Instrumental piezoeléctrico en comparación a instrumental rotatorio convencional para la exodoncia de terceros molares mandibulares / Piezoelectric bone surgery versus conventional rotatory system for lower third molar surgery

RESUMEN: Introducción: Tradicionalmente la osteotomía requerida en la exodoncia de terceros molares mandibulares incluidos o semi-incluidos ha sido realizada con instrumental manual o rotatorio. Con el advenimiento de la técnica ultrasónica de la cirugía piezoeléctrica, se hace necesario comparar la seguridad y efectividad de ambas técnicas. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos ocho revisiones sistemáticas que en conjunto incluyeron 22 estudios primarios, de los cuales 12 corresponden a ensayos clínicos aleatorizados. Concluimos que el uso de instrumental piezoeléctrico en comparación con el instrumental rotatorio convencional podría aumentar el tiempo quirúrgico y podría disminuir el dolor temprano y tardío, junto con el edema al día siete, pero la certeza de la evidencia es baja. Por otra parte, el uso de instrumental piezoeléctrico podría resultar en poca o nula diferencia en el desarrollo de alteraciones neurológicas postoperatorias ya que la certeza de la evidencia es baja. Además, el uso de piezoeléctrico probablemente resulte en poca o nula diferencia en la apertura bucal.

ABSTRACT: Introduction: Traditionally, osteotomy techniques required in exodontia of included or semi-included mandibular third molars has been performed with manual or rotary instruments. With the advent of the ultrasonic technique of piezoelectric surgery, it is necessary to evaluate the effectiveness and safety of both osteotomy techniques. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed primary studies' data, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified eight systematic reviews that together included 22 primary studies overall, of which 12 were randomized trials. We conclude that the use of piezoelectric surgery compared with conventional rotary instruments may increase operative time and reduce early and late pain, along with edema at day seven, but the certainty of the evidence is low. On the other hand, the use of piezoelectric instrumentation may result in little or no difference in the development of postoperative neurologic disturbances as the certainty of the evidence is low. Also, piezoelectric use probably makes little or no differences in mouth opening.

Shaping ability of rotatory or reciprocating instruments in curved canals: a micro-computed tomographic study

Abstract This study aimed to compare apical transportation, centering ratio, and working time during root canal preparation with Wizard Navigator (WN), WaveOne (WO), or ProTaper Universal (PT) and to describe deformation and fracture of these instruments. Thirty-six mesiobuccal roots from maxillary molars were micro-computed tomography (micro-CT) scanned and then sorted into three groups (n = 12): Wizard Navigator (WN), WaveOne (WO), and ProTaper Universal (PT). The root canals were prepared using WN, WO, or PT; the time of each canal preparation was timed; and the specimens were micro-CT re-scanned. The instruments were submitted to scanning electron microscopy (SEM) before and after their use. The data on canal transportation at 1, 2, 3, 4 and 5 mm and preparation time were analyzed by the Kruskal-Wallis test, followed by the Mann-Whitney U test. The centering ratio was analyzed by ANOVA, followed by Tukey's test. Both instrument deformation and fracture were described. Apical transportation was similar among groups at 1, 2, 3 and 4 mm. The WO group showed higher canal transportation at 5mm than the other groups (p = 0.03). There was no significant difference in centering ratio among the groups. Preparation time in the WO group was significantly lower than in the other groups (p = 0.004). Small differences were observed in the surface area of all instruments. The WN, WO, and PT groups had a similar centering ratio without procedural errors or significant structural changes. At 5 mm from the apex, the WO group showed the largest canal transportation toward the furcation and root canal preparation was faster than in the WN and PT groups.