Emprego da microtomografia computadorizada na análise de preparo, limpeza e obturação de canais radiculares ovalados
Data
2018-02-19
Autores
Passador, Camila Galletti Espir
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Este estudo avaliou morfologia, preparo e obturação com diferentes técnicas e materiais em canais radiculares ovais. Quinhentos e vinte incisivos inferiores foram avaliados por meio de radiografias digitais nos sentidos vestíbulo lingual (VL) e mesio distal (MD), sendo obtidos a partir da relação de diâmetro VL/MD: 23.3% canais achatados; 41.3% ovais; 27.3% arredondados; 4.5% redondos e 3.6% com achatamento VL (Publicação 1). Os incisivos classificados como ovais foram preparados: Reciproc 40 (R40) reciprocante anti-horário; MTwo 40, taper .06 (M 40.06) reciprocante horário (150° horário e 30° anti-horário); e MTwo 20, taper .06 seguido de MTwo 40, taper .06 (M 20/40.06) em reciprocante horário (Publicação 2); R40, Unicone 20.06 seguido de 40.06 reciprocante (Uni20/40.06) e sistema Mtwo até 40.06 rotatório (Mtwo seq) (Publicação 3); e R40, M40.06 e Mtwo seq (Publicação 4). A obturação foi realizada pelas técnicas de cone único (CU) ou condensação lateral (CL) e cimento AH Plus (AHP) (Publicação 4); CU e AHP ou Neo MTA Plus (NMTAP) (Publicação 5); e CL e MTA Fillapex (MTAF) ou AHP (Publicação 6). Escaneamentos foram realizados antes e após cada etapa experimental, utilizando o microtomófrafo SkyScan 1176. Volume, porcentagem de debris, de superfície não instrumentada e de falhas na obturação foram obtidos. Dados foram submetidos aos testes estatísticos ANOVA e Tukey, Kruskal-Wallis e Dunn, T Pareado ou Mann-Whitney (α=0.05). Reciproc e MTwo usando diferentes cinemáticas apresentaram aumento similar de volume do canal, e de superfície não instrumentada. M20/40.06 apresentou o menor percentual de debris no terço médio. O movimento reciprocante para R40 e M40.06 apresentaram preparos similares. Melhor limpeza de debris no terço médio foi obtida utilizando dois instrumentos com diâmetros diferentes (Publicação 2). O preparo Unicone apresentou maior aumento de volume, e maior percentual de debris e de superfície não instrumentada no canal e no terço médio. Maior limpeza e menor percentual de debris foi obtido para preparo reciprocante com R40 e MTwo seq (Publicação 3). MTwo seq apresentou maior percentual de debris e superfície não instrumentada no terço cervical, além de maior percentual de falha para técnica de CU na extensão total e terços cervical e apical após este preparo. O preparo de canais ovais com R40 e M40.06 proporcionaram maiores percentuais de limpeza, e obturação semelhante para CU e CL (Publicação 4). Não foram observadas diferenças significantes nos diferentes terços para obturação com cimentos AHP ou NMTAP. O cimento NMTAP apresenta capacidade de preenchimento de canais ovais pela técnica de CU similar ao AHP (Publicação 5). Obturação com MTAF apresentou maior percentual de falhas no terço cervical, sem diferença nos demais terços. A análise da alteração volumétrica demonstrou maior perda volumétrica para MTAF. MTAF proporciona maior porcentagem de falhas no preenchimento de canais ovais, e apresenta maior perda volumétrica que o AHP. (Publicação 6).
This study evaluated the morphology, preparation and filling using different techniques and materials in oval-shaped canals. Five hundred and twenty mandibular incisors were evaluated using digital radiography in the buccolingual (BL) and mesio distal (MD) directions, being obtained from the VL / MD diameter ratio: 23.3% flattened canals; 41.3% ovals; 27.3% rounded; 4.5% round e 3.6% with flattening BL (Publication 1). The oval-shaped incisors were prepared: Reciproc 40 (R40) counterclockwise reciprocating; MTwo 40, taper .06 (M 40.06) clockwise reciprocating (150° clockwise and 30° counterclockwise); and MTwo 20, taper .06 and MTwo 40, taper .06 (M 20/40.06) clockwise reciprocating (Publication 2); R40, Unicone 20.06 and 40.06 reciprocanting (Uni20/40.06) and Mtwo rotary system until 40.06 (Mtwo seq) (Publication 3); and R40, M40.06 e Mtwo seq (Publication 4). Filling was performed using single-cone technique (SC) or lateral condensation (LC) and AH Plus sealer (AHP) (Publication 4); SC and AHP or Neo MTA Plus (NMTAP) sealer (Publication 5); and LC using MTA Fillapex (MTAF) or AHP sealer (Publication 6). Scans were performed before and after each experimental stage, using the SkyScan 1176 micro-computed tomography. Volume, percentage of debris, percentage of uninstrumented surface and voids in obturation were obtained. Data were submetted to ANOVA and Tukey’s tests or Kruskal–Wallis and Dunn tests, non-paired T test or Mann-Whitney (α=0.05). Reciproc and Mtwo using different kinematics were associated with a similar increase in root canal volume. M20/40.06 was associated with significantly lower debris in the middle third. The reciprocation motion for R40 and the clockwise reciprocation motion for Mtwo resulted in similar root canal preparations. Less remaining debris was present in the middle third when two instruments with diferente diameters were used (Publication 2). Unicone preparation was associated with higher debris, increase in root canal volume and uninstrumented surface in entire root canal and in the middle third. Better cleaning and less remaining debris was observed when R40 and Mtwo seq were used (Publication 3). MTwo seq was associated with higher debris and uninstrumented surface in the cervical third, and higher percentage of failure for the SC in the entire root canal and in cervical and apical thirds after this prepare. R40 and M40.06 were associated with less remaining debris and a similarity between SC and LC (Publication 4). No significant differences were observed in the different thirds for AHP or NMTAP sealer. NMTAP sealer presents the ability to fill oval canals by SC similar to AHP (Publication 5). Filling using MTAF showed higher percentual of voids in cervical third, with no difference in the other thirds. The volumetric change analysis revealed higher volumetric loss to MTAF. MTAF provides a greater percentage of voids in the filling of oval canals, and presents greater volumetric loss than the AHP. (Publication 6).
This study evaluated the morphology, preparation and filling using different techniques and materials in oval-shaped canals. Five hundred and twenty mandibular incisors were evaluated using digital radiography in the buccolingual (BL) and mesio distal (MD) directions, being obtained from the VL / MD diameter ratio: 23.3% flattened canals; 41.3% ovals; 27.3% rounded; 4.5% round e 3.6% with flattening BL (Publication 1). The oval-shaped incisors were prepared: Reciproc 40 (R40) counterclockwise reciprocating; MTwo 40, taper .06 (M 40.06) clockwise reciprocating (150° clockwise and 30° counterclockwise); and MTwo 20, taper .06 and MTwo 40, taper .06 (M 20/40.06) clockwise reciprocating (Publication 2); R40, Unicone 20.06 and 40.06 reciprocanting (Uni20/40.06) and Mtwo rotary system until 40.06 (Mtwo seq) (Publication 3); and R40, M40.06 e Mtwo seq (Publication 4). Filling was performed using single-cone technique (SC) or lateral condensation (LC) and AH Plus sealer (AHP) (Publication 4); SC and AHP or Neo MTA Plus (NMTAP) sealer (Publication 5); and LC using MTA Fillapex (MTAF) or AHP sealer (Publication 6). Scans were performed before and after each experimental stage, using the SkyScan 1176 micro-computed tomography. Volume, percentage of debris, percentage of uninstrumented surface and voids in obturation were obtained. Data were submetted to ANOVA and Tukey’s tests or Kruskal–Wallis and Dunn tests, non-paired T test or Mann-Whitney (α=0.05). Reciproc and Mtwo using different kinematics were associated with a similar increase in root canal volume. M20/40.06 was associated with significantly lower debris in the middle third. The reciprocation motion for R40 and the clockwise reciprocation motion for Mtwo resulted in similar root canal preparations. Less remaining debris was present in the middle third when two instruments with diferente diameters were used (Publication 2). Unicone preparation was associated with higher debris, increase in root canal volume and uninstrumented surface in entire root canal and in the middle third. Better cleaning and less remaining debris was observed when R40 and Mtwo seq were used (Publication 3). MTwo seq was associated with higher debris and uninstrumented surface in the cervical third, and higher percentage of failure for the SC in the entire root canal and in cervical and apical thirds after this prepare. R40 and M40.06 were associated with less remaining debris and a similarity between SC and LC (Publication 4). No significant differences were observed in the different thirds for AHP or NMTAP sealer. NMTAP sealer presents the ability to fill oval canals by SC similar to AHP (Publication 5). Filling using MTAF showed higher percentual of voids in cervical third, with no difference in the other thirds. The volumetric change analysis revealed higher volumetric loss to MTAF. MTAF provides a greater percentage of voids in the filling of oval canals, and presents greater volumetric loss than the AHP. (Publication 6).
Descrição
Palavras-chave
Endodontia, Obturação do canal radicular, Preparo de canal radicular, Endodontics, Root canal obturation, Root canal preparation