOG), XP-Endo Shaper (XPS), XP-Endo Finisher (XPF) and XP Clean (XPC). Each group had 10 teeth and were instrumented according to the manufacturers' recommendations. The scanning of the prototypes by micro-CT was performed before and after instrumentation and the reconstructions were standardized for each set of images. The Shapiro-Wilk test was used to verify the normality of the data. ANOVA followed by the Tukey test was used to compare the averages of final canal volume, debris formation, dentin volume removed and untouched area of the canal walls. Student's t-test was used to compare the initial and final volumes of the canal between each instrumentation group. The presence of cracks and / or perforations along the canal was recorded and a qualitative description was made. All groups showed a significant difference in volume of the canal after instrumentation. The greatest increase in volume of the canal was with hand files, which had a statistically significant difference when compared to rotary files, which showed no difference among them. Regarding the accumulation of debris and noninstrumented areas, there was no statistical difference between the groups. The largest volume of dentin removed was when using hand files. Only the hand files and WOG groups showed cracks. Root perforation was observed only in the hand file group. We concluded that the use of rotary systems showed better results in the biomechanical preparation of the canal of primary maxillary incisors when compared to hand files. The XP Clean system combined good results, with little debris accumulation and a larger area played by the instrument inside the canal. (AU)
Assuntos
Dente Decíduo , Preparo de Canal Radicular/instrumentação , Instrumentos Odontológicos/normas , Microtomografia por Raio-X , Incisivo , Fenômenos Biomecânicos , Preparo de Canal Radicular/métodosRESUMO
Objective: To evaluate the efficacy of rotary Kedo-S and hand K-files in shaping ability in primary canines using cone beam computed tomography. Material and Methods: Thirty extracted primary maxillary and mandibular canines were selected. Using cone beam computed tomography the teeth were scanned before instrumentation. In Group I, the teeth were prepared using stainless steel K file up to the size of 40. In the Group II teeth, U1 size Kedo-S rotary file was used in crown down technique. The instrumented teeth were scanned again with cone beam computed tomography and the images were compared. Results: The canal taper was more conical for rotary Kedo-S files as compared to K-files, which was statistically significant. Conclusion: Canal preparation with Rotary files resulted in more conical canals when compared to manual instrumentation in primary teeth that contributes to more uniform obturation. (AU)
Objetivo: Avaliar a eficácia da instrumentação rotatória com limas Kedo-S e instrumentação manual com limas Kerr na modelagem de caninos decíduos utilizando tomografia computadorizada de feixe cônico (TCFC). Material e Métodos: Foram selecionados 30 caninos decíduos superiores e inferiores extraídos. Usando a TCFC, os dentes foram escaneados previamente a instrumentação. No Grupo I, os dentes foram confeccionados com limas de aço inoxidável até o tamanho 40. Nos dentes do Grupo II, utilizou-se a lima rotatória Kedo-S tamanho U1 na técnica coroaápice. Os dentes instrumentados foram novamente escaneados por TCFC e as imagens foram comparadas. Resultados: A conicidade do canal foi maior no grupo com instrumentação rotatória em comparação com a instrumentação manual, com diferença estatística significante entre eles. Conclusão: O preparo do canal com o Rotary resulta em canais mais cônicos em comparação com a instrumentação manual em dentes decíduos, o que contribui para uma obturação mais uniforme.(AU)
Assuntos
Pulpectomia , Dente Decíduo , Dente Canino , Tomografia Computadorizada de Feixe CônicoRESUMO
Introduction: The aim of this study was to evaluate the canal transportation and centering ability of ProTaper Next (PTN), WaveOne Gold (WOG) and Reciproc Blue (RCB) in simulated curved resin canals. Methods and Materials: A total of 43 blocks of simulated resin canals with 40° of curvature were prepared to an apical size of 0.02. Flexofile #15 instruments were used along the root canal to reach patency. The blocks were randomly assessed and sequence instruments were used according to each system: PTN, RCB and WOG. The imposition of pre and post instrumentation images were composited and analyzed. The canal transportation and apical centralization were measured using the software GIMP (2.8.4, Creative Commons - Share Alike 4.0 International License, 2013). Data were statistically analyzed using the Shapiro-Wilk test, ANOVA test and Tukey's test. The level of significance was set at 0.05. Results: There were no statistical differences in canal transportation between three systems. The general assessment of three systems presented the RCB group with higher values of centralization and more numbers of centralized points with significant differences between the PTN and RCB groups (P<0.05). Conclusion: In this in vitro study, there were no statistical differences in canal transportation between the RCB, WOG and PTN systems. The lowest transportation was observed in the apical region at 3 mm performed with RCB system, followed by WOG and PTN systems. The RCB demonstrated higher values of centralization and more centralized points when assessed by regions.
RESUMO
La mantención de la anatomía original del canal radicular incide directamente en el éxito del tratamiento endodóntico. Para ello, los sistemas rotatorios de instrumentación requieren de canales radiculares permeables. Existen distintas limas y sistemas para la permeabilización o glide path como las limas tipo K manuales de acero inoxidable y los sistemas de NiTi rotatorios PathFile y ProGlider (Dentsply, Maillefer). Así, el objetivo de esta investigación fue comparar la capacidad de distintos sistemas de permeabilización para mantener la anatomía radicular sin producir transporte apical en canales mesiales de molares inferiores humanos extraídos. Se realizó un estudio cuantitativo experimental cuya muestra estuvo conformada por 36 canales mesiales de molares mandibulares humanos extraídos. Las muestras fueron divididas aleatoriamente en tres grupos conformados por 12 canales, cada uno de los cuales fueron sometidos a distintos sistemas de permeabilización (Lima K, PathFile y ProGlider). Las muestras fueron fotografiadas antes y después de la permeabilización utilizando un microscopio con magnificación 30X. Se cuantificó el desplazamiento del canal radicular en sentido mesio - distal y buco - lingual posterior a la permeabilización. Para el análisis de los datos se utilizó el paquete estadístico InfoStat/L y se aplicó la prueba de ANOVA / Tukey. Se observó que el sistema PathFile produce mayor transporte del canal radicular en su tercio apical en la dirección mesio-distal (p=0,77) y el sistema ProGlider en la dirección buco-lingual (p=0,57). Sin embargo, estas diferencias no fueron significativas. En conclusión, los sistemas de permeabilización analizados no presentaron diferencias en cuanto a su capacidad para mantener la anatomía sin producir transporte apical.
Preservation of the original root canal anatomy has a direct influence on the success of an endodontic treatment. In order to achieve this, rotary instrumentation systems require permeable root canals. Different files and systems are used for the establishment of a glide path such as manual stainless steel K files and NiTi rotatory systems like PathFile and ProGlider (Dentsply, Maillefer). Thus, the objective of this research was to compare the ability of different systems to create a glide path and maintain root canal anatomy without producing apical transportation in mesial root canals of extracted human lower molars. A quantitative experimental study was performed with a sample of 36 mesial root canals of extracted human mandibular molars. The samples were randomly divided into three groups consisting of 12 root canals each, which were subjected to different glide path systems (K-Files, PathFile and ProGlider). Samples were photographed before and after creating glide path using a microscope with 30X magnification. The displacement of the root canal in a mesio - distal and bucco - lingual direction was quantified after creating glide path. Data was analyzed using the statistical package InfoStat / L and the ANOVA / Tukey test was applied. The PathFile system produced greater transport of the root canal in its apical third in the mesio-distal direction (p = 0.77) and the ProGlider system in the bucco-lingual direction (p = 0.57). However, these differences were not significant. In conclusion, the glide path systems analyzed do not present any differences in their ability to maintain the anatomy without producing apical transportation.
Assuntos
Humanos , Preparo de Canal Radicular/instrumentação , Cavidade Pulpar , Microscopia Eletrônica de Varredura , Ápice Dentário , Desenho de Equipamento , Dente MolarRESUMO
Abstract This study aimed to evaluate the performance of the Wave One, Easy ProDesign Logic and One Shape systems in the preparation of long oval root canals. Forty-two mandibular incisors were randomized into three groups: Group I, Wave One Primary (WO) (#25.08); Group II, Easy ProDesign Logic (EPL) (#25.06) and Group III, One Shape (OS) (#25.06). Micro-computed tomography scans were obtained pre- and post-preparation of the samples. Instrument fractures or loss of working length did not occur in any of the groups. There was a statistically significant difference in total root canal volume between the WO and EPL (p<0.05) and OS systems (p<0.05) The mean percentages of instrumented canal area in the middle thirds were 76.9% in the WO, 62.3% in the EPL and 71.8% in the OS (p>0.05). The OS system had the strongest correlation between volume increase and instrumented area (R=0.63). The WO, EPL and OS systems presented mean preparation times of 2.13 min, 0.54 min, and 2.21 min (p<0.05), respectively. All three systems enabled the safe preparation of long oval root canals. The WO system most effectively increased root canal volume, but it did not affect the instrumented areas. The OS system had the strongest correlation between volume increase and instrumented area, while the EPL system was the fastest.
Resumo Este estudo teve como objetivo avaliar o desempenho dos sistemas Wave One, Easy ProDesign Logic e One Shape no preparo de canais radiculares ovais. Quarenta e dois incisivos inferiores foram randomizados em três grupos: Grupo I, Wave One primary (WO) (#25.08); Grupo II, Easy ProDesign Logic (EPL) (#25.06) e Grupo III, One Shape (OS) (#25.06). As amostras foram submetidas a microtomografia computadorizada antes e após o preparo. Não ocorreram fraturas de instrumento ou perda de comprimento de trabalho em qualquer dos três grupos. Houve diferença estatisticamente significante no volume total do canal radicular entre o WO e EPL. A média do percentual de área instrumentada do canal no terço médio foi 76,9% no grupo WO, 62,3% no grupo EPL e 71,8% no grupo OS (p>0,05). O sistema OS teve a correlação mais forte entre o aumento de volume e área instrumentada (R=0,63). Os sistemas WO, EPL e OS apresentaram tempos de preparo médios de 2,13 min, 0,54 min e 2,21 min (p<0,05). Todos os três sistemas foram seguros no preparo canais radiculares ovais. O sistema WO foi mais eficaz no aumento do volume de canal, entretanto, isso não afetou as áreas instrumentadas. O sistema OS teve a correlação mais forte entre o aumento de volume e área instrumentada, enquanto o sistema EPL foi o mais rápido.
Assuntos
Humanos , Instrumentos Odontológicos , Preparo de Canal RadicularRESUMO
AIM: The aim of this study was to determine the root canal area before and after the instrumentation 1 mm short of the apical foramen by clinical and cone beam computed tomography (CBCT) methods, and to evaluate the cleanliness of the apical region in mesiodistal flattened teeth by using optical microscopy. MATERIALS AND METHODS: Forty-two human single-canal mandibular incisors were instrumented using the Free Tip Preparation technique up to three, four or five instruments from the initial. Cone beam computed tomography scans were acquired of the samples before and after root canal preparation (RCP). Irrigation was performed by conventional or hydrodynamic means, using 2.5% sodium hypochlorite. The samples were prepared for observation under an optical microscope. Images were digitally obtained, analyzed and the results were submitted to statistical analysis (two-way ANOVA complemented by Bonferroni's post-test). RESULTS: There was no significant difference between the studied anatomical areas with both CBCT and clinical methods. There were no differences between irrigation methods. It was verified differences between instrumentation techniques. Instrumentation with four instruments from the initial instrument determined a significant increase in the contact area when compared to preparation with three instruments, but RCP with 5 instruments did not result in a better cleanliness. CONCLUSION: The analysis with CBCT was not capable to determine the precise shape of surgical apical area comparing to the clinical method. CLINICAL SIGNIFICANCE: Both the conventional and hydrodynamic irrigation techniques were not able to promote root canals debris-free. The instruments action in root canal walls was proportional to the number of instruments used from the initial apical instrument.
Assuntos
Irrigantes do Canal Radicular/administração & dosagem , Preparo de Canal Radicular/métodos , Tratamento do Canal Radicular/métodos , Ápice Dentário/anatomia & histologia , Tomografia Computadorizada de Feixe Cônico/métodos , Ligas Dentárias , Cavidade Pulpar , Dentina , Desenho de Equipamento , Humanos , Incisivo , Microscopia Eletrônica de Varredura , Tratamento do Canal Radicular/instrumentação , Camada de Esfregaço/prevenção & controle , Hipoclorito de Sódio , Propriedades de Superfície , Ápice Dentário/diagnóstico por imagemRESUMO
OBJECTIVES: To evaluate the effectiveness of TRUShape® 3D Conforming Files, compared with Twisted Files, in reducing bacteria load from root canal walls, in the presence or absence of irrigant agitation. METHODS: Extracted human premolars with single oval-shaped canals were infected with Enterococcus faecalis. Teeth in Group I (N=10; NaOCl and QMix® 2in1 as respective initial and final irrigants) were subdivided into 4 subgroups: (A) TRUShape® instrumentation without irrigant activation; (B) TRUShape® instrumentation with sonic irrigant agitation; (C) Twisted Files without irrigant agitation; (D) Twisted Files with sonic irrigant agitation. To remove confounding factor (antimicrobial irrigants), teeth in Group II (N=10) were irrigated with sterile saline, using the same subgroup designations. Specimens before and after chemomechanical débridement were cultured for quantification of colony-forming units (CFUs). Data from each group were analyzed separately using two-factor ANOVA and Holm-Sidak multiple comparison (α=0.05). Canal wall bacteria were qualitatively examined using scanning electron microscopy (SEM) and light microscopy of Taylor-modified Brown and Brenn-stained demineralised sections. RESULTS: CFUs from subgroups in Group I were not significantly different (P=0.935). For Group II, both file type (P<0.001) and irrigant agitation (P<0.001) significantly affected log-reduction in CFU concentrations. The interaction of these two factors was not significant (P=0.601). Although SEM showed reduced canal wall bacteria, bacteria were present within dentinal tubules after rotary instrumentation, as revealed by light microscopy of longitudinal root sections. CONCLUSIONS: TRUShape® files removed significantly more canal wall bacteria than Twisted Files when used without an antibacterial irrigant; the latter is required to decontaminate dentinal tubules. CLINICAL SIGNIFICANCE: Root canal disinfection should not be focused only on a mechanistic approach. Rather, the rational choice of a rotary instrumentation system should be combined with the use of well-tested antimicrobial irrigants and delivery/agitation techniques to establish a clinically realistic chemomechanical débridement protocol.
Assuntos
Ligas , Instrumentos Odontológicos/microbiologia , Cavidade Pulpar/microbiologia , Preparo de Canal Radicular/instrumentação , Tratamento do Canal Radicular/instrumentação , Anti-Infecciosos/farmacologia , Carga Bacteriana , Dente Pré-Molar/microbiologia , Biguanidas/farmacologia , Cavidade Pulpar/efeitos dos fármacos , Dentina/efeitos dos fármacos , Dentina/microbiologia , Desinfecção/instrumentação , Desinfecção/métodos , Enterococcus faecalis/efeitos dos fármacos , Enterococcus faecalis/patogenicidade , Humanos , Polímeros/farmacologia , Irrigantes do Canal Radicular/farmacologia , Preparo de Canal Radicular/métodos , Tratamento do Canal Radicular/métodos , Rotação , Hipoclorito de Sódio/farmacologiaRESUMO
This aim of this study was to assess the ability of manual or rotary instrumentation associated with photodynamic therapy (PDT) to reduce Enterococcus faecalis using three combinations of light/photosensitizers: toluidine blue O/laser, fuchsin/halogen light and fuchsin/LED. Twenty deciduous molars were selected and contaminated with Enterococcus faecalis (McFarland 0.5 scale). Working length determination was performed by visual method. The teeth were randomly divided into two groups: G1 (n=10): manual instrumentation (Kerr-type files) and G2 (n=10): rotary instrumentation (ProTaper system). The bacteria were collected three times using sterile paper cones compatible with the anatomic diameter of the root canal for 30 s before and after instrumentation and after PDT. The samples were diluted in peptone water, seeded on blood agar plates and incubated in an oven at 37 °C for colony-forming units counting. The decrease of E. faecalis counts after instrumentation and after PDT was compared using the Wilcoxon test, t-test and Kruskal Wallis test. A significant reduction of E. faecalis occurred after manual and rotary instrumentation and after PDT using the three combinations of light/photosensitizer (p<0.05). It may be concluded that both rotary and manual instrumentation reduced E. faecalis. Fuchsin with halogen light or LED irradiation and toluidine blue O with laser irradiation can be used to reduce E. faecalis in root canals of primary molars. PDT can be used as an adjuvant to conventional endodontic treatment.
O objetivo do presente estudo foi avaliar a redução de Enterococcus faecalis após instrumentação manual ou rotatória associada à terapia fotodinâmica (PDT) utilizando 3 combinações luz/fotossensibilizante: azul de toluidina O/laser, fucsina/luz halógena e fucsina/LED. Foram selecionados 20 molares decíduos que foram contaminados com Enterococcus faecalis (escala 0,5 de McFarland). A odontometria foi feita através do método visual. Os dentes foram divididos aleatoriamente em dois grupos: G1 (n=10): instrumentação manual (limas tipo Kerr) e G2 (n=10): instrumentação rotatória (sistema ProTaper). Foram realizadas coletas com cone de papel estéril compatível com o diâmetro anatômico do canal durante 30 s antes e após a instrumentação e a PDT. As amostras foram diluídas em água peptonada, semeadas em placas de agar-sangue e incubadas em estufa a 37 °C para contagem das unidades formadoras de colônias. As comparações antes da redução de E. faecalis após a instrumentação e após a realização da PDT foram realizadas pelo teste de Wilcoxon, teste t e Kruskal Wallis. Houve redução significante de E. faecalis após a instrumentação manual ou rotatória e após realização da PDT com as três combinações de luz/fotossensibilizante (p<0,05). Pode-se concluir que a instrumentação rotatória e manual acarretou a redução de E. faecalis. A fucsina irradiada com luz halógena ou led e o azul de toluidina irradiado com laser podem ser utilizados para redução de E. faecalis do sistema de canais radiculares de molares decíduos. A terapia fotodinâmica pode ser utilizada como coadjuvante ao tratamento endodôntico convencional.