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Utilização do laser Er:YAG no retratamento endodôntico : eficácia na remoção de guta-percha e cimento residual
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Resumo(s)
Objetivo e hipóteses: Comparar, in vitro, a eficácia do laser Er:YAG em modo SWEEPS, na remoção de guta-percha e cimento residual durante o retratamento endodôntico não cirúrgico, comparativamente à ativação sónica e à irrigação convencional. Hipótese nula: não existem diferenças na quantidade de material residual removido entre os três grupos experimentais. Hipótese alternativa: existem diferenças significativas entre, pelo menos, um dos grupos experimentais.
Materiais e Métodos: Foram utilizados 20 pré-molares humanos monorradiculares, preparados e obturados segundo um protocolo padronizado, distribuídos por três grupos de desobturação: irrigação convencional com soro fisiológico (controlo), ativação sónica com o sistema EDDY® e laser Er:YAG em modo SWEEPS. Após a desobturação, os canais foram avaliados por microscopia ótica nos terços cervical, médio e apical, segundo a escala de Hülsmann e Stotz (1997).
Resultados: Observaram-se diferenças estatisticamente significativas entre os grupos (p = 0,002). A ativação sónica com o sistema EDDY® foi a única técnica significativamente superior à irrigação convencional (p = 0,001), sobretudo nos terços cervical e médio. O laser Er:YAG em modo SWEEPS não revelou diferenças significativas relativamente à irrigação convencional nem à ativação sónica, e no terço apical não se observaram diferenças entre os grupos. A concordância intra-observador foi substancial (kappa de Cohen = 0,667).
Conclusão: A ativação sónica com o sistema EDDY® foi a única técnica a demonstrar uma eficácia significativamente superior à irrigação convencional na remoção de guta-percha e cimento residual, não se tendo verificado superioridade significativa do laser Er:YAG em modo SWEEPS. São necessários estudos adicionais, com amostras alargadas e anatomias mais complexas, para esclarecer o seu papel no retratamento endodôntico.
Objective and hypotheses: To compare, in vitro, the efficacy of the Er:YAG laser in SWEEPS mode for the removal of residual gutta-percha and cement during non-surgical endodontic retreatment, compared to sonic activation and conventional irrigation. Null hypothesis: There are no differences in the amount of residual material removed among the three experimental groups. Alternative hypothesis: There are significant differences among at least one of the experimental groups. Materials and Methods: Twenty single-rooted human premolars were used, prepared and obturated according to a standardized protocol, and distributed among three deobturation groups: conventional irrigation with saline (control), sonic activation with the EDDY® system, and Er:YAG laser in SWEEPS mode. After deobturation, the canals were evaluated by light microscopy in the cervical, middle, and apical thirds, according to the Hülsmann and Stotz scale (1997). Results: Statistically significant differences were observed between the groups (p = 0.002). Sonic activation with the EDDY® system was the only tech-nique significantly superior to conventional irrigation (p = 0.001), particularly in the cervical and middle thirds. The Er:YAG laser in SWEEPS mode showed no significant differences compared to conventional irrigation or sonic activation, and no differences were observed between the groups in the apical third. Intra-obser-ver agreement was substantial (Cohen’s kappa = 0.667). Conclusion: Sonic activation with the EDDY® system was the only tech-nique to demonstrate significantly greater efficacy than conventional irrigation in removing residual gutta-percha and cement; no significant superiority was ob-served for the Er:YAG laser in SWEEPS mode. Further studies are needed, with larger samples and more complex anatomies, to clarify its role in endodontic re-treatment.
Objective and hypotheses: To compare, in vitro, the efficacy of the Er:YAG laser in SWEEPS mode for the removal of residual gutta-percha and cement during non-surgical endodontic retreatment, compared to sonic activation and conventional irrigation. Null hypothesis: There are no differences in the amount of residual material removed among the three experimental groups. Alternative hypothesis: There are significant differences among at least one of the experimental groups. Materials and Methods: Twenty single-rooted human premolars were used, prepared and obturated according to a standardized protocol, and distributed among three deobturation groups: conventional irrigation with saline (control), sonic activation with the EDDY® system, and Er:YAG laser in SWEEPS mode. After deobturation, the canals were evaluated by light microscopy in the cervical, middle, and apical thirds, according to the Hülsmann and Stotz scale (1997). Results: Statistically significant differences were observed between the groups (p = 0.002). Sonic activation with the EDDY® system was the only tech-nique significantly superior to conventional irrigation (p = 0.001), particularly in the cervical and middle thirds. The Er:YAG laser in SWEEPS mode showed no significant differences compared to conventional irrigation or sonic activation, and no differences were observed between the groups in the apical third. Intra-obser-ver agreement was substantial (Cohen’s kappa = 0.667). Conclusion: Sonic activation with the EDDY® system was the only tech-nique to demonstrate significantly greater efficacy than conventional irrigation in removing residual gutta-percha and cement; no significant superiority was ob-served for the Er:YAG laser in SWEEPS mode. Further studies are needed, with larger samples and more complex anatomies, to clarify its role in endodontic re-treatment.
Descrição
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Palavras-chave
Laser Er:YAG Retratamento endodôntico Desobturação Remoção de guta-percha