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Ativação de irrigantes em endodontia: irrigação sónica vs ultrassónica – revisão narrativa
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Abstract(s)
A irrigação é uma etapa fundamental para o sucesso de um tratamento endodôntico não cirúrgico. Promove a limpeza da região canalar não só através da remoção da polpa necrosada e/ou vital, da eliminação de tecido, detritos e microrganismos, bem como através da lubrificação dos instrumentos. Essas funções exigem conhecimento do conceito de biofilme. Uma das bactérias mais comuns na infeção endodôntica é a E. faecalis, que possui capacidade de adesão à dentina, visto que penetra nos túbulos dentinários e em zonas anatómicas complexas. Neste trabalho foi feita uma análise das características dos irrigantes mais utilizados em Endodontia, entre eles o hipoclorito de sódio, que se destaca pela sua capacidade de dissolver matéria orgânica e propriedades antimicrobianas aprimoradas, sendo por isso o irrigante mais utilizado em tratamentos endodônticos. Apesar da clorohexidina geralmente apresentar níveis de remoção microbiana menos elevados, possui substantividade, permitindo assim uma desinfeção duradoura. O EDTA surge como irrigante complementar a estes, já que é o único com capacidade de eliminar matéria inorgânica e assim erradicar a “smear layer”. A ativação da irrigação permite resultados aprimorados nestes parâmetros, porque a distribuição melhorada de irrigante ao longo do sistema de canais radiculares permite alcançar zonas de difícil acesso aos instrumentos endodônticos e à irrigação convencional sem ativação. Deste modo, o contacto do irrigante com as superfícies canalares é superior e, consequentemente, o objetivo de desinfeção da irrigação é melhorado. Dois dos métodos de ativação do irrigante mais comuns são a ativação sónica e a ativação ultrassónica. A irrigação ultrassónica atua em frequências de 25 kHz a 40 kHz, induzindo dois processos: cavitação e fluxo acústico. Com este tipo de irrigação, a desinfeção torna-se superior comparativamente à irrigação convencional, apesar dos riscos de transporte apical, formação de irregularidades e de uma nova “smear layer” devido à remoção descontrolada de dentina. Estes aspetos negativos são reduzidos utilizando irrigação sónica. Apesar de atuar com frequências mais baixas, a cavitação pode ser induzida, já que a sua formação também depende da amplitude, que se verifica mais elevada na irrigação sónica. Necessita de um pré-alargamento canalar demasiado elevado para a sua ponta atuar sem interferências das paredes do canal. No entanto, alguma literatura descreve que o antinodo que este mecanismo gera permite obtenção de uma desinfeção com resultados interessantes a nível apical. Após esta contextualização do tema, o objetivo desta dissertação foca-se em comparar estas duas técnicas, de modo a possibilitar uma avaliação mais informada sobre qual o procedimento mais indicado na prática clínica, respondendo à seguinte questão: «Na ativação de irrigantes em Endodontia, quais são as vantagens e desvantagens da ativação ultrassónica em comparação à ativação sónica?». Os materiais e métodos deste estudo consistiram em pesquisa bibliográfica nos motores de pesquisa «SciELO» e «PubMed», através de 6 palavras-chave. Com estas 6 palavras-chave, realizaram-se 6 combinações de palavras. No final, foram incluídos 60 artigos científicos como referências na execução da dissertação de mestrado apresentada.
Irrigation is a fundamental step for the success of nonsurgical endodontic treatment. It promotes the cleaning of the canal area by removing necrotic and/or vital pulp, eliminating tissue, debris, and microorganisms, as well as lubricating the instruments. These functions require knowledge of the concept of biofilm. One of the most common bacteria in endodontic infection is E. faecalis, which has the ability to adhere to dentin, penetrate the dentinal tubules and in complex anatomical zones. In this work, an analysis of the most commonly used irrigants in endodontics was conducted, among them sodium hypochlorite, which stands out for its ability to dissolve organic matter and its enhanced antimicrobial properties, making it the most widely used irrigant in endodontic treatments. Although chlorhexidine generally shows lower levels of microbiota removal, it has substantivity, thus allowing for prolonged disinfection. EDTA is used as a complementary irrigant to these, as it is the only one capable of eliminating inorganic material and thereby eradicating the smear layer. The activation of irrigation enables improved results in these parameters, as the improved distribution of irrigant throughout the root canal system allows access to areas that are difficult for endodontic instruments and conventional irrigation without activation to reach. Thus, the irrigant’s contact with the canal walls is enhanced, and consequently, the objective of disinfection through irrigation is improved. Two of the most common methods of irrigant activation are sonic and ultrasonic activation. Ultrasonic irrigation operates at frequencies between 25 kHz and 40 kHz, inducing two processes: cavitation and acoustic streaming. With this type of irrigation, disinfection becomes superior comparing to conventional irrigation, despite the risks of apical transportation, ledging, and the formation of a new smear layer due to uncontrolled dentin removal. These negative aspects are reduced using sonic irrigation. Although it operates with lower frequencies, cavitation can still be induced, as its formation also depends on amplitude, which is higher in sonic irrigation. It requires excessive canal enlargement for the tip to function without interference from the canal walls. Although some literature describes that the antinode generated by this mechanism allows for effective disinfection with promising results at the apical level. After this contextualization of the subject, the objective of this dissertation is to compare these two techniques in order to provide a more informed evaluation of which procedure is most suitable for clinical practice, addressing the following question: «What are the advantages and disadvantages of ultrasonic activation compared to sonic activation of irrigants in Endodontics?». The materials and methods of this study consisted of a bibliographic search in the "SciELO" and "PubMed" databases, using 6 keywords. These 6 keywords were used to form 6 word combinations. In total, 60 scientific articles were included as references in the preparation of the presented master’s dissertation.
Irrigation is a fundamental step for the success of nonsurgical endodontic treatment. It promotes the cleaning of the canal area by removing necrotic and/or vital pulp, eliminating tissue, debris, and microorganisms, as well as lubricating the instruments. These functions require knowledge of the concept of biofilm. One of the most common bacteria in endodontic infection is E. faecalis, which has the ability to adhere to dentin, penetrate the dentinal tubules and in complex anatomical zones. In this work, an analysis of the most commonly used irrigants in endodontics was conducted, among them sodium hypochlorite, which stands out for its ability to dissolve organic matter and its enhanced antimicrobial properties, making it the most widely used irrigant in endodontic treatments. Although chlorhexidine generally shows lower levels of microbiota removal, it has substantivity, thus allowing for prolonged disinfection. EDTA is used as a complementary irrigant to these, as it is the only one capable of eliminating inorganic material and thereby eradicating the smear layer. The activation of irrigation enables improved results in these parameters, as the improved distribution of irrigant throughout the root canal system allows access to areas that are difficult for endodontic instruments and conventional irrigation without activation to reach. Thus, the irrigant’s contact with the canal walls is enhanced, and consequently, the objective of disinfection through irrigation is improved. Two of the most common methods of irrigant activation are sonic and ultrasonic activation. Ultrasonic irrigation operates at frequencies between 25 kHz and 40 kHz, inducing two processes: cavitation and acoustic streaming. With this type of irrigation, disinfection becomes superior comparing to conventional irrigation, despite the risks of apical transportation, ledging, and the formation of a new smear layer due to uncontrolled dentin removal. These negative aspects are reduced using sonic irrigation. Although it operates with lower frequencies, cavitation can still be induced, as its formation also depends on amplitude, which is higher in sonic irrigation. It requires excessive canal enlargement for the tip to function without interference from the canal walls. Although some literature describes that the antinode generated by this mechanism allows for effective disinfection with promising results at the apical level. After this contextualization of the subject, the objective of this dissertation is to compare these two techniques in order to provide a more informed evaluation of which procedure is most suitable for clinical practice, addressing the following question: «What are the advantages and disadvantages of ultrasonic activation compared to sonic activation of irrigants in Endodontics?». The materials and methods of this study consisted of a bibliographic search in the "SciELO" and "PubMed" databases, using 6 keywords. These 6 keywords were used to form 6 word combinations. In total, 60 scientific articles were included as references in the preparation of the presented master’s dissertation.
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Keywords
Endodontia Biofilme Irrigação Ativação Sónica Ultrassónica Endodontics Biofilm Irrigation Activation Sonic Ultrasonic