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Abstract(s)
Introdução: A doença cárie na infância ainda continua a ser um problema grave de saúde
e a presença de lesão de cárie nos dentes decíduos pode gerar a necessidade de algum
tipo de tratamento pulpar. Saber escolher o melhor tipo de tratamento, é sempre um desafio
clínico. Além disso existem diferentes possibilidades de materiais de preenchimento
endodôntico sendo importante saber selecionar o mais adequado para cada tipo de
tratamento.
Objetivos: O objetivo do presente estudo, foi realizar uma revisão sistemática, do tipo
umbrella review, sobre diferentes tipos de tratamento pulpar e materiais de preenchimento
endodôntico em dentes decíduos.
Materiais e métodos: Foi estabelecida a PICO (S) question (“Qual o melhor tipo de
tratamento pulpar e material de preenchimento endodôntico para dentes decíduos?”). A
estratégia de busca foi definida, sendo utilizada nas bases de dados selecionadas.
(PubMed, Web of Science e o Scopus). A qualidade metodológica desta umbrella review foi
avaliada através da ferramenta AMSTAR-2, enquanto o risco de viés com a ROBIS. Por
outro lado, a análise do nível de evidência foi avaliada através da ferramenta GRADE.
Resultados: No total 8 revisões sistemáticas foram incluídas. Três dos estudos incluídos
avaliaram o tratamento pulpar (desfecho 1) e os 5 restantes, os materiais endodônticos
(desfecho 2). Em relação ao tratamento pulpar, a remoção seletiva/proteção pulpar indireta
mostraram ser efetivos, sendo o selamento da cavidade um fator muito importante, com
destaque para a técnica de hall technique, com os melhores índices sucesso clínico. A
proteção pulpar direta é um procedimento que depente de fatores clínicos, difíceis de serem
avaliados, podendo ser mais efetivo evoluir para pulpectomia nas situações de exposição
pulpar. Ao comparar o tratamento endodôntico (com e sem instrumentação) não há
evidências de superioridade entre os diferentes tipos. Quanto aos materiais utilizados para
pulpotomia, o formocresol e o MTA tem elevados índices de sucesso clínico, enquanto nos
materiais de preenchimento endodôntico, as pastas a base de óxido de zinco e eugenol, e
as a base, de hidróxido de cálcio e iodofórmio associadas, tem bom nível de evidência
clínica.
Conclusão: Pode-se concluir que em relação aos tipos de tratamento pulpar, o
conservador, utilizando a remoção seletiva associado a um bom material ou técnica de
selamento da cavidade, tem alto índice de sucesso clínico. A proteção pulpar direta não é
uma opção segura e previsível e o tratamento endodôntico que utiliza a instrumentação
ainda não pode ser substituído pelo a opção de não instrumentar. Para os materiais
utilizados nos diferentes tipos de tratamento pulpar, a pulpotomia com MTA ou formocresol,
tem alto nível de evidência científico e sucesso clínico, já o tratamento endodôntico pode
ser realizado com pastas a base de óxido de zinco e eugenol ou hidróxido de cálcio
associado ao iodofórmio.
Introduction: Caries disease in childhood is still a serious health problem, and the presence of caries lesions in deciduous teeth may generate the need for some type of pulp treatment. Knowing how to choose the best type of treatment is always a clinical challenge. Furthermore, there are different possibilities of endodontic filling materials, and it is important to know how to select the most appropriate one for each type of treatment. Objetive: The objective of the present study was to perform a systematic review, of the umbrella review type, on different types of pulp treatment and endodontic filling materials in deciduous teeth Materials and Methods: The PICO (S) question ("What is the best type of pulp treatment and endodontic filling material for deciduous teeth?") was established. The search strategy was defined and used in the selected databases (PubMed, Web of Science and Scopus). The methodological quality of this umbrella review was assessed using the AMSTAR-2 tool, while the risk of bias with ROBIS. On the other hand, the level of evidence analysis was evaluated using the GRADE tool. Results: A total of 8 systematic reviews were included. Three of the included studies evaluated pulp treatment (endpoint 1) and the remaining 5 evaluated endodontic materials (endpoint 2). Regarding pulp treatment, selective removal/indirect pulp protection proved to be effective, with cavity sealing being a very important factor, especially the hall technique, with the best clinical success rates. Direct pulp protection is a procedure that depends on clinical factors that are difficult to evaluate, and it may be more effective to evolve to pulpectomy in situations of pulp exposure. When comparing the endodontic treatment (with and without instrumentation) there is no evidence of superiority between the different types. As for the materials used for pulpotomy, formocresol and MTA have high rates of clinical success, while in the endodontic filling materials, oxide-based fillers have high rates of clinical success. zinc oxide and eugenol, and calcium hydroxide and iodoform fillings have a good level of clinical evidence. Conclusion: It can be concluded that regarding the types of pulp treatment, the conservative one, using selective removal associated with a good material or technique for sealing the cavity, has a high rate of clinical success. Direct pulp protection is not a safe and predictable option, and the endodontic treatment that uses instrumentation cannot yet be replaced by the option of not instrumenting. For the materials used in the different types of pulp treatment, pulpotomy with MTA or formocresol has a high level of scientific evidence and clinical success, while endodontic treatment can be performed with pastes based on zinc oxide and eugenol or calcium hydroxide associated with iodoform.
Introduction: Caries disease in childhood is still a serious health problem, and the presence of caries lesions in deciduous teeth may generate the need for some type of pulp treatment. Knowing how to choose the best type of treatment is always a clinical challenge. Furthermore, there are different possibilities of endodontic filling materials, and it is important to know how to select the most appropriate one for each type of treatment. Objetive: The objective of the present study was to perform a systematic review, of the umbrella review type, on different types of pulp treatment and endodontic filling materials in deciduous teeth Materials and Methods: The PICO (S) question ("What is the best type of pulp treatment and endodontic filling material for deciduous teeth?") was established. The search strategy was defined and used in the selected databases (PubMed, Web of Science and Scopus). The methodological quality of this umbrella review was assessed using the AMSTAR-2 tool, while the risk of bias with ROBIS. On the other hand, the level of evidence analysis was evaluated using the GRADE tool. Results: A total of 8 systematic reviews were included. Three of the included studies evaluated pulp treatment (endpoint 1) and the remaining 5 evaluated endodontic materials (endpoint 2). Regarding pulp treatment, selective removal/indirect pulp protection proved to be effective, with cavity sealing being a very important factor, especially the hall technique, with the best clinical success rates. Direct pulp protection is a procedure that depends on clinical factors that are difficult to evaluate, and it may be more effective to evolve to pulpectomy in situations of pulp exposure. When comparing the endodontic treatment (with and without instrumentation) there is no evidence of superiority between the different types. As for the materials used for pulpotomy, formocresol and MTA have high rates of clinical success, while in the endodontic filling materials, oxide-based fillers have high rates of clinical success. zinc oxide and eugenol, and calcium hydroxide and iodoform fillings have a good level of clinical evidence. Conclusion: It can be concluded that regarding the types of pulp treatment, the conservative one, using selective removal associated with a good material or technique for sealing the cavity, has a high rate of clinical success. Direct pulp protection is not a safe and predictable option, and the endodontic treatment that uses instrumentation cannot yet be replaced by the option of not instrumenting. For the materials used in the different types of pulp treatment, pulpotomy with MTA or formocresol has a high level of scientific evidence and clinical success, while endodontic treatment can be performed with pastes based on zinc oxide and eugenol or calcium hydroxide associated with iodoform.
Description
Keywords
Cáries dentárias Pulpotomia Pulpetomia Dentes decíduos Revisão sistemática Dental caries Pulpotomy Pulpectomy Tooth deciduous Systematic review