Nossa revisão sistemática é a primeira revisão que sintetiza os estudos que avaliam a influência de diferentes técnicas de instrumentação radicular, na formação e/ou propagação de defeitos dentinários em dentes tratados endodonticamente. Evidências claras que desaprovam qualquer influência na instrumentação radicular foram encontradas contestando qualquer influência alegada na preparação do canal radicular levando à iniciação e/ou propagação de defeitos dentinários, como a maioria dos estudos que usavam uma metodologia precisa e confiável não apresentaram relação entre esses fatores.
A falta de consenso do efeito da técnica de instrumentação no desenvolvimento de defeitos dentinários foi principalmente motivada pela influência da avaliação dos métodos que agem tendenciosamente. As metodologias destrutivas, tais como esteriomicroscopias ópticas demonstraram que as técnicas de instrumentação radicular levam a formação de defeitos dentinários que não estavam presentes antes da instrumentação (STRINGUETA et al., 2017). De outro lado, estudos utilizando a análise por microtomografia computadorizada não demonstraram a formação de defeitos dentinários após o preparação do canal radicular (DE-DEUS et al., 2015; BAYRAM et al., 2017; CASSIMIRO et al., 2017; DE OLIVEIRA et al., 2017; DE-DEUS et al., 2017; STRINGHETA et al., 2017; ZUOLO et al.,2017). A razão pela qual isso ocorre é que esse método de avaliação por microtomografia computadorizada é o mais confiável e preciso. Os problemas relatados com o uso de técnicas destrutivas são que elas não consideram o dano potencial causado pela simples interação de diferentes fontes de estresse na dentina radicular em diferentes momentos do tratamento. Assuntos tais como o efeito da solução de hipoclorito de sódio usada durante a irrigação, o próprio preparo mecânico, a metodologia de seccionamento (STRINGUETA et al., 2017), a desidratação inerente causada pela dificuldade em manter uma condição adequada durante o período de execução de tal metodologia (SHEMESH et al., 2018), e o álcool obrigatório na desidratação em série que precede a análise por microscopia eletrônica de varredura não é considerada. Além disso, os métodos destrutivos somente avaliam níveis limitados do comprimento da raiz do canal radicular (STRINGUETA et al., 2017).
A análise por microtomografia computadorizada acessa o comprimento total do canal radicular, permitindo um posicionamento preciso dos defeitos dentinários existentes na dentina. A reconstrução tridimensional pode ser realizada em diferentes estágios do tratamento endodôntico, permitindo que os defeitos dentinários pré-existentes possam ser observados, uma vez que é um método não-destrutivo (SWAIN & XUE 2009; DE-DEUS et al., 2016).
Outra consideração importante é a influência do comprimento de trabalho definido para a instrumentação do canal radicular, independentemente da técnica utilizada. Estudos são quase unânimes, com relação a subtração de um milímetro do comprimento do canal radicular que deveria ser realizado para evitar danos (iniciação e/ou propagação dos defeitos dentinários) à região do ápice, para todas as técnicas de instrumentação consideradas (ROSE & SVEC, 2015).
A importância do nosso estudo é que este inclui métodos rigorosos para a seleção de estudos e dados de extração, incluindo todos os dados disponíveis nesta temática. Além disso, a maioria dos estudos incluídos apresentou baixo risco de viés em todos os domínios considerados. Como limitação do nosso estudo, a avaliação do impacto do viés de publicação nos resultados da revisão sistemática não foi possível. Embora pareça claro que a técnica de instrumentação do canal radicular não esteja provavelmente relacionada ao desenvolvimento de defeitos dentinários, o impacto de várias estratégias restauradoras, na propagação de defeitos dentinários detectadas em tratamentos pré-endodônticos, e seu comportamento permanecem amplamente desconhecidos. Além disso, a observância de protocolos rígidos desde a extração dentária até a análise final deve ser tomada e completamente relatada quando publicada.
REFERÊNCIAS
ABOU EL NASR HM, ABD EL KADER KG. Dentinal damage and fracture resistance of oval roots prepared with single-file systems using different kinematics. J Endod. v.40, n.6, p. 849-851, sep., 2014.
ADORNO CG, YOSHIOKA T, SUDA H. The effect of root preparation technique and instrumentation length on the development of apical root cracks. J Endod v.35, n.3, p.389-392, dec., 2009.
ADORNO CG, YOSHIOKA T, SUDA H. The effect of working length and root canal preparation technique on crack development in the apical root canal wall. International
Endodontic Journal v.43, n.4, p.321-327, dec., 2010.
ARIAS A, LEE YH, PETERS CI, GLUSKIN AH, PETERS OA. Comparison of 2 canal preparation techniques in the induction of microcracks: a pilot study with cadaver mandibles. J Endod v.40, n.7, p. 982-985, dec., 2014.
ASHWINKUMAR V, KRITHIKADATTA J, SURENDRAN S, VELMURUGAN N. Effect of reciprocating file motion on microcrack formation in root canals: an SEM study. Int
Endod J, v.47, p.622–627, sep., 2014.
AYDIN U, AKSOY F, KARATASLIOGLU E, YILDIRIM C. Effect of
ethylenediaminetetraacetic acid gel on the incidence of dentinal cracks caused by three novel nickel-titanium systems. Aust Endod J, v.41, n.3, p.104-110, 2015.
BAHRAMI P, SCOTT R, GALICIA JC, ARIAS A, PETERS OA. Detecting Dentinal Microcracks Using Different Preparation Techniques: An In Situ Study with Cadaver Mandibles. J Endod v.43, n.12, p. 2070-2073, jul., 2017.
BAYRAM M, BAYRAM E, OCAK M, UYGUN A, CELIK H. Effect of ProTaper Gold, Self-Adjusting File, and XP-endo Shaper Instruments on Dentinal Microcrack Formation: A Micro–computed Tomographic Study." Journal of Endodontics v.43, n.7, p. 1166-1169, feb., 2017.
BIER CA, SHEMESH H, TANOMARU-FILHO M, WESSELINK PR, WU MK. The ability of different nickel-titanium rotary instruments to induce dentinal damage during canal preparation. J Endod v.35, n.2, p. 236-238, Feb., 2009.
BORGES AH, DAMIÃO MS, PEREIRA TM, FILHO GS, MIRANDA-PEDRO F, ROSA W, PIVA E, GUEDES O. Influence of Cervical Preflaring on the Incidence of Root Dentin Defects. J Endod v.44, n.2, p. 286-291, sep., 2018.
BURKLEIN S, TSOTSIS P, SCHAFER E. Incidence of dentinal defects after root canal preparation: reciprocating versus rotary instrumentation. J Endod v.39, n. 4, p.501-504, apr., 2013.
CAPAR ID, ARSLAN H. A review of instrumentation kinematics of engine-driven nickel-titanium instruments. Int Endod J v.49, p 119-35, jan, 2015.
CASSIMIRO M, ROMEIRO K, GOMINHO L, DE ALMEIDA A, COSTA L,
ALBUQUERQUE D. Occurence of dentinal defects after root canal preparation with R-phase, M-Wire and Gold Wire instruments: a micro-CT analysis. BMC Oral Health v. 17, p.2-6, 2017.
CASSIMIRO M, ROMEIRO K, GOMINHO L, DE ALMEIDA A, SILVA L,
ALBUQUERQUE D. Effects of Reciproc, ProTaper Next and WaveOne Gold on Root Canal Walls: A Stereomicroscope Analysis. Iran Endod J v. 13, n. 2 , p. 228-33, jan., 2018.
CEYHANLI KT, ERDILEK N, TATAR I, CELIK D. Comparison of ProTaper, RaCe and Safesider instruments in the induction of dentinal microcracks: a micro-CT study. Int
Endod J v. 49, p. 684-9, 2016.
ÇIÇEK E, KOÇAK MM, SAILAM BC, KOÇAK S. Evaluation of microcrack formation in root canals after instrumentation with different NiTi rotary file systems: A scanning electron microscopy study. Scanning v. 37, p. 01-05, oct, 2014.
COELHO MS, CARD SJ, TAWIL PZ. Light-emitting Diode Assessment of Dentinal Defects after Root Canal Preparation with Profile, TRUShape, and WaveOne Gold Systems. Journal of Endodontics v. 42, n. 9, p. 1393-6, sep., 2016.
DE OLIVEIRA BP, CAMARA AC, DUARTE DA, HECK RJ, ANTONINO ACD, AGUIAR CM. Micro-computed Tomographic Analysis of Apical Microcracks before and after Root Canal Preparation by Hand, Rotary, and Reciprocating Instruments at Different Working Lengths. J Endod v. 43, n. 7, p. 1143-7, jul., 2017.
DE-DEUS G. et al. Lack of causal relationship betweendentinal microcracks and root canal preparations with reciprocation systems. J Endod., v. 40, p. 1447-50, 2014. DE-DEUS G, BELLADONNA FG, SILVA EJ, SOUZA EM, VERSIANI MA. Critical appraisal of some methodological aspects of using micro-CT technology in the study of dentinal microcracks in endodontics. Int Endod J v. 49,p 216-9, jul., 2016.
DE-DEUS G, BELLADONNA FG, SOUZA EM, SILVA EJ, NEVES ADE A, ALVES H, ET AL. Micro-computed Tomographic Assessment on the Effect of ProTaper Next and Twisted File Adaptive Systems on Dentinal Cracks. J Endod v. 41, n. 7, p.1116-9, 2015. DE-DEUS G, CESAR DE AZEVEDO CARVALHAL J, BELLADONNA FG, SILVA E, LOPES RT, MOREIRA FILHO RE, ET AL. Dentinal Microcrack Development after Canal Preparation: A Longitudinal in Situ Micro-computed Tomography Study Using a Cadaver Model. J Endod v. 43, p. 1553-8, 2017.
DEVALE MR, MAHESH MC, BHANDARY S. Effect of instrumentation length and
instrumentation systems: Hand versus rotary files on apical crack formation – an in vitro study. Journal of Clinical and Diagnostic Research v. 11, n. 1, p. ZC15-ZC8, jan., 2017.
FREGNANI, E.; HIZATUGU, R. Endodontia: uma visão contemporânea. São Paulo, Santos, p.249-265, 2012.
GARG S, MAHAJAN P, THAMAN D, MONGA P. Comparison of dentinal damage induced by different nickel-titanium rotary instruments during canal preparation: An in vitro study. J Conserv Dent v. 18, n. 4, p. 302-5, jul-aug., 2015.
GRIFFITH AA. The Phenomena of Rupture and Flow in Solids. Philosophical
Transactions of the Royal Society of London. Series A, Containing Papers of a Mathematical or Physical Character v. 221, p. 163-98, 1921.
HARANDI A, MIRZAEERAD S, MEHRABANI M, MAHMOUDI E, BIJANI A. Incidence of Dentinal Crack after Root Canal Preparation by ProTaper Universal, Neolix and
SafeSider Systems. Iran Endod J v.12, n. 4, p. 432-8, 2017.
HELVACIOGLU-YIGIT D, AYDEMIR S, YILMAZ A. Evaluation of dentinal defect formation after root canal preparation with two reciprocating systems and hand
instruments: an in vitro study. Biotechnol Biotechnol Equip v. 29, n. 2, p. 368-73, nov., 2015.
HIGGINS J, GREEN S, EDITORS. Cochrane Handbook for Systematic Reviews of Interventions 2011. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011.
HIN ES, WU MK, WESSELINK PR, SHEMESH H. Effects of self-adjusting file, Mtwo, and ProTaper on the root canal wall. J Endod v. 39,n. 2, p. 262-4, feb., 2013.
ISOLAN CP, SARKIS-ONOFRE R, LIMA GS, MORAES RR. Bonding to Sound and Caries-Affected Dentin: A Systematic Review and Meta-Analysis. J Adhes Dent v. 20, n., p. 7-18, 2018.
JAIN A, BHADORIA K, CHOUDHARY B, PATIDAR N. Comparison of dentinal defects induced by hand files, multiple, and single rotary files: A stereomicroscopic study. World
Journal of Dentistry v. 8, n. 1, p. 45-8, jan-feb., 2017.
JALALI S, EFTEKHAR B, PAYMANPOUR P, YAZDIZADEH M, JAFARZADEH M. Effects of Reciproc, Mtwo and ProTaper Instruments on Formation of Root Fracture.
KANSAL R, RAJPUT A, TALWAR S, ROONGTA R, VERMA M. Assessment of dentinal damage during canal preparation using reciprocating and rotary files. J Endod v. 40, n. 9, p. 1443-6, sep., 2014.
KARATAS E, ARSLAN H, ALSANCAK M, KIRICI DO, ERSOY I. Incidence of Dentinal Cracks after Root Canal Preparation with Twisted File Adaptive Instruments Using Different Kinematics. J Endod v. 41, n. 7, p. 1130-3,jul., 2015.
KARATAS E, GUNDUZ HA, KIRICI DO, ARSLAN H, TOPCU MC, YETER KY. Dentinal crack formation during root canal preparations by the twisted file adaptive, ProTaper Next, ProTaper Universal, and WaveOne instruments. J Endod v. 41, n. 2 , p. 261-4, feb., 2015.
KARATAS E, GUNDUZ HA, KIRICI DO, ARSLAN H. Incidence of dentinal cracks after root canal preparation with ProTaper Gold, Profile Vortex, F360, Reciproc and ProTaper Universal instruments. Int Endod J v.49, p.905-910, 2016.
KESIM B, SAGSEN B, ASLAN T. Evaluation of dentinal defects during root canal
preparation using thermomechanically processed nickel-titanium files. Eur J Dent v. 11, n. 2, p. 157-61, jun., 2017.
KFIR A, ELKES D, PAWAR A, WEISSMAN A, TSESIS I. Incidence of microcracks in maxillary first premolars after instrumentation with three different mechanized file
systems: a comparative ex vivo study. Clin Oral Investig v. 21, p. 405-11, march, 2017. KHIRTIKA SG, RAMESH S. Comparative evaluation of dentinal cracks and detachments after instrumentation with hand and rotary files at various instrumentation lengths: An in vitro study. Journal of Advanced Pharmacy Education and Research v. 7, n. 3, p. 236-9, jul-sept, 2017.
KHOSHBIN E, DONYAVI Z, ABBASI ATIBEH E, ROSHANAEI G, AMANI F. The Effect of Canal Preparation with Four Different Rotary Systems on Formation of Dentinal Cracks: An In Vitro Evaluation. Iran Endod J v. 13, n. 2, p. 163-8, 2018.
KUMARI MR, KRISHNASWAMY MM. Comparative Analysis of Crack Propagation in Roots with Hand and Rotary Instrumentation of the Root Canal -An Ex-vivo Study. J
Clin Diagn Res v. 10, n. 7, Zc 16-9, jul., 2016.
LANDRIGAN M. D.et al., Detection of dentinal cracks using contrast-enhanced microcomputed tomography. Journal of the mechanical behaviorof biomedical
materials v. 3, p. 223-227, 2010.
LI ML, LIAO WL, CAI HX. A micro-computed tomographic evaluation of dentinal
microcrack alterations during root canal preparation using single-file Ni-Ti systems. Exp
LI SH, LU Y, SONG D, ZHOU X, ZHENG QH, GAO Y, et al. Occurrence of Dentinal Microcracks in Severely Curved Root Canals with ProTaper Universal, WaveOne, and ProTaper Next File Systems. J Endod v. 41, n. 11, p. 1875-9, nov., 2015.
LIU R, HOU BX, WESSELINK PR, WU MK, SHEMESH H. The incidence of root microcracks caused by 3 different single-file systems versus the ProTaper system. J
Endod v. 39, n. 8, p. 1054-6, jan., aug., 2013.
LIU R, KAIWAR A, SHEMESH H, WESSELINK PR, HOU B, WU MK. Incidence of apical root cracks and apical dentinal detachments after canal preparation with hand and rotary files at different instrumentation lengths. J Endod v. 39, n. 1, p. 129-32, jan., 2013. MILANI AS, FROUGHREYHANI M, RAHIMI S, JAFARABADI MA, PAKSEFAT S. The effect of root canal preparation on the development of dentin cracks. Iran Endod J v.7, n. 4, p. 177-82, 2012.
MISSAU T, DE CARLO BELLO M, MICHELON C, MASTELLA LANG P, KALIL PEREIRA G, BALDISSARA P ET AL. Influence of Endodontic Treatment and
Retreatment on the Fatigue Failure Load, Numbers of Cycles for Failure, and Survival Rates of Human Canine Teeth. Journal of Endodontics v. 43, p. 2081-2087, 2017. MOHER D, LIBERATI A, TETZLAFF J, ALTMAN DG, GROUP P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin.
Epidemiol., v. 62, n. 10, p. 1006-12, 2009.
MONGA P, BAJAJ N, MAHAJAN P, GARG S. Comparison of incidence of dentinal defects after root canal preparation with continuous rotation and reciprocating instrumentation. Singapore Dent J v 36, p. 29-33, 2015.
PEDULLA E, GENOVESI F, RAPISARDA S, LA ROSA GR, GRANDE NM, PLOTINO G, ET AL. Effects of 6 Single-File Systems on Dentinal Crack Formation. J Endod v. 43, n. 3,p. 456-61, march, 2017.
POP I, MANOHARAN A, ZANINI F, TROMBA G, PATEL S, FOSCHI F. Synchrotron light-based μCT to analyse the presence of dentinal microcracks post-rotary and reciprocating NiTi instrumentation. Clinical Oral Investigations v. 19, p. 11-6, 2015. PRIYA NT, CHANDRASEKHAR V, ANITA S, TUMMALA M, RAJ TB, BADAMI V, et al. "Dentinal microcracks after root canal preparation" a comparative evaluation with hand, rotary and reciprocating instrumentation. J Clin Diagn Res v. 8, n. 12, p. Zc 70-2, dec., 2014.
ROBINSON JP, LUMLEY PJ, COOPER PR, GROVER LM, WALMSLEY AD. Reciprocating root canal technique induces greater debris accumulation than a continuous rotary technique as assessed by 3-dimensional micro-computed tomography. J Endod v. 39, n. 8, p. 1067-70, 2013.
ROSE E, SVEC T. An Evaluation of Apical Cracks in Teeth Undergoing Orthograde Root Canal Instrumentation. J Endod v. 41, n. 12 , p. 2021-4, dec., 2015.
SAHA SG, VIJAYWARGIYA N, SAXENA D, SAHA MK, BHARADWAJ A, DUBEY S. Evaluation of the incidence of microcracks caused by Mtwo and ProTaper Next rotary file systems versus the self-adjusting file: A scanning electron microscopic study. J
Conserv Dent v. 20, p. 355-9, 2017.
SARKIS-ONOFRE R, SKUPIEN JA, CENCI MS, MORAES RR, PEREIRA-CENCI T. The role of resin cement on bond strength of glass-fiber posts luted into root canals: a systematic review and meta-analysis of in vitro studies. Oper Dent v. 39, n. 1, p. E31-44, 2014.
SARKIS-ONOFRE R, FERGUSSON D, CENCI MS, MOHER D, PEREIRA-CENCI T. Performance of Post-retained Single Crowns: A Systematic Review of Related Risk Factors. J Endod. n 43-2, p.175-183, 2017.
SIQUEIRA JF; LIMA KC; MAGALHÃES FA; LOPES HP; UZEDA M. “Mechanical reduction of the bacterial population in the root canal by three instrumentation techniques”. J Endod. v. 25, p. 332-335, 1999.
SHAMSEER L et al, PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015 Jan 2;349(jan02 1):g7647.
HEMESH H, LINDTNER T, PORTOLES CA, ZASLANSKY P. Dehydration Induces Cracking in Root Dentin Irrespective of Instrumentation: A Two-dimensional and Three-dimensional Study. J Endod v. 44, p. 120-5, 2018.
SHORI DD, SHENOI PR, BAIG AR, KUBDE R, MAKADE C, PANDEY S.
Stereomicroscopic evaluation of dentinal defects induced by new rotary system: "proTaper NEXT". J Conserv Dent 2015;18:210-3.
STRINGHETA CP, PELEGRINE RA, KATO AS, FREIRE LG, IGLECIAS EF, GAVINI G, ET AL. Micro–computed Tomography versus the Cross-sectioning Method to Evaluate Dentin Defects Induced by Different Mechanized Instrumentation Techniques. Journal
of Endodontics v. 43, n. 12, p. 2102-7, dec, 2017.
SWAIN MV, XUE J. State of the art of Micro-CT applications in dental research.
International Journal of Oral Science v. 1, p. 177-188, 2009.
THOMPSON SA. An overview of nickel-titanium alloys used in dentistry. International
Endodontic Journal v. 33, p. 297-310, 2000.
TOPÇUOĞLU HS, DÜZGÜN S, AKPEK F, TOPÇUOĞLU G. Effect of glide path and apical preparation size on the incidence of apical crack during the canal preparation
using Reciproc, WaveOne, and ProTaper Next systems in curved root canals: A stereomicroscope study. Scanning v. 38, p. 585-90, 2016.
USTUN Y, ASLAN T, SAGSEN B, KESIM B. The effects of different nickel-titanium instruments on dentinal microcrack formations during root canal preparation. Eur J Dent v. 9, n. 1, p. 41-6, jan-mar, 2015.
VIEIRA V, BELLADONNA F, SOUZA E, DE-DEUS G, NEVES A, MOREIRA E, SILVA E. Quantitative transportation assessment in simulated curved canals after large apical preparations. Braz J Oral Sci. v. 15, n. 3, p. 221-225, 2016.
VILAS-BOAS R., ALCALDE M., GUIMARÃES B. et al. RECIPROC: Comparativo entre a cinemática reciprocante e rotatória em canais curvos. Rev Odontol. Bras. Central v. 22, p.164-168, 2013.
VILLAGRA, R. M. Avaliação da vida em fadiga de instrumentos endodônticos
submetidos a ensaios de flexão rotativa em diferentes ângulos reciprocantes. Rio de Janeiro. Dissertação. Programa de Pós-Graduação Stricto Sensu em Odontologia; 2014.
WALIA HM, BRANTLEY WA, GERSTEIN H. An initial investigation of the bending and torsional properties of Nitinol root canal files. J Endod v. 14, p. 346-51, 1988.
YARED, G. Canal preparation using only one Ni-Ti rotary instru- ment: preliminar bservations. Int. Endod. J., v.41 n.4, p. 339-44, 2008.
WEI X, HU B, PENG H, TANG M, SONG J. The incidence of dentinal cracks during root canal preparations with reciprocating single-file and rotary-file systems: A meta-analysis.
Dent Mater J v. 36, p. 243-52, 2017.
YOLDAS O, YILMAZ S, ATAKAN G, KUDEN C, KASAN Z. Dentinal microcrack
formation during root canal preparations by different NiTi rotary instruments and the self-adjusting file. J Endod v 38, n. 2, p. 232-5, feb., 2012.
YE, J., GAO, Y. Metallurgical characterization of M-Wire nickel-titanium shape memory alloy used for endodontic rotary instruments during low-cycle fatigue. Rev. J Endod., v.38, p.105-107, 2012.
ZHOU X, JIANG S, WANG X, WANG S, ZHU X, ZHANG C. Comparison of dentinal and apical crack formation caused by four different nickel-titanium rotary and reciprocating systems in large and small canals. Dent Mater J v. 34, n. 6, p. 903-9, 2015.
ZUOLO ML, DE-DEUS G, BELLADONNA FG, SILVA EJ, LOPES RT, SOUZA EM, et al. Micro-computed Tomography Assessment of Dentinal Micro-cracks after Root Canal Preparation with TRUShape and Self-adjusting File Systems. J Endod v. 43, n. 4, p. 619-22, apr., 2017.