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Controlo do tratamento endodontico não-cirúrgico de dentes com diagnóstico de necrose pulpar associada ou não a lesão apical: continuação
| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| PPG_31004 | 12.02 MB | Adobe PDF |
Authors
Advisor(s)
Abstract(s)
Introdução: De forma a se poder pronunciar o grau de recuperação de uma lesão com
Necrose Pulpar e/ou Periodontite Apical Crónica, o Tratamento Endodôntico Não-
Cirúrgico (TENC) deve ser sujeito a uma avaliação do sucesso, tendo em conta diversos
critérios. O trabalho, agora apresentado, pretende esclarecer os conceitos de sucesso e
insucesso do TENC, enumerar os critérios de avaliação do sucesso e insucesso desta
opção terapêutica, relatar os fatores inerentes ao procedimento clínico condicionantes
da taxa de sucesso. Bem como analisar as taxas de sucesso atualmente prevalentes e
mostrar os dados do acompanhamento, até ao momento, do protocolo desenvolvido num
projeto de investigação intitulado “Analysis of endodontic pathogens by classical
microbiological and nucleic acid approaches”, na Universidade Fernando Pessoa.
Materiais e métodos: Num estudo de controlo randomizado (“Analysis of endodontic
pathogens by classical microbiological and nucleic acid approaches”) iniciado em 2011,
foram selecionados 71 pacientes de ambos os géneros, possuidores de um dente
monorradicular, com diagnósticos de Necrose Pulpar ou de Periodontite Apical Crónica,
(com imagem radiolúcida associada, indicativa de lesão periapical, sem exposição
pulpar e sem sinais de doença periodontal). Nesse estudo, o tratamento foi realizado de
acordo com um protocolo clínico que propunha testar a eficácia da pasta de hidróxido
de cálcio e do gel de digluconato de clorhexidina a 2%, como medicação intracanalar
(MI). O controlo dos resultados, realizado de forma longitudinal num período estimado
de 4 anos (6 em 6 meses, no primeiro ano, e 12 em 12 meses, nos seguintes anos), foi
efetuado por examinador duplo. Por questões temporais, neste trabalho, fez-se análise
dos resultados aos acima de 30 meses e aos abaixo de 42 meses, ou seja, numa média
estimada de 3 anos para 26 doentes. A análise dos resultados foi realizada por aplicação
do IBM© SPSS© Statistics, vs. 22.0, considerando um nível de significância de 0,05
nos procedimentos de inferência estatística.
Resultados e discussão: Aos 3 anos , 88,5 % (n=23) dos controlos foram classificados
como bem-sucedidos, 11,5% (n=3) como questionáveis. Fatores tais como a MI, o
diagnostico, a profundidade de sondagem, a mobilidade, adaptação tridimencional da
obturação, adaptação da restauração ao material obturador, adaptação da restauração coronal, infiltração marginal, o tamanho da radiolucidez periapical e a classificação do
Índice Periapical, prevêem alguma interferência na recuperação no período de 3 anos.
Conclusão: Os resultados sugerem que é possível atingir taxas de sucesso elevadas para
o TENC quando as causas intrarradiculares e/ou extrarradiculares, de origem
endodôntica, são bem controladas. Contudo, não se pode considerar como terminado o
tratamento na fase de obturação do canal radicular. O retorno do dente às suas funções,
só fica concluído com a execução da restauração definitiva o mais próxima possível da
data de conclusão do TENC e sua preservação ao longo do controlo dos primeiros 4
anos.
Introduction: In order to be able to pronounce the degree of recovery from injury with Pulp Necrosis or Chronic Apical Periodontitis, the Root Canal Treatment should be subject to an assessment of success, taking into account several criteria. The work presented is intended to clarify the concepts of success and failure SRCT, enumerate the criteria for assessing the success and failure of this therapeutic option, reporting factors inherent constraints of the clinical procedure success rate, analyze success rates currently prevalent and show the data monitoring, until the moment, the protocol developed in a research project titled: “Analysis of endodontic pathogens by classical microbiological and nucleic acid approaches”, at the University Fernando Pessoa. Materials and methods: In a randomized control study (“Analysis of endodontic pathogens by classical microbiological and nucleic acid approaches”) started in 2011, were selected 71 patients of both sexes, possessed of a tooth monorradicular with diagnoses of Pulp necrosis or Chronic Apical Periodontitis (associated with radiolucent image, indicative of apical lesions, without pulp exposure and without signs of periodontal disease). In this study, treatment was conducted according to a clinical protocol which proposed to test the effectiveness of calcium hydroxide paste and 2% digluconate chlorhexidine gel, as intracanalar dressing. The control of the results, carried out in a longitudinal form in an estimated period of 4 years (6 in 6 months, in the first year, and 12 in 12 months, in the following years), was effected by double examiner. In temporal matters, this work was done analyzing the results up to 30 months and under 42 months, an estimated average of three years to 26 patients. The analysis was performed by application of IBM© SPSS© Statistics, vs. 20.0, assuming a significance level of 0.05 in procedures of statistical inference. Results and discussion: At 3 years, 88.5 % (n = 23) of controls were classified as successful, 11.5 % (n = 3) as questionable. Factors such as intracanalar dressing, diagnosis, periodontal probing depth, mobility, three-dimensional adjustment of the root filling, quality of adapted filling to the root filling material, adaptation of coronal restoration, marginal leakage, the size of the periapical radiolucency and the classification of the Periapical Index provide some interference in the recovery within 3 years. Conclusion: The results suggest that it is possible to achieve high success rates for endodontic treatment, when the intracanalar and extrarradiculars causes of endodontic failure are well controlled. However, it cannot be considered as completed the treatment phase of root canal filling. The return of the tooth to its functions is only finished with the execution of the definitive restoration as close as possible to the date of conclusion of SRCT, and preservation over control of the first 4 years.
Introduction: In order to be able to pronounce the degree of recovery from injury with Pulp Necrosis or Chronic Apical Periodontitis, the Root Canal Treatment should be subject to an assessment of success, taking into account several criteria. The work presented is intended to clarify the concepts of success and failure SRCT, enumerate the criteria for assessing the success and failure of this therapeutic option, reporting factors inherent constraints of the clinical procedure success rate, analyze success rates currently prevalent and show the data monitoring, until the moment, the protocol developed in a research project titled: “Analysis of endodontic pathogens by classical microbiological and nucleic acid approaches”, at the University Fernando Pessoa. Materials and methods: In a randomized control study (“Analysis of endodontic pathogens by classical microbiological and nucleic acid approaches”) started in 2011, were selected 71 patients of both sexes, possessed of a tooth monorradicular with diagnoses of Pulp necrosis or Chronic Apical Periodontitis (associated with radiolucent image, indicative of apical lesions, without pulp exposure and without signs of periodontal disease). In this study, treatment was conducted according to a clinical protocol which proposed to test the effectiveness of calcium hydroxide paste and 2% digluconate chlorhexidine gel, as intracanalar dressing. The control of the results, carried out in a longitudinal form in an estimated period of 4 years (6 in 6 months, in the first year, and 12 in 12 months, in the following years), was effected by double examiner. In temporal matters, this work was done analyzing the results up to 30 months and under 42 months, an estimated average of three years to 26 patients. The analysis was performed by application of IBM© SPSS© Statistics, vs. 20.0, assuming a significance level of 0.05 in procedures of statistical inference. Results and discussion: At 3 years, 88.5 % (n = 23) of controls were classified as successful, 11.5 % (n = 3) as questionable. Factors such as intracanalar dressing, diagnosis, periodontal probing depth, mobility, three-dimensional adjustment of the root filling, quality of adapted filling to the root filling material, adaptation of coronal restoration, marginal leakage, the size of the periapical radiolucency and the classification of the Periapical Index provide some interference in the recovery within 3 years. Conclusion: The results suggest that it is possible to achieve high success rates for endodontic treatment, when the intracanalar and extrarradiculars causes of endodontic failure are well controlled. However, it cannot be considered as completed the treatment phase of root canal filling. The return of the tooth to its functions is only finished with the execution of the definitive restoration as close as possible to the date of conclusion of SRCT, and preservation over control of the first 4 years.
Description
Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária