Fatores clínicos associados ao diagnóstico e prognóstico do tratamento endodôntico: observações in vivo e revisão sistemática

Abstract

The conduct and execution of all stages of endodontic treatment must be judicious and are directly related to making a correct diagnosis. The objective of this work was to verify the factors that influence the endodontic diagnosis and/or the intra/postoperative pain development and the success of the endodontic treatment. Chapter 1. Accuracy of dental pulp sensitivity test by cold spray for the diagnosis of pulp diseases: observational clinical study. The accuracy of the pulp sensitivity test (PST) using cold spray (1,1,1,2-tetrafluoroethane) was assessed in the diagnosis of pulp diseases and the effect of individual and clinical variables on the test's reliability. Sixty patients with indication for primary endodontic treatment were selected and examined by means of interview, clinic and radiographic examination and PST, between August 2017 and July 2018. It was concluded that PST with cold spray is an accurate and reliable diagnostic method, mainly in cases of irreversible pulpitis. Chapter 2. Influence of glide path kinematics during endodontic treatment on the occurrence and intensity of intra and postoperative pain: a systematic review of randomized clinical trials. The systematic review followed the PRISMA recommendations and was registered with PROSPERO (CRD42020139989). The variability between studies regarding treatment protocols and patient selection made the meta-analysis unfeasible. It was concluded that the glide path kinematics can influence the occurrence and intensity of intra and postoperative pain. Chapter 3. Result of the treatment of young molars obstructed by fractured endodontic instruments: report of two cases. Ultrasonic inserts or XP-Clean files represent strategies to improve the cleaning and disinfection of the root canals, but they are not free from the possibility of fracture. Two 14-year-old female patients underwent root canal treatment of tooth 37 (case 1) and 47 (case 2). During the final irrigation protocols, case 1 presented a fractured XP-Clean file within the mesiovestibular canal and within the distal canal in case 2, which also had a fractured E1-Irrisonic tip in the mesiovestibular and distal canals. Non-surgical management and bypassing retained instrument fragments were successful in both cases and they may be considered adequate approaches, allowing teeth to be preserved. Chapter 4. Interdisciplinary approach in molars of young patients, the challenge to avoid premature extraction: case reports. Two male patients, 14 and 17 years old, were assisted in an extension project aimed at rehabilitating endodontic treatment of children and adolescents aged 8 to 18 years. Teeth 46 and 36 were cleaned and disinfected using the TF Adaptive automated system and completed with XP Endo Finisher files and final irrigation with ultrasound tips. After 14 days of intracanal medication with calcium hydroxide, the canals were obturated and the teeth were restored with bulk-fill composite resin by direct technique. Periapical bone repair and absence of signs and symptoms were observed after 6 months and 1 year.