Resumen
Un tratamiento de endodoncia exitoso requiere de una satisfactoria instrumentación mecánica, protocolos de irrigación adecuados y obturación tridimensional del sistema de conductos radiculares. La irrigación se considera el procedimiento más crítico para garantizar la limpieza y desinfección. Hasta la fecha, se ha propuesto una gran variedad de irrigantes. Sin embargo, el hipoclorito de sodio (NaOCl) sigue siendo el estándar de oro. Para lograr una limpieza y desinfección completa, se ha utilizado como protocolo ideal la irrigación final con EDTA y dispositivos ultrasónicos. La mayor parte de la investigación en endodoncia se enfoca en las propiedades antibacterianas y de limpieza de las soluciones de irrigación. Reciente evidencia demostró que los protocolos de irrigación provocan erosión, afectando la ultraestructura de la dentina radicular. Este artículo tiene como objetivo describir algunas consideraciones clínicas del conocimiento actual sobre el efecto de los protocolos de irrigación en la dentina radicular.
Citas
AAE. Treatment Standards. aae.org. 2018. p. 1-26.
Pereira Lopes H., Siqueira Jr. J. Endodontia: Biologia e Técnica. 2nd ed. Rio de Janeiro: MEDSI; 2004. 281-288 p.
Bystrom A., Happonen R.P., Sjogren U., Sundqvist G. Healing of periapical lesions of pulpless teeth after endodontic treatment with controlled asepsis. Endod Dent Traumatol. 1987 Apr; 3 (2): 58-63.
Prada I., Micó-Muñoz P., Giner-Lluesma T., Micó-Martínez P., Muwaquet-Rodríguez S., Albero-Monteagudo A. Update of the therapeutic planning of irrigation and intracanal medication in root canal treatment. A literature review. J Clin Exp Dent. 2019 Feb; 11 (2): e185-93.
Haapasalo M., Shen Y., Wang Z., Gao Y. Irrigation in endodontics. British Dental Journal. 2014 Mar 21; 216 (6): 299-303.
Siqueira J.F., Rôças I.N., Favieri A., Lima K.C. Chemomechanical reduction of the bacterial population in the root canal after instrumentation and irrigation with 1%, 2.5%, and 5.25% sodium hypochlorite. J Endod. 2000 Jun; 26 (6): 331-4.
Barrette W.C., Hannum D.M., Wheeler W.D., Hurst JK. General mechanism for the bacterial toxicity of hypochlorous acid: abolition of ATP production. Biochemistry. 1989 Nov 14; 28 (23): 9172-8.
Harrison J.W., Hand R.E. The effect of dilution and organic matter on the anti-bacterial property of 5.25% sodium hypochlorite. J Endod. 1981 Mar; 7 (3): 128-32.
Alpizar S., Bustamante G., Calderón C., Calvo J., Gutiérrez .J, Salazar P. Análisis de los diferentes protocolos de irrigación y su efecto en la permeabilidad y selle radiculary selle . [San José]: Universidad de Costa Rica; 2016.
Barbosa A.F.A., Lima C.O. de, Sassone L.M., Fares R.D., Fidalgo T.K. da S., Silva E.J.N.L. Effect of passive ultrasonic irrigation on hard tissue debris removal: a systematic review and meta-analysis. Braz Oral Res. 2021; 35: e123.
Orlowski N.B., Schimdt T.F., Teixeira C. da S., Garcia L. da F.R., Savaris J.M., Tay F.R., et al. Smear Layer Removal Using Passive Ultrasonic Irrigation and Different Concentrations of Sodium Hypochlorite. J Endod. 2020 Nov; 46 (11): 1738-44.
Spangberg L., Engström B., Langeland K. Biologic effects of dental materials. 3. Toxicity and antimicrobial effect of endodontic antiseptics in vitro. Oral Surg Oral Med Oral Pathol. 1973 Dec; 36 (6): 856-71.
Teixeira C.S., Felippe M.C.S., Felippe W.T. The effect of application time of EDTA and NaOCl on intracanal smear layer removal: an SEM analysis. Int Endod J. 2005 May; 38 (5): 285-90.
Klyn S.L., Kirkpatrick T.C., Rutledge R.E. In vitro comparisons of debris removal of the EndoActivator system, the F file, ultrasonic irrigation, and NaOCl irrigation alone after hand-rotary instrumentation in human mandibular molars. J Endod. 2010 Aug; 36 (8): 1367-71.
Bolles J.A., He J., Svoboda K.K.H., Schneiderman E., Glickman G.N. Comparison of Vibringe, EndoActivator, and needle irrigation on sealer penetration in extracted human teeth. J Endod. 2013 May; 39 (5): 708-11.
Stojicic S., Zivkovic S., Qian W., Zhang H., Haapasalo M. Tissue dissolution by sodium hypochlorite: effect of concentration, temperature, agitation, and surfactant. J Endod. 2010 Sep; 36 (9): 1558-62.
Augusto C.M., Cunha Neto M.A., Pinto K.P., Barbosa A.F.A., Silva E.J.N.L., dos Santos A.P.P., et al. Influence of the use of chelating agents as final irrigant on the push-out bond strength of epoxy resin-based root canal sealers: A systematic review. Aust Endod J. 2021 Sep 9.
de Souza Matos F., Rosatto C.M.P. de, Cunha T.C., Vidigal M.T.C., Blumenberg C., Paranhos LR, et al. Influence of chelating solutions on tubular dentin sealer penetration: A systematic review with network meta-analysis. Aust Endod J. 2021 Dec; 47 (3): 715-30.
Retana-Lobo C., Ramírez-Mora T., Murillo-Gómez F., Maria Guerreiro-Tanomaru J., Tanomaru-Filho M, Reyes-Carmona J. Final irrigation protocols affect radicular dentin DMP1-CT expression, microhardness, and biochemical composition. Clin Oral Investig. 2022 May 2. doi: 10.1007/s00784-022-04516-8. Epub ahead of print.
Tay F.R., Pashley D.H. Guided tissue remineralisation of partially demineralised human dentine. Biomaterials. 2008 Mar; 29 (8): 1127-37.
Prasad M., Butler W.T., Qin C. Dentin sialophosphoprotein in biomineralization. Connect Tissue Res. 2010 Oct; 51 (5): 404-17.
Retana-Lobo C., Guerreiro-Tanomaru J.M., Tanomaru-Filho M., Mendes de Souza B.D., Reyes-Carmona J. Non-Collagenous Dentin Protein Binding Sites Control Mineral Formation during the Biomineralisation Process in Radicular Dentin. Materials (Basel). 2020 Feb 27; 13 (5): 1053.
Retana-Lobo C., Guerreiro-Tanomaru J.M., Tanomaru-Filho M., Mendes de Souza B.D., Reyes-Carmona J. Sodium Hypochlorite and Chlorhexidine Downregulate MMP Expression on Radicular Dentin. Med Princ Pract. 30 (5): 470-6.
Wagner M.H., da Rosa R.A., de Figueiredo J.A.P., Duarte M.A.H., Pereira J.R., Só M.V.R. Final irrigation protocols may affect intraradicular dentin ultrastructure. Clinical Oral Investigations. 2017 Sep 1; 21 (7): 2173-82.
Reyes-Carmona J.F., Felippe M.S., Felippe W.T. Biomineralization ability and interaction of mineral trioxide aggregate and white portland cement with dentin in a phosphate-containing fluid. J Endod. 2009 May; 35 (5): 731-6.
Sum Dr. C.P., Neo J., Kishen A. What we leave behind in root canals after endodontic treatment: Some issues and concerns. Australian Endodontic Journal. 2005 Dec; 31 (3): 94-100.
Sim T.P., Knowles J.C., Ng Y.L., Shelton J., Gulabivala K. Effect of sodium hypochlorite on mechanical properties of dentine and tooth surface strain. Int Endod J. 2001 Mar; 34 (2): 120-32.
García-Godoy F., Loushine R.J., Itthagarun A., Weller R.N., Murray P.E., Feilzer A.J., et al. Application of biologically-oriented dentin bonding principles to the use of endodontic irrigants. Am J Dent. 2005 Aug; 18 (4): 281-90.
Pascon F.M., Kantovitz K.R., Sacramento P.A., Nobre-dos-Santos M., Puppin-Rontani R.M. Effect of sodium hypochlorite on dentine mechanical properties. A review. J Dent. 2009 Dec; 37 (12): 903-8.
Perdigão J., Eiriksson S., Rosa B.T., Lopes M., Gomes G. Effect of calcium removal on dentin bond strengths. Quintessence Int. 2001 Feb; 32 (2): 142-6.
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