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Resultados e fatores prognósticos da microcirurgia endodôntica: revisão sistemática
| Name: | Description: | Size: | Format: | |
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| Projeto de pós-graduação_41350 | 330.6 KB | Adobe PDF |
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Abstract(s)
Introdução: A periodontite apical (PA) é uma inflamação dos tecidos periapicais causada por agentes endodônticos, podendo levar à perda dentária se não tratada. O tratamento principal é a terapia endodôntica não cirúrgica, embora o seu sucesso varie. Em casos de insucesso, pode ser necessário o retratamento ou a cirurgia apical. A microcirurgia endodôntica moderna tem vindo a melhorar as taxas de sucesso, beneficiando de técnicas avançadas como a CBCT e materiais regenerativos. Apesar dos avanços, a dor pós-operatória e a cicatrização completa continuam a ser desafios. Esta revisão sistemática visa avaliar criticamente os resultados e os fatores prognósticos da microcirurgia endodôntica. Materiais e métodos: Foi realizada uma pesquisa estruturada nas bases de dados PubMed, Lilacs, Embase, Cochrane Library e Scopus, entre 25 de maio de 2024 e 15 de março de 2025. Estabeleceram-se critérios específicos de inclusão e exclusão, considerando estudos prospetivos, retrospetivos, transversais, comparativos, clínicos, randomizados e controlados, realizados em humanos. A intervenção analisada foi a microcirurgia apical, incluindo resseção apical, curetagem e retro-preenchimento, com o objetivo de eliminar infeções periapicais e reabilitar as estruturas dentárias afetadas. Avaliou-se a taxa de cicatrização, considerando variáveis como dimensão da lesão, género do paciente e arcada dentária envolvida. O estudo foi registado no PROSPERO (CRD420251022076) e seguiu as diretrizes do PRISMA, com avaliação metodológica através da ferramenta do JBI. Resultados: A pesquisa inicial gerou 168 referências, das quais 10 estudos foram incluídos após triagem rigorosa. A taxa de cura em lesões <5 mm foi de 84%, e apenas 26,7% em lesões >5 mm. A maxila apresentou 82,3% de sucesso, comparada com 78,1% na mandíbula. A dimensão da lesão mostrou-se o fator mais significativo. Conclusão: A microcirurgia endodôntica revela-se uma alternativa eficaz à extração dentária, destacando a importância de uma abordagem personalizada e mais investigação futura.
Introduction: Apical periodontitis (AP) is an inflammation of the periapical tissues caused by endodontic agents and may lead to tooth loss if left untreated. The main treatment is non-surgical endodontic therapy, although its success may vary. In cases of failure, retreatment or apical surgery may be required. Modern endodontic microsurgery has improved success rates, benefiting from advanced techniques such as CBCT and regenerative materials. Despite these advances, postoperative pain and complete healing remain challenging. This systematic review aims to critically assess the outcomes and prognostic factors of endodontic microsurgery. Materials and Methods: A structured search was conducted in the PubMed, Lilacs, Embase, Cochrane Library and Scopus databases between 25 May 2024 and 15 March 2025. Specific inclusion and exclusion criteria were established, considering prospective, retrospective, cross-sectional, comparative, clinical, randomized and controlled studies conducted in humans. The intervention analyzed was apical microsurgery, including apical resection, curettage, and retrograde filling, aiming to eliminate periapical infections and rehabilitate affected dental structures. The healing rate was assessed, taking into account variables such as lesion size, patient gender, and the dental arch involved. The study was registered in PROSPERO (CRD420251022076) and followed PRISMA guidelines, with methodological assessment using the JBI tool. Results: The initial search generated 168 references, of which 10 studies were included after rigorous screening. The healing rate for lesions <5 mm was 84%, and only 26.7% for lesions >5 mm. The maxilla showed an 82.3% success rate compared to 78.1% in the mandible. Lesion size proved to be the most significant factor. Conclusion: Endodontic microsurgery is an effective alternative to tooth extraction, highlighting the importance of a personalized approach and the need for further research.
Introduction: Apical periodontitis (AP) is an inflammation of the periapical tissues caused by endodontic agents and may lead to tooth loss if left untreated. The main treatment is non-surgical endodontic therapy, although its success may vary. In cases of failure, retreatment or apical surgery may be required. Modern endodontic microsurgery has improved success rates, benefiting from advanced techniques such as CBCT and regenerative materials. Despite these advances, postoperative pain and complete healing remain challenging. This systematic review aims to critically assess the outcomes and prognostic factors of endodontic microsurgery. Materials and Methods: A structured search was conducted in the PubMed, Lilacs, Embase, Cochrane Library and Scopus databases between 25 May 2024 and 15 March 2025. Specific inclusion and exclusion criteria were established, considering prospective, retrospective, cross-sectional, comparative, clinical, randomized and controlled studies conducted in humans. The intervention analyzed was apical microsurgery, including apical resection, curettage, and retrograde filling, aiming to eliminate periapical infections and rehabilitate affected dental structures. The healing rate was assessed, taking into account variables such as lesion size, patient gender, and the dental arch involved. The study was registered in PROSPERO (CRD420251022076) and followed PRISMA guidelines, with methodological assessment using the JBI tool. Results: The initial search generated 168 references, of which 10 studies were included after rigorous screening. The healing rate for lesions <5 mm was 84%, and only 26.7% for lesions >5 mm. The maxilla showed an 82.3% success rate compared to 78.1% in the mandible. Lesion size proved to be the most significant factor. Conclusion: Endodontic microsurgery is an effective alternative to tooth extraction, highlighting the importance of a personalized approach and the need for further research.
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Keywords
Microcirurgia apical Prognóstico Fator de risco Microcirurgia endodôntica Periodontite apical Fatores prognósticos Apical microsurgery Prognosis Risk factor Endodontic microsurgery Apical periodontitis Prognostic factors