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Previous issue date: 2014-02-26 / The persistence of infection within the root canal system is one of the main factors responsible for endodontic failures. The complexity of the internal anatomy of root canals prevents its complete removal by current instrumentation techniques. Thus, alternative disinfection protocols, including irrigating solutions and photo-activated therapy (PAD), have been acessed. In this study, 10 dogs were randomly divided into two groups (n= 5): with and without PAD. The canals of upper and lower premolars of each dog were distributed in the experimental subgroups: SX (400ppm Sterilox), H2 (2% sodium hypochloride (NaOCl)), H5 (5% NaOCl) and C+ (positive control: saline solution) in a total sample of 134 root canals. Teeth of the experimental and C+ groups were opened and the canals were left exposed to the oral environment for 15 days and then sealed for apical periodontitis (AP) induction. After 60 days, the root canals were treated in accordance with each disinfection protocol proposed and filled in the same session. After 120 days, the dogs were euthanized and the following procedures were carried out: periapical radiography (PR), to measure the AP area; cone beam computed tomography (CBCT), to measure the AP area and volume; light microscopy, to evaluate inflammatory periapical events. Based on the colected data, the study was divided into two papers. The first carried out an evaluation of the efficacy of 400ppm Sterilox, 2%NaOCl and 5%NaOCl, with and without PAD, in a single visit root canal treatment of dog s teeth with AP. In the histological evaluation, scores were given according to the intensity of inflammatory infiltrate. Data was colected and analized statistically with Kruskall-Wallis and Mann-Whitney tests (α= .05). The PAD did not produce significant differences in the scores for apical inflammation when used after chemo-mechanical preparation. The irrigating solutions SX, H2 and H5 without PAD were statistically different from SS (P<0,05) that presented the greatest scores for apical inflammation. In conclusion, PAD did not show any clinical relevance for the treatment of root canal with pulpal necrosis and AP. The use of 400 ppm Sterilox in the chemo-mechanical preparation provided efficient cleaning and may be considered an alternative to NaOCl in root canal treatment. The second paper investigated the correlation and agreement between PR (area) and CBCT (area and volume) data, correlating with the correspondig histopathological data. The correlation between methods was evaluated by Pearson's coefficient and Bland-Altman's (BA) method was used to assess the agreement between PR and CBCT data. The results showed that, despite a strong correlation between PR and CBCT areas, the limits of agreement were very broad (95%: 0.19 to 1.08). PR only measured on average 63% of CBCT values. Although the strong correlation between PR area and CBCT volume, BA suggests that the larger the CBCT volume the more underestimated the PR value. When APs had volumes smaller than 6 mm3, the PR estimates of CBCT data were unpredictable. The correlation between PR area, CBCT area, CBCT volume and histology data was significant. In conclusion, the diagnosis of AP based on PR data is clinically limited and it should not be used for scientific investigations. / A persist?ncia de infec??o no interior do sistema de canais radiculares constitui um dos principais fatores respons?veis pelos insucessos endod?nticos. A complexidade da anatomia interna dos canais dificulta sua elimina??o completa pelas t?cnicas de instrumenta??o atuais. Diante desta realidade, protocolos alternativos de desinfec??o, abrangendo meios qu?micos e terapia fotodin?mica (PAD), t?m sido pesquisados. Nessa pesquisa, 10 c?es foram divididos aleatoriamente em dois grandes grupos (n=5): submetidos ou n?o ? PAD. Os canais dos dentes pr?-molares superiores e inferiores de cada c?o foram distribu?dos nos subgrupos experimentais: SX (Sterilox 400ppm), H2 (hipoclorito de s?dio (NaOCl) 2%), H5 (NaOCl 5%) e controle: C+ (controle positivo: soro fisiol?gico) totalizando uma amostra de 134 canais radiculares. Os dentes dos grupos experimentais e do grupo C+ foram abertos e os canais foram deixados expostos ao ambiente oral por 15 dias. Ap?s o selamento das cavidades, aguardaram-se 60 dias, objetivando-se a indu??o de periodontite apical (PA). Os canais foram preparados de acordo com cada protocolo de desinfec??o proposto e obturados na mesma sess?o. Decorridos 120 dias, os c?es foram mortos, sendo realizados os seguintes procedimentos: radiografias periapicais (PR), para mensura??o das ?reas das PAs; tomografias cone beam (CBCT), para mensura??o das ?reas e dos volumes das PAs; microscopia ?ptica, para avalia??o dos eventos inflamat?rios periapicais. Com base na coleta desses dados, o experimento foi dividido em 2 artigos. O primeiro realizou uma avalia??o da efic?cia das solu??es irrigadoras Sterilox 400ppm e NaOCl nas concentra??es de 2% e 5%, associados ou n?o ? PAD, na endodontia em sess?o ?nica de dentes de c?es com PAs. Na avalia??o histol?gica, o processo inflamat?rio 6 apical foi categorizado em escores, de acordo com a intensidade. Os dados foram coletados e analisados estatisticamente com os testes Kruskall-Wallis e Mann-Whitney (α= .05). A PAD n?o apresentou efeito significativo sobre o processo inflamat?rio apical quando utilizada ap?s o preparo qu?mico-mec?nico (PQM). As solu??es irrigadoras H5, H2 e SX do grupo sem PAD apresentaram diferen?as estat?sticas do grupo C+ (P=.02). Este estudo sugere que o emprego da PAD n?o apresentou relev?ncia cl?nica nos resultados da endodontia de dentes com necrose pulpar associados a PA. O emprego do Sterilox 400ppm no PQM promoveu limpeza eficiente e pode ser considerado como um irrigante alternativo ao NaOCl no tratamento endod?ntico. O segundo artigo avaliou a correla??o e a concord?ncia existentes entre as medidas da PA, fornecidas pela PR (?rea) e pela CBCT (?rea e volume), correlacionando com seu correspondente histol?gico. A correla??o entre os m?todos foi avaliada por meio do coeficiente de Person e a concord?ncia pelo m?todo de Bland-Altman (BA). Os resultados demonstraram que, apesar de uma forte correla??o entre as medidas das ?reas obtidas na PR e na CBCT, os limites de concord?ncia se apresentaram muito amplos (95%: 0.19 a 1.08). A PR mensurou em m?dia apenas 63% do valor da ?rea da CBCT. De acordo com o m?todo de BA, apesar da forte correla??o entre a ?rea da PR e o volume da CBCT, quanto maior o volume da PA na CBCT, mais subestimado ? o seu tamanho pela PR. Quando as PAs apresentaram volumes menores de 6 mm3, a estimativa dos valores da CBCT pela PR foram imprevis?veis. A correla??o da ?rea da PR, ?rea da CBCT e volume da CBCT com os dados histol?gicos foi significativa. Em conclus?o, o diagn?stico da PA baseado em dados radiogr?ficos ? clinicamente limitado e n?o deveria ser usado para investiga??es cient?ficas.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/1261 |
| Date | 26 February 2014 |
| Creators | Lopez, Fernanda Ullmann |
| Contributors | Pelisser, Fabiana Vieira Vier |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Odontologia, PUCRS, BR, Faculdade de Odontologia |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | -8096554818733665164, 500, 600, 4673435736271820140 |
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