Revista de Odontologia da UNESP
https://revodontolunesp.com.br/article/doi/10.1590/1807-2577.05015
Revista de Odontologia da UNESP
Original Article

Eficácia das manobras de desbridamento no preparo químico-mecânico quanto à desinfecção no terço apical em molares humanos

Efficacy of chemo-mechanical preparation debridement procedures in disinfection of the apical third of human molar root canals

Moreira, Ana Lúcia Barbosa; Gadê Neto, Cícero Romão; Dametto, Fábio Roberto; Sant'anna, Giselle Rodrigues de; Carvalho, Rejane Andrade de

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Resumo

Objetivo: Avaliar a eficácia das manobras de desbridamento no preparo químico-mecânico (PQM) quanto a limpeza e desinfecção no terço apical em molares humanos. Material e método: Cinquenta raízes mesiais de molares inferiores humanos com dois canais radiculares foram inoculadas com E. faecalis e distribuídas aleatoriamente em cinco grupos (n=10). O PQM foi realizado com o sistema Protaper associado ao desbridamento com as limas Kerr #10 (G1 e G3) e as limas Kerr #15 (G2 e G4). O G5 representou o controle positivo, o qual foi submetido apenas ao PQM, sem receber o desbridamento. Outra variável foi o uso da medicação intracanal (MIC) à base de hidróxido de cálcio (Calen), que foi aplicada aos grupos G3 e G4. A irrigação foi feita com hipoclorito de sódio 2,5% e EDTA 17%. A análise da ação antimicrobiana se deu através da contagem das unidades formadoras de colônias (UFC). Resultado: Foram aplicados o Teste Kruskal-Wallis (nas análises imediatas) e o Teste Mann-Whitney (nas análises mediatas), ambos com p=0,01. A análise imediata ao PQM apresentou-se sem diferença estatística entre os grupos (p=0,11). No G4 (#15 + MIC), os resultados das coletas mediatas foram estatisticamente significantes (p=0,01). Conclusão: O desbridamento com as limas Kerr #10 e #15 não apresentou diferença significativa quanto à redução das colônias de E. faecalis quando comparado ao grupo em que não se realizou o desbridamento. Nos espécimes em que se aplicou a MIC, o desbridamento com a lima Kerr #15 (G4) foi mais eficiente do que a lima Kerr #10 (G3) em reduzir as UFC.

Palavras-chave

Desbridamento, Enterococus faecalis, microbiologia

Abstract

Aim: The aim of this in vitro study was to evaluate the efficacy of chemo-mechanical preparation (CMP) debridement procedures in regard to cleansing and disinfection of the apical third of human molar canals using different protocols. Material and method: Fifty mesial roots of human mandibular molars containing two canals were inoculated with E. faecalis strains and randomly allocated to five groups (n=10). CMP was carried out with the rotatory Protaper system associated with Kerr files #10 (G1 and G3) and #15 (G2 and G4). G5, the positive control, was subjected to CMP without debridement. Another variable studied was the use of calcium hydroxide-based temporary intracanal medication (Calen) prior to the chemo-mechanical performed in the G3 and G4 groups. Irrigation was performed with 2.5% sodium hypoclorite and 17% EDTA. Antimicrobial activity was quantified by counting the number of colony-forming units (CFU). Result: Kruskal-Wallis was used for immediate analyses and Mann-Whitney for mediate analyses both with a stipulated value of significance of p=0.01. In the imediate analyses following CMP there were no significant differences among the groups (p=0.11). In the G4 (#15 + MIC) the results of the mediate collections were statistically significant (p=0.01). Conclusion: Debridement with #10 and #15 Kerr files did not produce significant differences in regard to reduction of E. faecalis when compared to the positive control. In samples where Calen intracanal medication was used debridement with #15 Kerr files was more efficient in reducing the number of CFUs than #10 Kerr files.

Keywords

Debridement, Enterococus faecalis, microbiology

References

1. Love RM, Jenkinson HF. Invasion of dentinal tubules by oral bacteria. Crit Rev Oral Biol Med. 2002;13(2):171-83. http://dx.doi.org/10.1177/154411130201300207. PMid:12097359.

2. Smadi L. Comparison between two methods of working length determination and its effect on radiographic extent of root canal filling: a clinical study. BMC Oral Health. 2006;6(1):4. http://dx.doi.org/10.1186/1472-6831-6-4. PMid:16472401.

3. Souza RA. The importance of apical patency and cleaning of the apical foramen on root canal preparation. Braz Dent J. 2006;17(1):6-9. http://dx.doi.org/10.1590/S0103-64402006000100002. PMid:16721456.

4. Bechelli C, Orlandini SZ, Colafranceschi M. Scanning electron microscope study on the efficacy of root canal wall debridement of hand versus Lightspeed instrumentation. Int Endod J. 1999 Nov;32(6):484-93. http://dx.doi.org/10.1046/j.1365-2591.1999.00250.x. PMid:10709497.

5. Soares JA, Silveira FF, Nunes E, Jham B, Borges EF. Análise in vitro da distância do forame principal ao extremo radiográfico dos dentes anteriores. Arq Odontol. 2005;41(3):215-25.

6. Ribeiro APD, Malnati PS, Costa ED Jr. Limpeza do forame e extrusão apical de raspas de dentina em dentes unirradiculares submetidos ao procedimento de patência apical. Pesq Bras Odontoped Clin Integr. 2010;10(1):55-60. http://dx.doi.org/10.4034/1519.0501.2010.0101.0009.

7. Kuttler Y. Microscopic investigation of root apexes. J Am Dent Assoc. 1955 May;50(5):544-52. http://dx.doi.org/10.14219/jada.archive.1955.0099. PMid:14366934.

8. Souza-Filho FJ, Benatti O, Almeida OP. Influence of the enlargement of the apical foramen in periapical repair of contaminated teeth of dog. Oral Surg Oral Med Oral Pathol. 1987 Oct;64(4):480-4. http://dx.doi.org/10.1016/0030-4220(87)90157-5. PMid:3477772.

9. Matsumiya S. Experimental pathological study on the effect of treatment of infected root canals in the deciduous tooth on growth of the permanent tooth germ. Int Dent J. 1968 Sep;18(3):546-59. PMid:5246847.

10. Souza RA. Limpeza de forame e sua relação com a dor pós-operatória. Jornal Brasileiro de Endo/Perio. 2000 Out-Dez;1(3):45-8.

11. Molander A, Reit C, Dahlén G, Kvist T. Microbiological status of root-filled teeth with apical periodontitis. Int Endod J. 1998 Jan;31(1):1-7. http://dx.doi.org/10.1046/j.1365-2591.1998.t01-1-00111.x. PMid:9823122.

12. Dametto FR, Ferraz CC, Gomes BP, Zaia AA, Teixeira FB, Souza-Filho FJ. In vitro assessment of the immediate and prolonged antimicrobial action of chlorhexidine gel as an endodontic irrigant against Enterococcus faecalis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Jun;99(6):768-72. http://dx.doi.org/10.1016/j.tripleo.2004.08.026. PMid:15897866.

13. Lopes HP, Martins CMMS, Carvalho RM, Siqueira JF Jr, Cabreira MS. Análise de diversas marcas de água sanitária: confiabilidade e segurança de uso como solução química auxiliar em endodontia. Rev Bras Odontol. 1999 Nov-Dez;56(3):319-22.

14. Yang SF, Rivera EM, Walton RE, Baumgartner KR. Canal debridement: effectiveness of sodium hypochlorite and calcium hydroxide as medicaments. J Endod. 1996 Oct;22(10):521-5. http://dx.doi.org/10.1016/S0099-2399(96)80010-0. PMid:9198438.

15. Drake DR, Wiemann AH, Rivera EM, Walton RE. Bacterial retention in canal walls in vitro: effect of smear layer. J Endod. 1994 Feb;20(2):78-82. http://dx.doi.org/10.1016/S0099-2399(06)81186-6. PMid:8006570.

16. Kokkas AB, Boutsioukis AC, Vassiliadis LP, Stavrianos CK. The influence of the smear layer on dentinal tubule penetration depth by three different root canal sealers: an in vitro study. J Endod. 2004 Feb;30(2):100-2. http://dx.doi.org/10.1097/00004770-200402000-00009. PMid:14977306.

17. Berutti E, Marini R. A scanning electron microscopic evaluation of the debridement capability of sodium hypochlorite at different temperatures. J Endod. 1996 Sep;22(9):467-70. http://dx.doi.org/10.1016/S0099-2399(96)80079-3. PMid:9198427.

18. Munley PJ, Goodell GG. Comparison of passive ultrasonic debridement between fluted and nonfluted instruments in root canals. J Endod. 2007 May;33(5):578-80. http://dx.doi.org/10.1016/j.joen.2007.01.009. PMid:17437876.

19. Coniglio I, Carvalho CA, Magni E, Cantoro A, Ferrari M. Post space debridement in oval-shaped canals: the use of a new ultrasonic tip with oval section. J Endod. 2008 Jun;34(6):752-5. http://dx.doi.org/10.1016/j.joen.2008.03.017. PMid:18498906.

20. Siu C, Baumgartner JC. Comparison of the debridement efficacy of the Endo Vac irrigation system and conventional needle root canal irrigation in vivo. J Endod. 2010 Nov;36(11):1782-5. http://dx.doi.org/10.1016/j.joen.2010.08.023. PMid:20951287.

21. Flanders DH. Endodontic patency. How to get it. How to keep it. Why it is so important. N Y State Dent J. 2002 Mar;68(3):30-2. PMid:11989335.

22. Yu DC, Tam A, Schilder H. Patency and envelope of motion: two essential procedures for cleaning and shaping the root canal systems. Gen Dent. 2009 Nov-Dec;57(6):616-21. PMid:19906613.

23. Alencar AH, Pimenta FC, Ito IY, Bruno KF, Leonardo MR. Determinação dos microrganismos no canal radicular, antes do preparo biomecânico e após a utilização de medicação intracanal em dentes com necrose pulpar e reação periapical crônica. Arq Odontol. 2005;41(2):170-82.

24. Camões IC, Salles MR, Fernando MV, Freitas LF, Gomes CC. Relationship between the size of patency file and apical extrusion of sodium hypochlorite. Indian J Dent Res. 2009 Oct-Dec;20(4):426-30. http://dx.doi.org/10.4103/0970-9290.59443. PMid:20139565.

25. Sjögren U, Figdor D, Spångberg L, Sundqvist G. The antimicrobial effect of calcium hydroxide as a short-term intracanal dressing. Int Endod J. 1991 May;24(3):119-25. http://dx.doi.org/10.1111/j.1365-2591.1991.tb00117.x. PMid:1778624.

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