Objective:The purpose of this study was to compare the amount of residual smear layer after root canal instrumentation by using Ni-Ti, M-Wire, and CM-Wire instruments.Materials and Methods:Seventy-two mandibular incisors were randomly divided into six groups according to the system used: WaveOne (WO), Reciproc (RP), Unicone (UC), ProTaper Next (PN), Mtwo (MT), and HyFlex (HF). Afterward, the specimens were cleaved in the mesiodistal and buccolingual direction for analysis by scanning electron microscopy.Results:Considering both directions and root canal thirds, there was no difference between HF, MT, and PN. RP, UC, and WO presented a significant difference between the directions, and the cervical third showed a significantly smaller quantity of residual smear layer compared with the apical third. When the systems were compared among them, there was a significant difference only between RP and WO.Conclusions:Residual smear layer observed after instrumentation with the different systems was similar, except for quantities between the reciprocating systems.
Objectives The aim of this study was to compare smear layer removal by conventional application (CA), passive ultrasonic irrigation (PUI), EasyClean (EC), and XP-Endo Finisher (XPF), using 17% ethylenediaminetetraacetic acid (EDTA) after chemomechanical preparation, as evaluated with scanning electron microscopy (SEM). Materials and Methods Forty-five single-rooted human mandibular premolars were selected for this study. After chemomechanical preparation, the teeth were randomly divided into 5 groups according to the protocol for smear layer removal, as follows: G1 (control): CA of distilled water; G2 (CA): CA of 17% EDTA; G3 (PUI): 17% EDTA activated by PUI; G4 (EC): 17% EDTA activated by EC; and G5 (XPF): 17% EDTA activated by XPF. SEM images (×1,000) were obtained from each root third and scored by 3 examiners. Data were evaluated using the Kruskal-Wallis and Dunn tests ( p < 0.05). Results In the apical third, there were no statistically significant differences among the groups ( p > 0.05). In the cervical and middle thirds, the experimental groups performed better than the control group ( p < 0.05); however, G2 presented better results than G3, G4, and G5 ( p < 0.05), which showed no differences among one another ( p > 0.05). Conclusions No irrigation method was able to completely remove the smear layer, especially in the apical third. Using CA for the chelating solution performed better than any form of activation.
Objectives To evaluate postoperative pain after endodontic treatment of necrotic teeth using large intentional foraminal enlargement (LIFE). Materials and Methods The sample included 60 asymptomatic necrotic teeth (with or without chronic apical periodontitis), and a periodontal probing depth of 3 mm, previously accessed and referred to perform endodontic treatment. After previous procedures, the position and approximate size of the apical foramen (AF) were determined by using an apex locator and K flexo-files, respectively. The chemomechanical preparation was performed with Profile 04 files 2 mm beyond the AF to achieve the LIFE, using 2.5 mL of 2.5% NaOCl at each file change. The filling was performed by Tagger's hybrid technique and EndoFill sealer. Phone calls were made to all the patients at 24, 48 and 72 hours after treatment, to classify postoperative pain. Statistical analysis was performed by different tests with a significance level of 5%. Results Age, gender, periradicular status and tooth type did not influence postoperative pain ( p > 0.05). Only 1 patient (1.66%) reported severe pain after 72 hours. Moderate pain was reported by 7, 4 and 3 patients after 24, 48 and 72 hours, respectively ( p = 0.0001). However, paired analyses showed a statistically significant difference only between 24 and 72 hours ( p = 0.04). Sealer extrusion did not influence the postoperative pain ( p > 0.05). Conclusions Acute or moderate postoperative pain was uncommon after endodontic treatment of necrotic teeth with LIFE. Trial Registration The Brazilian Clinical Trials Registry Identifier: RBR-3r967t
Introdução: A infecção endodôntica pode alcançar a saída foraminal e, inclusive, ir além dela. Logo, a determinação da constrição apical como o limite ideal para instrumentação e obturação tem sido questionada. A instrumentação foraminal intencional é realizada com o intuito de diminuir o contingente microbiano a níveis mais favoráveis ao reparo. Entretanto, repercussões locais e sistêmicas estão associadas à sua execução. Objetivo: Realizar uma revisão crítica da literatura sobre repercussões locais e sistêmicas relativas à instrumentação foraminal intencional. Métodos: Em março de 2018, uma busca eletrônica realizada na base de dados PUBMED utilizando os termos “foraminal enlargement” OR “foraminal widening” OR “apical limit” AND “endodontics” identificou 74 artigos científicos. Esses artigos, a análise de suas referências bibliográficas e a utilização de mais 5 artigos base resultaram nos 111 estudos consultados para a realização dessa pesquisa. Resultados: A ampliação foraminal intencional nem sempre pode ser praticada em virtude de razões anatômicas e morfológicas. Quanto maior a ampliação do forame apical, maior a possibilidade de extravasamento de substâncias e/ou materiais utilizados para a realização do tratamento endodôntico. A instrumentação foraminal intencional parece ser contraindicada em pacientes que fazem ou fizeram uso de bisfosfonatos recentemente, com distúrbios de coagulação e/ou sob uso crônico de anticoagulantes e com alto risco de bacteremia. Conclusões: Os impactos da instrumentação foraminal intencional sobre o sucesso do tratamento endodôntico devem ser investigados. Contudo, os delineamentos metodológicos dos estudos clínicos devem ser cuidadosos, principalmente no tocante às condições sistêmicas dos pacientes que farão parte do universo amostral.
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