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Master's Dissertation
DOI
Document
Author
Full name
Luiza Riomar Paz
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Pinheiro, Ericka Tavares (President)
Akisue, Eduardo
Gavini, Giulio
Iglecias, Elaine Faga
Title in Portuguese
Avaliação da taxa de sucesso do tratamento endodôntico de dentes com periodontite apical utilizando procedimentos complementares de desinfecção: estudo clínico prospectivo
Keywords in Portuguese
Periodontite Apical
Tomografia Computadorizada de Feixe Cônico
Tratamento do canal radicular
Abstract in Portuguese
Este estudo clínico prospectivo avaliou a taxa de sucesso do tratamento endodôntico utilizando um protocolo antimicrobiano definido. Trinta e cinco dentes unirradiculares com periodontite apical primária foram submetidos ao tratamento endodôntico. O preparo químico-cirúrgico foi realizado com instrumentos reciprocantes, utilizando NaOCl 2,5%, seguidos de ativação com o instrumento XP-endo Finisher e irrigação ultrassônica passiva como procedimentos complementares de desinfecção (PCD) na 1a consulta. Os canais radiculares foram preenchidos com pasta de hidróxido de cálcio por 14 dias e obturados após reinstrumentação dos canais radiculares na 2a consulta. Coletas microbiológicas realizadas no momento da obturação, analisadas por qPCR baseada em 16S rDNA, foram correlacionadas com o prognóstico do tratamento. Vinte e sete casos retornaram para acompanhamento, aproximadamente 12 meses após o tratamento. O sucesso do tratamento endodôntico foi analisado baseado em critérios clínicos, radiográficos e tomográficos. A análise das imagens foi realizada por 2 avaliadores treinados, com valor de Kappa igual a 0,74 e 0,6 para tomografia e radiografia, respectivamente. A tomografia computadorizada de feixe cônico (TCFC) apresentou maior especificidade (37%) pós tratamento quando comparada com a radiografia periapical (59,3%) (p = 0,03). Porém, quando o sucesso do tratamento foi analisado pela ausência ou redução da lesão periapical, ambos os métodos apresentaram o mesmo índice de sucesso (89%). A variação do volume das lesões periapicais foi significativa 1 ano após o tratamento (p < 0.0001). Dos 22 casos que possuíam dados microbiológicos, 32% apresentaram reações qPCR positivas no momento da obturação. A presença de baixos níveis de DNA bacteriano no momento da obturação dos canais radiculares não exerceu influência no prognóstico do tratamento. Concluiu-se que a taxa de sucesso do tratamento endodôntico utilizando PCD foi elevada, provavelmente devido à drástica redução bacteriana promovida pelo protocolo estudado.
Title in English
Evaluation of the success rate of endodontic treatment of teeth with apical periodontitis using complementary disinfection procedures: a prospective clinical study
Keywords in English
Apical periodontitis
Cone-Beam Computed Tomography
Root canal therapy
Abstract in English
This prospective clinical trial evaluated the success rate of endodontic treatments using a defined antimicrobial protocol. Thirty-five unirradicular teeth with primary apical periodontitis were submitted to endodontic treatment. The chemicalsurgical preparation was performed with reciprocating instruments, using NaOCl 2.5%, followed by activation with XP-endo Finisher and passive ultrasonic irrigation as complementary procedures in the 1st session. The root canals were dressed with calcium hydroxide paste for 14 days and root filing were performed after re-instrumentation. Microbiological samples were performed at the time of root filling, analyzed by qPCR based on 16S rDNA, and correlated with the treatment outcome. Twenty-seven cases returned for follow-up, approximately 12 months after treatment. The success of endodontic treatment was analyzed based on clinical, radiographic and tomographic criteria. The images analysis was performed by 2 trained evaluators with a Kappa value of 0.74 and 0.6 for tomography and radiography, respectively. Cone-beam computed tomography (CBCT) showed higher rate of specificity (37%) post treatment when compared to periapical radiography (59.3%) (p = 0.03). However, when the success was analyzed by absence or reduction of the periapical lesion, both methods had similar success rate (89%). The periapical lesions volume was significantly reduced 1 year after treatment (p <0.0001). From 22 cases with microbiological data, 32% had positive qPCR reactions at the time of root filling. The presence of low levels of bacterial DNA at the moment of root filling had no influence on the treatment outcome. It was concluded that the success rate of endodontic treatment using complementary disinfection procedures was high, probably due to the drastic bacterial reduction promoted by the studied protocol.
 
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Publishing Date
2019-09-04
 
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