Avaliação em estudos longitudinais da eficácia do hipoclorito de sódio e da clorexidina sobre o Enterococcus faecalis presente em infecções endodônticas: revisão sistemática

Abstract

The efficacy of the sodium hypochlorite and chlorhexidine over the Enterococcus faecalis present in endodontic infections was evaluated in longitudinal studies through a systematic review. Bibliographic catalogue sources, electronically identified as MEDLINE (http://www.ncbi.nlm.nih.gov/PubMed), from 1966 until January 1st, and Cochrane Library on the same period, were used. On the searching strategy, the following combination of keywords were used faecalis and sodium hypochlorite or faecalis and chlorhexidine or faecalis and root canal infections or faecalis and endodontics infections or faecalis and root canal irrigants or faecalis and irrigant solution or faecalis and endodontics irrigants or faecalis and intracanal irrigant. The studies were selected by two independent reviewers that determined the inclusion and exclusion criteria. The search presented 229 related articles, with 6 of these as literature review articles, 39 articles were related with in vivo studies (humans or animals), and 189 included in vitro studies. From the 39 in vivo studies, 5 studies satisfied the inclusion criteria. The methodological structure of the included studies prohibited the combination of results. The efficacy of the sodium hypochlorite and chlorhexidine over the E. faecalis was demonstrated in vitro by direct contact test. On the studies involving contaminated dentin, either the sodium hypochlorite or the chlorhexidine were inefficient. On the 5 studies included, from the total of 159 teeth with endodontic infections primary or secundary, the E. faecalis was detected initially in 16 teeth by PCR and 42 by culture, and after the sanitization process in 11 teeth by PCR and 12 by culture. It was observed the absence of longitudinal studies in humans about the efficacy of chlorhexidine over the E. faecalis. The sanitization process with the emptying, enlargement and action of the sodium hypochlorite reduces the remaining endodontic microbiota, what certainly potentiates the action of the intracanal dressing and favors a higher level of success of the endodontic treatment.