Efetividade do sistema reciproc no tratamento endodôntico de dentes anteriores com lesão periapical: ensaio clínico pragmático randomizado controlado

• Autor(a) principal: Figueiredo, Fabrício Eneas Diniz de
• Data de Publicação: 2019
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UFS
• Texto Completo: http://ri.ufs.br/jspui/handle/riufs/13063
• topic: Doença periodontal; Canal radicular; Ensaio clínico; Tratamento; Periapical periodontitis; Root canal preparation; Clinical trial; CIENCIAS DA SAUDE

The technique of root canal instrumentation with a single reciprocating instrument was developed as an attempt to overcome the limitations presented by manual techniques and using continuous rotation. Despite the easiness to execute it, few studies evaluated the effectiveness of reciprocating instrumentation in clinical practice. Therefore, this pragmatic randomized clinical trial evaluated the clinical effectiveness obtained by an endodontic treatment using a reciprocating single file and a single cone approach. One hundred twenty anterior teeth with necrotic pulp and apical periodontitis were randomly instrumented with hand files and filed with lateral compaction technique; or with a single file in a reciprocating movement followed by root filling with a single cone. The apical extension, homogeneity and taper parameters of obturation were classified as ideal or altered, and the occurrence or absence of sealer extrusion was recorded. Postoperative pain was assessed until 7 days after the treatment using a visual analogue scale (VAS) and a verbal rating scale (VRS). The prevalence of pain (score different from 0 at VRS) and flare-up was evaluated. VAS was also used to assess the participants` perceptions regarding their comfort; time spent by procedures, their chewing ability, and general satisfaction. The periapical index was used to classify the periapical status at baseline and after 6 and 12-months of follow-up. The short version of OHIP questionnaire was used to investigate the impact on quality of Life. Data were analyzed through t-tests, Mann-Whitney, and Chi-Square analysis, and the odds-ratio for healing was adjusted using a Logistic Regression model (α = 0.05). No significant differences were observed between the endodontic techniques regarding the root filling quality, sealer extrusion, or postoperative pain incidence. A higher incidence of pain was observed in the first 24 h (≈ 43.3%), with progressive reduction within that time (≈ 1.7% after 7 days). Both treatments also yielded a similar intensity of postoperative pain measured by either VAS or VRS. Low incidences (≈ 3.3%) of flare-up were observed for both protocols. In general, high levels of participant perceptions were observed for all questions, with no difference between the treatments. The drop-out rate was 27,5%, and the overall healing rates were 66% and 75% for 6 and 12-month follow-up periods, respectively. The healing rate was only affected by the periapical index measured at baseline. Both treatment protocols improved the quality of life of patients. In conclusion, the reciprocating system evaluated resulted in similar quality of toot canal filling, incidence and intensity of postoperative pain, flare-up incidence, and healing rates of apical periodontitis than manual instrumentation. The endodontic protocol does not alter the patient’s perception of treatment. .