Efectividad en la remoción del hidróxido de calcio en el tercio apical en dientes naturales en investigaciones In vitro – revisión sistemática

Abstract

Background: Calcium hydroxide Ca (OH)2 must be removed in order to condition the dentin surface and provide the ideal physical and chemical conditions to achieve an optimal seal, but its total elimination from the canal system is tough. If the removal is not fully achieved, residues may affect some properties of endodontic sealers and subsequently affect treatment outcomes Objective: To assess the effectiveness of XP-endo® Finisher and Photon-Induced Photoacoustic Transmission Laser Activated Irrigation (PIPS) compared with the technique activated with ultrasound (PUI) in the removal of calcium hydroxide in the apical third in natural teeth during endodontic treatment reported in the literature. Selection criteria: Studies published from 2011 to 2021 dealing with the removal of calcium hydroxide PUI, XP-endo® Finisher and PIPS, studies where the irrigant is sodium hypochlorite, in vitro experimental studies, meta-analyses and randomized clinical trials. Data collection and analysis: Assessment of methodological quality, risk of bias, and data extraction were performed independently and in duplicate. The Faggion checklist was extracted for critical reading and evaluation of the methodological quality of in vitro articles and the PRISMA guide for systematic review and meta-analysis. For the evaluation of the risk of bias of the in vitro studies, a tool made by the authors based on the Faggion guide was used and for the other article, the Cochrane risk-of-bias tool for Random Trials (RoB2) was used. The statistical unit of analysis was the included studies. Results: Of the twelve studies selected, one is in vitro studies and one is a systematic review and meta-analysis. Three studies evaluated the PUI technique, five the Xp-endo® Finisher and the remaining four PIPS Conclusions: Although the three irrigation techniques had the capacity to eliminate intracanal calcium hydroxide, none of them completely remove it from the apical third. Due to the small sample sizes, low number of included studies, and limitations, more research is needed to confirm the results.