Estudo de novos dispositivos, instrumentos e materiais empregados no tratamento endodôntico
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Data
2019-05-02
Autores
Bueno, Carlos Roberto Emerenciano [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O tratamento endodôntico visa manter ou restabelecer a saúde do periodonto através do preparo biomecânico, utilizando instrumentos de níquel- titânio automatizados e associados com insertos ultrassônicos para potencializar a ação dos irrigantes. Os materiais empregados na endodontia que permanecerão em contato com tecidos devem apresentar biocompatibilidade e preferencialmente ser biomineralizador, a fim de selar comunicações (fisiológicas/iatrogênicas), isolando o sistema de canais radiculares. Objetivos: 1- Avaliar a resistência à fadiga cíclica das limas reciprocantes Genius e EdgeFile X1 Small, comparados à lima WaveOne Gold Primary; 2- Avaliar a capacidade de limpeza de um inserto ultrassônico de níquel titânio em ativação da irrigação de forma contínua e passiva; 3- Avaliar a biocompatiblidade e biomineralização do cimento reparador MTA Flow. Material e Métodos: Para avaliar a resistência à fadiga cíclica dos sistemas Genius, EdgeFile e WaveOne Gold, 80 instrumentos foram utilizados (n=20), divididos em 4 grupos experimentais: Genius 25.04, Genius 30.04; EdgeFile X1 Small e Wave One Gold Primary, acionados em um canal artificial de aço inoxidável com ângulo de curvatura de 60o e raio de curvatura de 5 mm. O tempo decorrido da ativação do motor foi gravado em um cronômetro digital e parado assim que a fratura foi detectada. O número de ciclos até a falha (NCF) e o tempo para fratura (TF) foram calculados e os comprimentos dos segmentos fraturados medidos. Para avaliar a capacidade de limpeza do inserto ultrassônico, 45 pré- molares inferiores, padronizados em 16 mm foram utilizados. A instrumentação foi realizada até lima 50.04 sob irrigação com hipoclorito de sódio e foram divididos em 3 grupos (n = 15) de acordo com a técnica de ativação final da solução irrigadora: irrigação convencional (IC) (passiva com pressão positiva/sucção concomitante) como controle; ativação ultrassônica passiva (PUI) e ativação ultrassônica contínua (CUI) do irrigante. Os três grupos tiveram os protocolos de ativação/irrigação final em soluções de hipoclorito de sódio e EDTA. As amostras foram clivadas, as imagens obtidas com microscopia eletrônica de varredura (MEV) e avaliadas quanto à capacidade de remoção da camada de smear layer no terço cervical, médio e apical, por um sistema de escores. Para análise biológica do material reparador MTA Flow, os materiais MTA Angelus e ProRoot MTA foram utilizados para comparação. Quarenta ratos receberam implantes subcutâneo de tubos de polietileno contendo os 3 materiais e tubo vazio como controle (n=10). Após 7, 15, 30 e 60 dias, os animais foram eutanasiados e os tubos removidos com o tecido conjuntivo circundantes. Infiltrado inflamatório e espessura da cápsula fibrosa foram avaliados histologicamente e indução da mineralização analisada por Von Kossa e sob luz polarizada. Os dados foram analisados com testes estatísticos específicos (p<5%). Resultados: Quanto à fadiga cíclica, os instrumentos EdgeFile X1 Small apresentaram maior resistência (NCF: 6175.74 ± 1608.99; TF: 1058.7 ± 275.82), seguido por ambos instrumentos Genius (p<0.05), de forma significativa comparados ao Waveone Gold Primary. O inserto de NiTi aumentou a limpeza, comparado com IC, principalmente no terço apical e CUI mostrou os melhores resultados (p<0.05). Nos resultados biológicos, MTA Angelus induziu a reação mais leve após 15 dias (p<0.05), seguido do MTA Flow. ProRoot MTA induziu uma inflamação severa no dia 7, reduzindo após 15 dias. Nenhuma diferença foi observada entre os materiais após 30 ou 60 dias (p>0.05). Estruturas coradas por Von Kossa e birrefringentes foram positivas para todos os materiais. Conclusões: 1- Os instrumentos EdgeFile X1 Small demonstraram maior resistência à fadiga cíclica que Genius e WaveOne Gold Primary. Ambos instrumentos Genius apresentaram resistência superior à WaveOne Gold Primary. 2- A ativação final do irrigante com o inserto NiTi melhorou a remoção de smear layer, com protocolo CUI superior à PUI ou IC. 3- O MTA Flow mostrou biocompatibilidade e induziu a biomineralização em todos os períodos observados.
Introduction: The endodontic treatment aims to maintain or restore periodontal health through biomechanical instrumentation with nickel-titanium automatized instruments, associated with an ultrasonic tip to activate the irrigant, enhancing cleanness. Materials used in endodontics that will remain in contact with tissues, should demonstrate properties as biocompatibility and biomineralization ability, in order to seal communications (physiological/iatrogenic) isolating the root canal system. Objectives: 1- Evaluate the cyclic fatigue resistance of reciprocating Genius and EdgeFile X1 Small instruments compared to Waveone Gold Primary instruments; 2- Evaluate the cleaning effectiveness of a nickel-titanium ultrasonic tip in continuous and passive irrigant activation; 3-Evaluate the biocompatibility and biomineralization of MTA Flow repair cement. Materials and Methods: To evaluate the cyclic fatigue resistance of Genius, EdgeFile and WaveOne Gold, 80 instruments were used (n = 20), divided into 4 experimental groups: Genius 25.04, Genius 30.04; EdgeFile X1 Small and Wave One Gold Primary, reciprocating in a stainless steel artificial canal with a 60° angle of curvature and 5mm radius of curvature. The elapsed time of the motor activation was recorded in a digital timer and stopped as soon as the fracture was detected. The number of cycles to fracture (NCF) and time to fracture (TF) were calculated and the fractured segments lengths measured. To evaluate the ultrasonic tip cleanness capacity, forty-five mandibular premolars, standardized at 16 mm were used. The instrumentation was performed until file 50.04 under irrigation with sodium hypochlorite. The specimens were divided into 3 groups (n = 15) according to the final irrigant activation protocol: conventional irrigation (CI) (passive, with positive pressure/simultaneous aspiration) as control; passive ultrasonic irrigant activation (PUI) and continuous ultrasonic irrigant activation (CUI). All groups had the final activation / irrigation protocols with solutions of sodium hypochlorite and EDTA, standardized with same volume. Samples were sodium hypochlorite and EDTA, standardized with same volume. Samples were cleaved and images obtained through scanning electron microscopy (SEM) to assess smear layer removal in the cervical, middle and apical thirds, via a score system. To biologically analyze MTA Flow repair cement, MTA Angelus and ProRoot MTA cements were used as comparison. Forty rats received subcutaneous implants of polyethylene tubes containing the 3 cements and empty tube as control (n = 10). After days 7, 15, 30 and 60, the animals were euthanized and the tubes removed with the surrounding tissues. Inflammatory infiltrate and fibrous capsule thickness were histologically evaluated and mineralization induction assessed by Von Kossa staining and under polarized light. The data were analyzed with specific statistical tests (p<5%). Results: The cyclic fatigue test showed EdgeFile X1 Small with the highest resistance (NCF: 6175.74 ± 1608.99; TF: 1058.7 ± 275.82), followed by both Genius instruments (p<0.05). The nickel-titanium tip enhanced cleanness, compared to CI, mainly in the apical area, whereas CUI showed the best results (p<0.05). In the biological results, MTA Angelus induced the mildest reaction after 7 (p>0.05) and 15 days (p<0.05), followed by MTA Flow. ProRoot MTA induced severe inflammation on day 7, reducing after day 15 (p>0.05). No difference was observed after 30 or 60 days (p>0.05). Von Kossa staining and birefringents structures were positive for all materials. Conclusion: 1- EdgeFile X1 Small instruments demonstrated superior cyclic fatigue resistance than Genius and WaveOne Gold Primary. In addition, both Genius instruments showed superior resistance than WaveOne Gold Primary. 2- The final irrigant activation with the NiTi tip improved smear layer removal, with CUI protocol superior to PUI or CI. 3 - MTA Flow showed biocompatibility and induced biomineralization in all observed periods.
Introduction: The endodontic treatment aims to maintain or restore periodontal health through biomechanical instrumentation with nickel-titanium automatized instruments, associated with an ultrasonic tip to activate the irrigant, enhancing cleanness. Materials used in endodontics that will remain in contact with tissues, should demonstrate properties as biocompatibility and biomineralization ability, in order to seal communications (physiological/iatrogenic) isolating the root canal system. Objectives: 1- Evaluate the cyclic fatigue resistance of reciprocating Genius and EdgeFile X1 Small instruments compared to Waveone Gold Primary instruments; 2- Evaluate the cleaning effectiveness of a nickel-titanium ultrasonic tip in continuous and passive irrigant activation; 3-Evaluate the biocompatibility and biomineralization of MTA Flow repair cement. Materials and Methods: To evaluate the cyclic fatigue resistance of Genius, EdgeFile and WaveOne Gold, 80 instruments were used (n = 20), divided into 4 experimental groups: Genius 25.04, Genius 30.04; EdgeFile X1 Small and Wave One Gold Primary, reciprocating in a stainless steel artificial canal with a 60° angle of curvature and 5mm radius of curvature. The elapsed time of the motor activation was recorded in a digital timer and stopped as soon as the fracture was detected. The number of cycles to fracture (NCF) and time to fracture (TF) were calculated and the fractured segments lengths measured. To evaluate the ultrasonic tip cleanness capacity, forty-five mandibular premolars, standardized at 16 mm were used. The instrumentation was performed until file 50.04 under irrigation with sodium hypochlorite. The specimens were divided into 3 groups (n = 15) according to the final irrigant activation protocol: conventional irrigation (CI) (passive, with positive pressure/simultaneous aspiration) as control; passive ultrasonic irrigant activation (PUI) and continuous ultrasonic irrigant activation (CUI). All groups had the final activation / irrigation protocols with solutions of sodium hypochlorite and EDTA, standardized with same volume. Samples were sodium hypochlorite and EDTA, standardized with same volume. Samples were cleaved and images obtained through scanning electron microscopy (SEM) to assess smear layer removal in the cervical, middle and apical thirds, via a score system. To biologically analyze MTA Flow repair cement, MTA Angelus and ProRoot MTA cements were used as comparison. Forty rats received subcutaneous implants of polyethylene tubes containing the 3 cements and empty tube as control (n = 10). After days 7, 15, 30 and 60, the animals were euthanized and the tubes removed with the surrounding tissues. Inflammatory infiltrate and fibrous capsule thickness were histologically evaluated and mineralization induction assessed by Von Kossa staining and under polarized light. The data were analyzed with specific statistical tests (p<5%). Results: The cyclic fatigue test showed EdgeFile X1 Small with the highest resistance (NCF: 6175.74 ± 1608.99; TF: 1058.7 ± 275.82), followed by both Genius instruments (p<0.05). The nickel-titanium tip enhanced cleanness, compared to CI, mainly in the apical area, whereas CUI showed the best results (p<0.05). In the biological results, MTA Angelus induced the mildest reaction after 7 (p>0.05) and 15 days (p<0.05), followed by MTA Flow. ProRoot MTA induced severe inflammation on day 7, reducing after day 15 (p>0.05). No difference was observed after 30 or 60 days (p>0.05). Von Kossa staining and birefringents structures were positive for all materials. Conclusion: 1- EdgeFile X1 Small instruments demonstrated superior cyclic fatigue resistance than Genius and WaveOne Gold Primary. In addition, both Genius instruments showed superior resistance than WaveOne Gold Primary. 2- The final irrigant activation with the NiTi tip improved smear layer removal, with CUI protocol superior to PUI or CI. 3 - MTA Flow showed biocompatibility and induced biomineralization in all observed periods.
Descrição
Palavras-chave
Endodontia, Inflamação, Ultrassom, Teste de materiais, Endodontics, Inflammation, Ultrasonics, Material testing