Tratamiento endodóntico en una sesión comparado con múltiples sesiones en pacientes con dentición permanente / Single versus multiple visits for endodontic treatment in permanent teeth

RESUMEN: Introducción: El tratamiento endodóntico corresponde a un procedimiento común en la práctica odontológica y su éxito depende de una serie de factores, entre los cuales se ha planteado que existe una diferencia entre los resultados de los tratamientos realizados en una o múltiples visitas. 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 meta análisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos 10 revisiones sistemáticas que en conjunto incluyeron 46 estudios primarios, de los cuales, 26 corresponden a ensayos aleatorizados que evalúan el tratamiento endodóntico en dientes vitales y no vitales. Concluimos que el tratamiento endodóntico en una sesión podría resultar en poca o nula diferencia sobre el dolor a corto plazo e infecciones postoperatorias, pero la certeza de la evidencia es baja. Además, podría reducir levemente el riesgo de exodoncias dentarias, también podría aumentar el uso de analgésicos y flare-ups, pero la certeza de la evidencia es baja. Finalmente, no está claro el efecto del tratamiento endodóntico en una sesión sobre el dolor a mediano plazo, debido a que la certeza de la evidencia existente ha sido evaluada como muy baja.

ABSTRACT: Introduction: Endodontic treatment is a common procedure in dentistry and its success depends on several factors. It has been suggested that there is a difference in terms of effectiveness on endodontic treatments performed in one compared to those performed in multiple visits. 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 data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified 10 systematic reviews including 46 studies overall, of which 26 were randomized trials. We concluded that single versus multiple visits for endodontic treatment in permanent teeth may make little or no difference to short-term pain and postoperative infection, but the certainty of the evidence has been assessed as low. Also, single visit treatment may reduce the risk of extraction due to endodontic problem, increased the risk of painkiller use and flare-ups, but the certainty of the evidence has been assessed as low. We are uncertain about the effect of single visit treatment on medium-term pain, as the certainty of the evidence has been assessed as very low.

Radiographic and immunohistochemical evaluation of root canal treatment using different irrigation systems

Abstract The aim of this study was to evaluate the radiographic periapical repair and the synthesis of inflammatory mediators after endodontic treatment in a single session, using different irrigation protocols, in teeth with apical periodontitis. Experimental apical periodontitis were induced in dog's teeth randomly assigned into 4 groups: G1 - Irrigation by Negative Apical Pressure (n= 20); G2 - Passive Ultrasonic Irrigation (n= 20), G3 - Positive Pressure Irrigation (n= 20); G4 - apical periodontitis without treatment (n= 20). After 180 days, the animals were euthanized, the tissues removed and submitted to histotechnical processing for immunohistochemical analysis of osteopontin (OPN), tumor necrosis factor-a (TNF-a) and interleukin 1-a (IL-1a). Radiographic analysis was performed using the Periapical Index (PAI), obtained prior to and 180 days following endodontic treatment. Data were analyzed using Wilcoxon signed-rank test, Fisher's Exact test or Kruskal-Wallis test and Dunn's post-test (a = 5%). Radiographically, after endodontic treatment, apical periodontitis persisted in 35% of G1 specimens, 40% of G2 and 40% of G3 (p>0.05), although a PAI reduction was observed (p<0.05). By immunohistochemical evaluation, endodontic treatment resulted in lower synthesis of TNF-a and OPN in periapical region, compared to apical periodontitis without treatment (p<0.05). Production of IL-1 was not modulated by endodontic treatment (p>0.05). Periapical healing was observed in approximately 60% of the cases after endodontic treatment performed in a single session with lower synthesis of TNF-a and OPN in the periapical region, regardless of the irrigation protocol used.

Resumo O objetivo deste estudo foi avaliar o reparo periapical e a síntese de mediadores inflamatórios após tratamento endodôntico em dentes de cães com lesão periapical, em sessão única, utilizando diferentes protocolos de irrigação. Lesões periapicais foram induzidas experimentalmente em dentes de cães e aleatoriamente divididas em 4 grupos: G1 - Irrigação por Pressão Apical Negativa (n = 20); G2 - Irrigação Ultrassônica Passiva (n = 20), G3 - Irrigação por Pressão Positiva (n = 20); G4 - Lesão periapical sem tratamento (n = 20). Após 180 dias, os animais foram eutanasiados, as peças removidas e submetidas ao processamento histotécnico para análise imunohistoquímica para osteopontina (OPN), fator de necrose tumoral-a (TNF-a) e interleucina 1-a (IL-1a). A análise radiográfica do reparo das lesões periapicais foi realizada por meio do Índice Periapical, obtido antes e 180 dias após o tratamento endodôntico. Os resultados obtidos foram submetidos à análise estatística por meio dos testes de sinais de Wilcoxon, Exato de Fisher ou Kruskal-Wallis seguido pelo pós-teste de Dunn (a = 5%). O exame radiográfico após o tratamento endodôntico, mostrou a persistência de áreas radiolúcidas periapicais e descontinuidade da lâmina dura em 35% dos espécimes do G1, 40% do G2 e 40% do G3, embora uma redução no PAI tenha sido observada (p<0,05). Pela análise imuno-histoquímica, o tratamento endodôntico resultou na menor síntese de TNF-a e de OPN na região periapical, comparativamente à lesão periapical sem tratamento (p<0,05). A produção de IL-1a não foi modulada pelo tratamento endodôntico (p>0,05). Reparo da lesão periapical foi observado em cerca de 60% dos casos após tratamento endodôntico realizado em sessão única e menor síntese de TNF-a e de OPN na região periapical, independente do protocolo de irrigação utilizado.

Effect of preoperative ibuprofen in controlling postendodontic pain with and without low-level laser therapy in single visit endodontics: A randomized clinical study

Aim: The aim of this study is to evaluate the effect of low-level laser irradiation and ibuprofen in reducing the onset and severity of postoperative pain following single visit endodontics. Materials and Methods: One hundred and twenty patients were recruited for this study. Group A (n = 30) patients were administered 400 mg of ibuprofen orally 1 h before the institution of an endodontic procedure. Group B (n = 30) patients were given irradiation of a low-level laser at 50 Hz for 3 min after the standard endodontic procedure at the periapical region on both buccal and lingual aspect. Group C (n = 30) patients were given preoperative ibuprofen followed with a low-level laser at 50 Hz for 3 min after endodontic treatment. Group D (n = 30) patients were administered no preoperative ibuprofen nor low-level laser irradiation after the endodontic procedure. The patient immediately recorded his/her pain perception on the Heft Parker pain survey after completion of the appointment and at 4, 8, 12, 24, and 48 h postoperatively. Inter group analysis was carried out using the analysis of variances with “least significant difference” post hoc test. For intra group analysis, Student's t-test was used. Chi-square test was applied for nonparametric data. Results: Pain was significantly reduced in all the treatment groups postoperatively. Ibuprofen showed significant pain reduction at 4 h and 8 h period. The combination of low-level laser and ibuprofen showed the best results in terms of postoperative pain reduction. Conclusion: This study proved that low-level laser therapy can be an effective alternative for conventional use of nonsteroidal anti-inflammatory drugs in controlling postendodontic pain thereby eliminating the adverse effects of such drugs on the patients.

Comparative evaluation of postoperative pain intensity after single-visit and multiple-visit retreatment cases: a prospective randomized clinical trial / Avaliação comparativa da intensidade da dor pos-operatoria após casos de retratamento em sessao unica ou multipla: estudo clínico randomizado prospectivo

Objectives: This study was designed to evaluate postoperative pain after endodontic retreatment. Material and Methods: Asymptomatic, multirooted molar & premolar teeth requiring retreatment with 2­5 mm periapical lesions were included. Seventy-eight teeth were randomly placed in four groups (n=20): single-visit (control, group 1), Ledermix (group 2), metronidazole, ciprofloxacin, minocycline mixture (group 3), calcium hydroxide (group 4). The postoperative pain was recorded using a VAS at 6, 12, 24, and 48 h after retreatment. Statistical evaluation was performed using TwoWay Repeated Measures ANOVA and Tukey test. Results: Mild pain occurred in 67.5%, moderate in 30%, and flare-ups in 2.5%, and there was a significant difference between the groups (p <0.01). Significantly lower postoperative pain was observed in TAP and CaOH2 groups (p <0.05). In the 6, 12, and 24 h intervals, there was a significant difference in the pain levels (p <0.05). Conclusion: TAP and CaOH2 are effective for reducing postoperative pain after retreatment. (AU)

Objetivo: Este estudo foi projetado para avaliar a dor pós-operatória após o retratamento endodôntico. Material e Métodos: Foram incluídos dentes molares e pré-molares multirradiculados e assintomáticos que necessitavam de retratamento com lesões periapicais de 2-5 mm. Setenta e oito dentes foram distribuídos aleatoriamente em quatro grupos (n = 20): sessão única (controle, grupo I), Ledermix (grupo II), metronidazol, ciprofloxacina, mistura de minociclina (grupo III), hidróxido de cálcio (grupo IV). A dor pós-operatória foi registrada usando um VAS às 6, 12, 24 e 48 h após o retratamento. A análise estatística foi realizada utilizando ANOVA de dois fatores para medidas repetidas e teste de Tukey. Resultados: Ocorreu dor leve em 67,5%, moderada em 30% e agudizações 2,5%, e houve diferença significativa entre os grupos (p <0,01). Foi observada dor pós-operatória significativamente menor nos grupos TAP e hidróxido de cálcio (p <0,05). Nos intervalos de 6, 12 e 24 h, houve diferença significativa nos níveis de dor (p <0,05). Conclusão: TAP e hidróxido de cálcio são eficazes para reduzir a dor pós-operatória após o retratamento.(AU)

Natural Rehabilitation of Fractured Anterior Tooth Using Reattachment, a Single Visit Endo- Esthetic Approach- A Case Report.

Anterior teeth crown fracture of a growing child requires immediate attention, not only because of damage to the dentition but also due to unsightly smile and facial appearance affected by trauma to the child. Thus esthetic management of anterior tooth fracture has been one of the most important aspects of dentistry and when it has to be done using the tooth’s own structure, it sounds psychologically more acceptable. And with the development of resin-based materials that offer high bond strength values, it has made possible to undoubtedly go for reattachment technique with ease. For further simplification, single visit rotary endodontics using ProTaper Universal system is recommended as it is designed to offer better features like flexibility and less chairside time than hand instrumentation. Presented here is one such case in which a combination of single visit rotary endodontics and adhesive reattachment using flowable composites has been carried out to reframe the broken tooth and comply with the patient’s concern. The treatment was found to be successful both functionally and aesthetically at the 18-month follow-up.

Endodontists perceptions of single and multiple visit root canal treatment: a survey in Florianópolis - Brazil

Introduction: One of the main debates that have occurred in Endodontics is about the amount of sessions required to complete an appropriate treatment. There are very different philosophies regarding this matter. Objective: to the aim of this study was to investigate the Endodontists' point of view regarding single and multiple visit root canal treatment, identifying the basis on which the choice is made and how the information necessary for the choice is acquired. Material and methods: Endodontists registered in the dental practice board of Florianópolis/SC were contacted, and if they agreed to participate, they were interviewed using a questionnaire. The following topics were addressed: demographics, current clinical procedures, treatment rationales and preferences. Forty-three endodontists agreed to participate in the study. Results: Single visit endodontic treatment is carried out in 59.5% of biopulpectomy cases, 31.0% of necropulpectomy cases without lesion and only 11.9% in necropulpectomy cases with periapical lesion. The presence of vital pulp (81.4%) and a canal without exudate (93.0%) are the most important criteria for carrying out single visit endodontic treatment. The most used intracanal medication was calcium hydroxide. The lack of studies comparing long-term success on single visit endodontic treatment is considered an important issue to determine this therapy. Conclusion: It can be concluded that Florianopolis-Brazil endodontists prefer multiple visit over single visit root canal treatment in pulp necrosis cases. When pulp vitality is not compromised there is an increase in the number of endodontists who choose single visit root canal treatment.

Single Visit Apexification With Mineral Trioxide Aggregate.

Mineral trioxide aggregate appears to be a promising alternative to calcium hydroxide apexification because of its high biocompatibility, superior sealing ability and reduced treatment time.. Two case reports where the patients presented with fractured upper anterior teeth. Radiographic evaluation revealed open apices with blunderbuss canals. Apical stop was created with mineral trioxide aggregate by apexification and the root canals were obturated with thermoplasticized guttapercha.