Análise do preparo, limpeza, desinfecção e obturação de canais radiculares de molares inferiores por diferentes protocolos e materiais
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Data
2019-11-08
Autores
João, Mariana Mena Barreto Pivoto
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Este estudo avaliou o preparo, limpeza e obturação de canais radiculares de molares inferiores por diferentes protocolos e materiais. Canais mesiais (n=48) de molares inferiores curvos (20°- 40°) foram preparados usando ProDesign Logic (PDL) até 25/.06 ou HyFlex EDM (HFEDM) 25/.08, e até PDL-40/.05 ou HFEDM-40/.04 na ampliação (Publicação 1). A irrigação final foi realizada com irrigação ultrassônica passiva-PUI ou easy clean-EC, hipoclorito de Sódio-NaOCl ou clorexidina-CLX ou água destilada (n=8): PUI/NaOCl2,5%; EC/NaOCl2,5%; EC/água destilada; PUI/CLX 2%; PUI/NaOCl 1%; PUI/NaOCl 2,5% (Publicação 2). A obturação foi realizada por condensação lateral-CL ou Termo Pack II e AHP (Publicação 3); cone único (CU) com nMTAP ou TFBC (Publicação 4). Escaneamentos (9 μm) foram realizados antes e após cada etapa experimental. Percentual de aumento volumétrico (%AV), debris (%D), redução de debris (%RD), superfície não instrumentada (%SNI), centralização, material obturador (%MO) e falhas (%F) foram analisados em toda a extensão do canal (total) e nos terços dos canais radiculares. Testes ANOVA e Tukey ou Kruskal-Wallis e Dunn, e T Pareado foram realizados (α = 0,05). HFEDM-25/.08 promoveu maior % AV. Após a dilatação, HFEDM apresentou maior volume (P < 0,05) e houve redução de %D e %SNI. Os sistemas produziram canais centralizados (Publicação 1). Houve diminuição do percentual e volume de debris acumulados após as técnicas e entre o PUI com diferentes soluções irrigantes. EC/NaOCl proporcionou maior %RD no terço apical que PUI/NaCl e EC/H20. PUI/CHX 2% promoveu maior percentual de debris acumulados em relação ao PUI/ NaOCl 1% e PUI/NaOCl 2,5% nos terços cervical/médio, sendo similares no terço apical. Canais preenchidos por (OCC) apresentaram menor %F, e maior %MO no total e terço apical (Publicação 3). nMATP mostrou maior %F e menor %MO no total em comparação com o cimento TFBC. O terço apical obteve %F e %MO similar entre os grupos (Publicação 4). Canais ovais de molares inferiores (n = 50) foram contaminados (E. faecalis) por 21 dias e utilizado o protocolo: PDL ou HFEDM com NaOCl ou SS. Após coletas microbiológicas (C1-inicial, C2-pós-instrumentação e C3-final), foi realizada UFC-mL-1log10 e análise em MCVL. Os dados foram analisados estatísticamente (α = 0,05). Na C1, a contaminação foi similar para os grupos. Na C2, PDL/NaOCl e HFEDM/NaOCl promoveram eliminação microbiana; PDL/SS e HFEDM/SS mostraram crescimento bacteriano similar e menor que C+ que mostrou maior contagem bacteriana. C3, os grupos experimentais foram similares ao C+. HFEDM/NaOCl e PDL/NaOCl apresentou escore 2, HFEDM/SS e PDL/SS, escore 0 e 1 e no grupo controle escore 0 (Publicação 5). Assim, os sistemas rotatórios tratados permitem o aumento apical promovendo menor quantidade de debris e superfície intocada. Quando associados a NaCOl promoveram desinfecção do canal radicular após preparo, mas não foram efetivos sobre E. faecalis do SCR. PUI é efetivo com substâncias antibacterianas e que dissolvem matéria orgânica e EC é adequado para limpeza do terço apical. Houve melhores resultados para Termo Pack-II e TFBC, exceto no terço apical na obturação de canais curvos de molares inferiores.
This study evaluated the preparation, cleaning and obturation of lower molar root canals by different protocols and materials. Mesial root canals (n = 48) of curved mandibular molars (20°- 40°) were prepared using ProDesign Logic (PDL) up to 25/.06 or HyFlex EDM (HFEDM) 25/.08 and up to PDL-40/.05 or HFEDM-40/.04 in the enlargement step (Publication 1). Final irrigation was performed with passive ultrasonic irrigation-PUI or easy clean-EC, sodium hypochlorite–NaOCl or clorhexidine-CLX or distilled water (n=8): PUI/NaOCl2,5%; EC/NaOCl2,5%; EC/distilled water; PUI/CLX 2%; PUI/NaOCl 1%; PUI/NaOCl 2,5% (Publication 2). The obturation was performed by using lateral compaction-LC or Termo Pack II and AHP (Publication 3); single cone-SC with nMTAP or TFBC (Publication 4). Scanning (9 μm) was performed before and after each experimental stage. Percentage of volume increase (%VI), debris (%D), reduction of debris (%RD) and untouched root canal surface (%SNI), centering ability, percentage of filling material (%FM) and percentage of voids (%V) was determined throughout the entire root canal extension (total) and thirds of roots canals. Data were submitted to ANOVA and Tukey or Kruskal-Wallis and Dunn, and paired t (α = 0,05). HFEDM 25/.08 resulted in higher %VI. After apical enlargement, HFEDM presented higher volume with reduction of debris and untouched surface. The systems promoted centered canals (Publication 1). There was a decrease in the percentage and volume of debris accumulated after the techniques and between the PUI with different irrigating solutions. EC/NaOCl promoted higher %RD in the apical third than PUI/NaOCl and EC/H2O. PUI/CHX 2% promoted higher percentage of accumulated debris than PUI/ NaOCl 1% and PUI/NaOCl 2,5% in the cervical / middle thirds, and similar in the apical third. Obturated canals with CWC presented smaller %V and higher %FM in the entire extension and apical third (Publication 3). nMATP presented higher %V and smaller %FM in the entire extension than TFBC sealer. The apical third showed similar percentage of voids (Publication 4). Oval-shaped mandibular molar canals (n=50) were inoculated (E. faecalis) and prepared using PDL or HFEDM with NaOCl ou SS. After microbiological collections (C1-initial, C2-post-instrumentation and C3-final), UFC-mL-1log10 was performed and evaluated by CLSM. Data were submitted to statistical tests (α = 0,05). In C1, the contamination was similar between groups. In C2, PDL/NaOCl and HFEDM/NaOCl presented microbial elimination; PDL/SS e HFEDM/SS showed bacterial growth similar and smaller than C+ that showed higher bacterial count. Considering C3, the experimental groups were similar to C+. HFEDM/NaOCl and PDL/NaOCl presented score 2, HFEDM/SS and PDL/SS, score 0 and 1 and in the control group, score 0 (Publication 5). Thus, the treated rotary systems allow apical increase and smaller amount of debris and untouched surface. When associated with NaOCl these systems promote root canal disinfection after preparation, which was not effective on E. faecalis from SCR. PUI is effective with antibacterial substances that dissolve organic matter. EC is appropriate for apical third cleaning. There were better results for Term Pack-II and TFBC, except for the apical third in the obturation of mesial root canals of curved mandibular molars.
This study evaluated the preparation, cleaning and obturation of lower molar root canals by different protocols and materials. Mesial root canals (n = 48) of curved mandibular molars (20°- 40°) were prepared using ProDesign Logic (PDL) up to 25/.06 or HyFlex EDM (HFEDM) 25/.08 and up to PDL-40/.05 or HFEDM-40/.04 in the enlargement step (Publication 1). Final irrigation was performed with passive ultrasonic irrigation-PUI or easy clean-EC, sodium hypochlorite–NaOCl or clorhexidine-CLX or distilled water (n=8): PUI/NaOCl2,5%; EC/NaOCl2,5%; EC/distilled water; PUI/CLX 2%; PUI/NaOCl 1%; PUI/NaOCl 2,5% (Publication 2). The obturation was performed by using lateral compaction-LC or Termo Pack II and AHP (Publication 3); single cone-SC with nMTAP or TFBC (Publication 4). Scanning (9 μm) was performed before and after each experimental stage. Percentage of volume increase (%VI), debris (%D), reduction of debris (%RD) and untouched root canal surface (%SNI), centering ability, percentage of filling material (%FM) and percentage of voids (%V) was determined throughout the entire root canal extension (total) and thirds of roots canals. Data were submitted to ANOVA and Tukey or Kruskal-Wallis and Dunn, and paired t (α = 0,05). HFEDM 25/.08 resulted in higher %VI. After apical enlargement, HFEDM presented higher volume with reduction of debris and untouched surface. The systems promoted centered canals (Publication 1). There was a decrease in the percentage and volume of debris accumulated after the techniques and between the PUI with different irrigating solutions. EC/NaOCl promoted higher %RD in the apical third than PUI/NaOCl and EC/H2O. PUI/CHX 2% promoted higher percentage of accumulated debris than PUI/ NaOCl 1% and PUI/NaOCl 2,5% in the cervical / middle thirds, and similar in the apical third. Obturated canals with CWC presented smaller %V and higher %FM in the entire extension and apical third (Publication 3). nMATP presented higher %V and smaller %FM in the entire extension than TFBC sealer. The apical third showed similar percentage of voids (Publication 4). Oval-shaped mandibular molar canals (n=50) were inoculated (E. faecalis) and prepared using PDL or HFEDM with NaOCl ou SS. After microbiological collections (C1-initial, C2-post-instrumentation and C3-final), UFC-mL-1log10 was performed and evaluated by CLSM. Data were submitted to statistical tests (α = 0,05). In C1, the contamination was similar between groups. In C2, PDL/NaOCl and HFEDM/NaOCl presented microbial elimination; PDL/SS e HFEDM/SS showed bacterial growth similar and smaller than C+ that showed higher bacterial count. Considering C3, the experimental groups were similar to C+. HFEDM/NaOCl and PDL/NaOCl presented score 2, HFEDM/SS and PDL/SS, score 0 and 1 and in the control group, score 0 (Publication 5). Thus, the treated rotary systems allow apical increase and smaller amount of debris and untouched surface. When associated with NaOCl these systems promote root canal disinfection after preparation, which was not effective on E. faecalis from SCR. PUI is effective with antibacterial substances that dissolve organic matter. EC is appropriate for apical third cleaning. There were better results for Term Pack-II and TFBC, except for the apical third in the obturation of mesial root canals of curved mandibular molars.
Descrição
Palavras-chave
Preparo de canal radicular, Microtomografia por Raio-x, Enterococcus faecalis, Root canal preparation, X-Ray Microtomography, Enterococcus faecalis