Eficácia clínica dos protocolos de preparo endodôntico e da medicação intracanal na redução de endotoxinas e bactérias cultiváveis nos canais radiculares de pacientes que foram submetidos à irradiação de cabeça e pescoço
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Data
2019-12-11
Autores
Rabello, Diego Guilherme Dias de [Unesp]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Este estudo clínico foi conduzido para comparar a eficácia de protocolos do preparo endodôntico biomecânico, assim como da medicação intracanal em pacientes que foram submetidos à radioterapia. 22 dentes com infecção endodôntica em pacientes que se submeteram à radioterapia de cabeça e pescoço foram selecionados e canais foram preparados com movimento reciprocante. Então como protocolo de irrigação suplementar, randomizadadamente divididos em 2 grupos de 11 pacientes: G1, pressão apical positiva e G2, irrigação ultrasonica passiva. Ambos grupos envolveram múltiplas sessões com colocação de medicação à base de Ca(OH)2 por 14 dias. Amostras foram coletadas antes e após procedimentos endodônticos. Teste LAL foi usado para quantificar endotoxinas. Teste de culturas foram realizados para quantificar carga bacteriana. Porcentagem foi calculada após entre grupos usando ANOVA com Tukey com nível de significância de 5%. Houve uma média de 16 meses de acompanhmento pós-cirúrgico. Dos 22 casos, 21 (95%) foram considerados sucesso. Em um caso foi detectado sinus tractus após 12 meses. Não houve ocorrência de osteorradionecrose. Endotoxinas e bactérias cultiváveis foram encontrados em todas as amostras iniciais. Todos os protocolos de tratamento foram estatisticamente significante em reduzir carga bacteriana e endotoxinas dos canais infectados (todos, P < .05): G1 (95.41%), G2 (97.86%) e após medicação intracanal G1 após Ca(OH)2 (97.41%), e G2 após Ca(OH)2 (98.95%). Não houve difernça estatisticamente significante entre os grupos tratados (P > .05). Todos os protocolos de tratamento foram estatisticamente efecicazes em reduzir os níveis iniciais de endotoxinas. Redução média: G1 de 78.61 % e para G2, 86.04% (P < .05). Além do mais, medicação intracanal com Ca(OH)2 reduziu níveis de endotoxinas em 94.87% (G1) e em 95.34% (G2) (todos, P < .05). Este estudo clínico demonstrou que tratamento endodôntico em pacientes irradiados podem ser eficazes. O preparo com movimentos reciprocantes e suplementação com irrigação tanto com ultrassom quanto com seringa, são capazes de reduzir o conteúdo contaminante dos canais radiculares. O uso de medicação intracanal com Ca(OH)2 nesta situação também se mostrou bastante eficiente na redução de carga bacteriana e níveis de endotoxinas.
Objective: this clinical study was conducted to compare the efficacy of endodontic biomechanical preparation protocols, as well as the intracanal medication on the reduction of endotoxins and cultivable bacteria of infected root canal in patients who have received irradiation to the head and neck. Methods: twenty-two infected root canals in patients who have undergone radiation therapy to the head and neck were selected and canals were prepared by reciprocating motion. Then, as supplementary irrigation protocol, randomly divided into 2 groups of 11 patients: G1, apical positive pressure (APP) and G2, passive ultrasonic irrigation (PUI). Both groups involved 2-visit treatment with the placement of Ca(OH)2 medication for 14 days. Samples were collected before and after clinical procedures. A chromogenic LAL assay test was used to quantify endotoxins. Culture techniques were used to determine bacterial counts. The mean percentage after the procedures was compared statistically between groups using the ANOVA post hoc Tukey test with a significance level set at 5%. Results: there was a mean follow-up period of 16 months. Of 22 cases, 21 (95%) were considered successful. One was found with sinus tractus after 12 months. There were no occurrences of osteoradionecrosis. Endotoxins and cultivable bacteria were detected in 100% of the initial samples. All treatment protocols were statistically effective in reducing bacterial load from infected root canals (all, P < .05): G1 (95.41%), G2 (97.86%) and after intracanal medication the bacterial load was G1 after Ca(OH)2 (97.41%), and G2 after Ca(OH)2 (98.95%). No differences were found in bacterial load reduction when comparing the treatment groups (P > .05). All treatment protocols were statistically effective in reducing endotoxin from initial levels. Median reduction for G1 was 78.61 % and for G2, 86.04% (P < .05). Furthermore, intracanal medication with Ca(OH)2 reduced level of endotoxin in 94.87% (G1) and in 95.34% (G2) (all, P < .05). Conclusions: our clinical study demonstrated that endodontic treatment in irradiated patients may be efficacious. The reciprocating preparation and supplemental irrigation with either ultrasonic or syringe demonstrated efficacy in reducing the contaminant contents of root canal. The use of intracanal medication with Ca(OH)2 in this situation was also very efficient regarding the bacterial load and endotoxins levels.
Objective: this clinical study was conducted to compare the efficacy of endodontic biomechanical preparation protocols, as well as the intracanal medication on the reduction of endotoxins and cultivable bacteria of infected root canal in patients who have received irradiation to the head and neck. Methods: twenty-two infected root canals in patients who have undergone radiation therapy to the head and neck were selected and canals were prepared by reciprocating motion. Then, as supplementary irrigation protocol, randomly divided into 2 groups of 11 patients: G1, apical positive pressure (APP) and G2, passive ultrasonic irrigation (PUI). Both groups involved 2-visit treatment with the placement of Ca(OH)2 medication for 14 days. Samples were collected before and after clinical procedures. A chromogenic LAL assay test was used to quantify endotoxins. Culture techniques were used to determine bacterial counts. The mean percentage after the procedures was compared statistically between groups using the ANOVA post hoc Tukey test with a significance level set at 5%. Results: there was a mean follow-up period of 16 months. Of 22 cases, 21 (95%) were considered successful. One was found with sinus tractus after 12 months. There were no occurrences of osteoradionecrosis. Endotoxins and cultivable bacteria were detected in 100% of the initial samples. All treatment protocols were statistically effective in reducing bacterial load from infected root canals (all, P < .05): G1 (95.41%), G2 (97.86%) and after intracanal medication the bacterial load was G1 after Ca(OH)2 (97.41%), and G2 after Ca(OH)2 (98.95%). No differences were found in bacterial load reduction when comparing the treatment groups (P > .05). All treatment protocols were statistically effective in reducing endotoxin from initial levels. Median reduction for G1 was 78.61 % and for G2, 86.04% (P < .05). Furthermore, intracanal medication with Ca(OH)2 reduced level of endotoxin in 94.87% (G1) and in 95.34% (G2) (all, P < .05). Conclusions: our clinical study demonstrated that endodontic treatment in irradiated patients may be efficacious. The reciprocating preparation and supplemental irrigation with either ultrasonic or syringe demonstrated efficacy in reducing the contaminant contents of root canal. The use of intracanal medication with Ca(OH)2 in this situation was also very efficient regarding the bacterial load and endotoxins levels.
Descrição
Palavras-chave
Periodontite periapical. Tratamento do canal radicular. Endotoxina. Radioterapia. Ultrassom. Cancer., Periodontite periapical, Tratamento do canal radicular, Endotoxina, Radioterapia, Ultrassom, Periapical periodontits, Endodontic treatment, Endotoxins, Radiation therapy, Ultrasonic, Cancer, Cancer