Usos del láser en la terapia endodóntica: revisión de la literatura / Laser uses in endodontic therapy: literature review

Últimamente, el uso del láser en endodoncia ha ganado aceptación llegando a considerarse como un complemento a la terapia endodóntica, la cual tiene como objetivo realizar una efectiva conformación, limpieza y desinfección del sistema de canales radiculares (SCR), permitiendo una eliminación eficaz de microorganismos presentes, y así prevenir la reinfección del canal. Se han adoptado diferentes métodos de aplicación del láser para mejorar la desinfección del SCR, los cuales podrían ser eficaces para reducir la población microbiana presentes al interior de los canales, por medio de la activación del irrigante utilizado. El empleo de láser también podría ser útil en procedimientos endodónticos quirúrgicos los cuales tienen por objetivo mantener el diente y sus raíces cuando el tratamiento convencional ha fallado, los efectos positivos del láser se centrarían en el descenso de la inflamación y del aumento de volumen, además de la disminución de la filtración de los materiales de sello ortógrado en dientes apicectomizados. Otro de los usos de láser en esta materia está relacionado con el manejo del dolor post-terapia endodóntica, el que se ha visto ser prometedor. Se definen dos tipos de láseres: de baja potencia, que produce una acción bioestimulante, analgésica y antiinflamatoria de los tejidos biológicos, utilizada además en procesos de descontaminación del SCR, y de alta potencia o láser quirúrgico, con el que se pueden realizar incisiones, exéresis, realizando funciones de corte y coagulación.

Lately, the use of laser in endodontics has gained acceptance, being considered as a complement to endodontic therapy, which aims to carry out an effective shaping, cleaning and disinfection of the root canal system (RCS), allowing an effective elimination of microorganisms present, and thus prevent reinfection of the canal. Different laser application methods have been adopted to improve the disinfection of the RCS, which could be effective in reducing the microbial population present inside the canals, by activating the irrigant used. The use of laser could also be useful in surgical endodontic procedures which aim to maintain the tooth and its roots when conventional treatment has failed, the positive effects of laser would focus on reducing inflammation and increasing volume, in addition of the reduction in the filtration of orthograde seal materials in apicoectomized teeth. Another use of laser in this area is related to post-endodontic therapy pain management, which has shown promise. Two types of lasers are defined; low-power, which produces a biostimulant, analgesic and anti-inflammatory action of biological tissues, also used in RCS decontamination processes, and high-power or surgical laser, with which incisions, excision, performing cutting functions and coagulation.

The top 10 most-cited articles on the management of fractured instruments: a bibliometric analysis.

OBJECTIVES: The purpose of this research was to identify the top 10 most-cited articles on the management of fractured or broken instruments and to perform a bibliometric analysis thereof. MATERIALS AND METHODS: Published articles related to fractured instruments were screened from online databases, such as Web of Science, Scopus, PubMed, and ScienceDirect, and highly cited papers, with at least 50 citations since publication, were identified. The most-cited articles were selected and analysed with regard to publication title, authorship, the journal of publication, year, institution, country of origin, article type, and number of citations. RESULTS: The top 10 most-cited articles were from various journals. Most were published in the Journal of Endodontics, followed by the International Endodontic Journal, and Dental Traumatology. The leading countries were Australia, Israel, Switzerland, the USA, and Germany, and the leading institution was the University of Melbourne. The majority of articles among the top 10 articles were clinical research studies (n = 8), followed by a basic research article and a non-systematic review article. CONCLUSIONS: This bibliometric analysis revealed interesting information about scientific progress in endodontics regarding fractured instruments. Overall, clinical research studies and basic research articles published in high-impact endodontic journals had the highest citation rates.

Apical Transportation of Mesiobuccal Canals of Maxillary Molars Following Root Canal Preparation with Two Rotary Systems and Hand Files: A Cone-Beam Computed Tomographic Assessment.

OBJECTIVES: This study aimed to compare the transportation of the mesiobuccal canal of maxillary molars following root canal preparation with HyFlex CM (HCM) and Edge Taper Platinum (ETP) rotary systems and stainless steel (SS) hand files using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: This in-vitro study was performed on 48 maxillary molars in three groups of 16. The teeth were mounted in acrylic blocks, and root canals were prepared using HCM in group 1 (up to #30/0.06), ETP in group 2 (up to F3/0.06), and SS hand files in group 3 (up to #30). CBCT scans were taken before and after root canal preparation. The amount of canal transportation was measured at 0, 3, 6, and 9mm from the apex. Data were analyzed using Kruskal-Wallis and Mann-Whitney tests. RESULTS: The difference in canal transportation at 0 and 6mm from the apex was significant between the HCM and ETP groups (P=0.031 and 0.023) but none of the systems showed any significant difference with hand files at 0-and 6-mm levels (P=0.10, 0.56, 0.22, and 0.50), respectively. At 3mm from the apex, no significant difference was noted among the groups (P=0.30). At the 9-mm level, the amount of canal transportation was not significantly different between HCM and ETP (P=0.83) but they showed significant differences with hand files (P<0.001). CONCLUSION: ETP and HCM caused less canal transportation at the curvature of the mesiobuccal canal of maxillary molars compared to hand files. ETP showed superior efficacy in root canal preparation compared to HCM.

The top 10 most-cited articles on the management of fractured instruments: a bibliometric analysis

OBJECTIVES: The purpose of this research was to identify the top 10 most-cited articles on the management of fractured or broken instruments and to perform a bibliometric analysis thereof. MATERIALS AND METHODS: Published articles related to fractured instruments were screened from online databases, such as Web of Science, Scopus, PubMed, and ScienceDirect, and highly cited papers, with at least 50 citations since publication, were identified. The most-cited articles were selected and analysed with regard to publication title, authorship, the journal of publication, year, institution, country of origin, article type, and number of citations. RESULTS: The top 10 most-cited articles were from various journals. Most were published in the Journal of Endodontics, followed by the International Endodontic Journal, and Dental Traumatology. The leading countries were Australia, Israel, Switzerland, the USA, and Germany, and the leading institution was the University of Melbourne. The majority of articles among the top 10 articles were clinical research studies (n = 8), followed by a basic research article and a non-systematic review article. CONCLUSIONS: This bibliometric analysis revealed interesting information about scientific progress in endodontics regarding fractured instruments. Overall, clinical research studies and basic research articles published in high-impact endodontic journals had the highest citation rates.

The incidence of dentinal cracks during root canal preparations with reciprocating single-file and rotary-file systems: A meta-analysis.

As a dangerous factor in vertical root fracture, dentinal crack formation is often associated with root canal instruments. We conducted this meta-analysis to compare the influence of two types of nickel titanium (NiTi) instruments that have different movements (reciprocating single-file versus full-sequence rotary file systems) on dentinal cracks formation during root canal preparation. Searches were conducted in PubMed, ISI Web of Knowledge, Embase and Cochrane Library using a combination of keywords. Titles and abstracts of all articles were independently assessed by two reviewers in accordance with the predefined inclusion criteria. Relevant studies were acquired in full-text form. Data in these articles were independently extracted. A meta-analysis was conducted using Review Manager 5.3. The results showed that the WaveOne and Reciproc files with a reciprocating motion produced significantly fewer dentinal cracks than the conventional rotational ProTaper technique.

Stereomicroscopic evaluation of dentinal defects induced by new rotary system: "ProTaper NEXT".

INTRODUCTION: The objective of this study was to evaluate dentinal defects formed by new rotary system - Protaper next™ (PTN). MATERIALS AND METHODS: Sixty single-rooted premolars were selected. All specimens were decoronated and divided into four groups, each group having 15 specimens. Group I specimens were prepared by Hand K-files (Mani), Group II with ProTaper Universal (PT; Dentsply Maillefer), Group III with Hero Shaper (HS; Micro-Mega, Besancon, France), and Group IV with PTN (Dentsply Maillefer). Roots of each specimen were sectioned at 3, 6, and 9mm from the apex and were then viewed under a stereomicroscope to evaluate presence or absence of dentinal defects. RESULTS: In roots prepared with hand files (HFs) showed lowest percentage of dentinal defects (6.7%); whereas in roots prepared with PT, HS, and PTN it was 40, 66.7, and 26.7%, respectively. There was significant difference between the HS group and the PTN group (P < 0.05). CONCLUSION: All rotary files induced defects in root dentin, whereas the hand instruments induced minimal defects.

Evaluation of dentinal defect formation after root canal preparation with two reciprocating systems and hand instruments: an in vitro study.

The purpose of this study was to evaluate the presence of dentinal defects after root canal preparation with hand instruments and two different reciprocating instruments. Sixty freshly extracted mandibular incisor teeth were selected for this in vitro study. On the basis of root length, mesiodistal and buccolingual dimensions, the teeth were allocated into three identical experimental groups (n = 15) and one control group (n = 15). The teeth in the control group were left unprepared. The other groups were: stainless steel hand instruments, WaveOne® Primary instruments and RECIPROC® R25 instruments. The reciprocating instruments were used with a reciprocating gentle in-and-out motion in a torque-limited electric motor at the appropriate preset mode. Horizontal sections were made 3, 6 and 9 mm from the apex. Samples were stained with methylene blue and viewed through a stereomicroscope. The presence of dentinal defects (fractures, incomplete cracks and craze lines) and their locations were investigated by two endodontists. These data were analysed statistically by Fisher's exact and chi-square tests. No defects were observed in the unprepared group. All instruments caused dentinal defects, with no significant differences between the instrument systems. All experimental groups demonstrated significantly more defects at the 3-mm level in comparison with the unprepared group (p = 0.032). At the other levels, there was no significant difference between the experimental groups and the control group. The use of hand or reciprocating instruments could induce the formation of dentinal defects during root canal preparation.

Assessment of dentinal damage during canal preparation using reciprocating and rotary files.

INTRODUCTION: The role of motion kinematics in creating dentinal damage during instrumentation is not very clear. The purpose of this study was to compare the formation of dentinal cracks with instruments working in continuous rotation and reciprocating motion. METHODS: One hundred twenty extracted human mandibular premolars were selected for the study. Thirty teeth served as controls, and the remaining 90 teeth were divided into 3 groups depending on the root canal preparation technique. Group 1 samples were treated with WaveOne primary files (Dentsply Maillefer, Ballaigues, Switzerland), group 2 samples with single F2 ProTaper (Dentsply Maillefer) working in reciprocating motion, and group 3 samples were prepared with sequential ProTaper (Dentsply Maillefer) until F2 working in continuous rotation motion. Roots were then sectioned at 3, 6, and 9 mm from the apex, and the cut surface was observed under a stereomicroscope for the presence of dentinal microcracks. RESULTS: The control group and WaveOne, single F2 ProTaper in reciprocating motion, and continuous ProTaper groups caused cracks in 0%, 15%, 26%, and 53% of samples, respectively. A statistically significant difference was found between 2 reciprocating file groups (WaveOne and single F2 ProTaper in reciprocating motion) and the continuous rotation group (ProTaper) (P < .05). However, no significant difference was found among the 2 reciprocating file groups (P > .05). CONCLUSIONS: Dentinal cracks are produced irrespective of motion kinematics. Within the limits of this study and the current literature, such incidence is less with instruments working in reciprocating motion compared with those working in continuous rotation.