Avaliação de diferentes protocolos clínicos para tratamento de lesão endo-periodontal: 3 séries de casos
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Data
2019-02-08
Autores
Santos, Carlos Henrique de Sales Dias [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Na prática clínica odontológica é comum observarmos dentes que apresentem lesões endodôntico-periodontais. Apesar das respostas inflamatórias nos dois tecidos poderem ocorrer de maneira isolada, o não-tratamento e a evolução dessas infecções pode levar a formação de lesão combinada, denominada lesão endo-perio. A falta de abordagem eficaz aumenta a possibilidade de possível perda do dente acometido pela lesão. O objetivo desse estudo foi a realização de 3 séries de casos clínicos em 44 dentes com lesão endoperio, utilizando o mesmo protocolo endodôntico e variando- se a terapia periodontal proposta - G1 (n=15): debridamento periodontal (RAR), G2 (n=16): antibioticoterapia (RAR + AB) e G3 (n=13): acesso cirúrgico (AC), analisando os dados clínicos de Profundidade de Sondagem (PS), Nível de Inserção Clínico (NIC), Recessão Gengival (RG), mobilidade, Sangramento a Sondagem (SS) e Índice de Placa (IP) nos períodos baseline, 30 dias 3 e 6 meses; além da análise do comprimento linear das lesões em radiografias periapicais e do volume das lesões em tomografias de baseline e 6 meses. Os dados clínicos nos períodos analisados e as avaliações radiográficas e tomográficas prévias e de controle dos tratamentos foram submetidos a análise estatística (Shapiro-Wilk e ANOVA) e evidenciaram melhora nos 3 grupos, considerando os diferentes tratamentos propostos. O G2 apresentou maior diminuição do volume da lesão na análise volumétrica tomográfica bem como na análise radiográfica, de forma estatisticamente significante em relação ao G1 e G3. Os dados clínicos de PS, NIC, RG e mobilidade mostraram melhora nos 3 grupos, sendo G2 melhor que os demais e quanto a SS houve melhora em 3 e 6 meses para os 3 grupos; e IP sem diferença. A partir dessas 3 séries de casos, sugere-se que o protocolo combinado endodôntico até a medicação intracanal (MIC) e terapia periodontal seguida de troca da MIC para posterior obturação endodôntica, resultou em melhora no quadro clínico, radiográfico e tomográfico dos padrões avaliados nos 3 tipos de terapia periodontal realizada nos tempos propostos, sendo que a raspagem e antibioticoterapia (G2) mostrou os melhores resultados no tratamento de lesões endo-perio.
In current dental practice it is common to observe teeth with endodontic-periodontal lesions. Although inflammatory responses in both tissues may occur in an isolated manner, non-treatment, and consequently, the evolution of these infections may lead to develop a combined lesion, referred as endo-perio lesion. The lack of an effective approach, besides of making the prognosis of the treatment uncertain, increases the possibility of a possible tooth loss affected by this lesion. The aim of this study was to perform 3 series of clinical cases in 44 teeth with endo-periodontal lesion, using the same endodontic protocol and varying the proposed periodontal therapy, G1 (n = 15): periodontal debridement, G2 (n = 16): antibiotic therapy and G3 (n = 13): surgical access; analysing Probe Depth (PD), clinical atachment level (CAL), gengival ressection (GR), mobility, bleeding on probing (BP), and plaque index at baseline, 30 days, 3 and 6 months, besides the analysis of the linear length of the lesions in periapical radiographic and volume of the lesions in baseline and 6-month CBCTs. clinical data in the analyzed periods and previous radiographic and tomographic evaluations and control of the treatments were submitted to statistical analysis (Shapiro-Wilk and ANOVA) and showed improvement in the 3 groups, considering the different treatments proposed. G2 presented a greater reduction in lesion volume in tomographic volume analysis as well as in radiographic analysis, statistically significant in relation to G1 and G3.The results of PD, CAL, GR and mobility showed improvement in the 3 groups, G2 being better than the others, and in BP there was improvement at 3 and 6 months for the 3 groups; and PI without difference. From these three series of cases, it is suggested that the combined endodontic protocol up to intracanal medication (MIC) and periodontal therapy followed by change of the intracanal medication for later endodontic obturation, resulted in an improvement in the clinical, radiographic and tomographic scores evaluated for the 3 types of periodontal therapy performed at the proposed times, and scalling and antibiotic therapy (G2) showed the best results in the treatment of endo-perio lesions.
In current dental practice it is common to observe teeth with endodontic-periodontal lesions. Although inflammatory responses in both tissues may occur in an isolated manner, non-treatment, and consequently, the evolution of these infections may lead to develop a combined lesion, referred as endo-perio lesion. The lack of an effective approach, besides of making the prognosis of the treatment uncertain, increases the possibility of a possible tooth loss affected by this lesion. The aim of this study was to perform 3 series of clinical cases in 44 teeth with endo-periodontal lesion, using the same endodontic protocol and varying the proposed periodontal therapy, G1 (n = 15): periodontal debridement, G2 (n = 16): antibiotic therapy and G3 (n = 13): surgical access; analysing Probe Depth (PD), clinical atachment level (CAL), gengival ressection (GR), mobility, bleeding on probing (BP), and plaque index at baseline, 30 days, 3 and 6 months, besides the analysis of the linear length of the lesions in periapical radiographic and volume of the lesions in baseline and 6-month CBCTs. clinical data in the analyzed periods and previous radiographic and tomographic evaluations and control of the treatments were submitted to statistical analysis (Shapiro-Wilk and ANOVA) and showed improvement in the 3 groups, considering the different treatments proposed. G2 presented a greater reduction in lesion volume in tomographic volume analysis as well as in radiographic analysis, statistically significant in relation to G1 and G3.The results of PD, CAL, GR and mobility showed improvement in the 3 groups, G2 being better than the others, and in BP there was improvement at 3 and 6 months for the 3 groups; and PI without difference. From these three series of cases, it is suggested that the combined endodontic protocol up to intracanal medication (MIC) and periodontal therapy followed by change of the intracanal medication for later endodontic obturation, resulted in an improvement in the clinical, radiographic and tomographic scores evaluated for the 3 types of periodontal therapy performed at the proposed times, and scalling and antibiotic therapy (G2) showed the best results in the treatment of endo-perio lesions.
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Palavras-chave
Lesões endo-perio, Terapia endodôntica, Raspagem e alisamento radicular, Endo-perio lesions, Endodontic treatment, Scaling and root planning