Dissertação
Avaliação das alterações morfológicas do forame apical após ampliação foraminal: uma revisão sistemática
Fecha
2022-07-22Autor
Isabella Figueiredo Assis Macedo
Institución
Resumen
This systematic review aimed to evaluate the morphological alterations of the apical
foramen after foraminal enlargement procedure. Electronic searches were performed
in PubMed/Medline, Scopus, Web of Science, SciELO, Embase, Google Scholar
databases and reference lists until April 2022. Only ex vivo studies evaluating the
influence of foraminal enlargement on morphological changes of the apical foramen
were included. Studies without a control group or full text available were excluded.
Foraminal deformation and increased area were considered the primary outcomes.
The risk of bias assessment was performed according to a modified Joanna Briggs
Institute checklist. Seven hundred two studies were retrieved, of which thirteen were
eligible for qualitative analysis. Most studies used maxillary or mandibular molars with
curved root canals and rotary and reciprocating systems for instrumentation. The
working length determined by the included studies ranged from two millimeters short
to one millimeter beyond the apical foramen. Regarding foraminal deformation, of the
studies included in this review, eight found an increase in foramen deformation after
foraminal enlargement, while five did not observe a significant influence. Among eight
studies that evaluated the foraminal area, all found an increase in the area after
foraminal enlargement. Insufficient data for touched/untouched cemental walls by
endodontic instruments and formation of dentin microcracks were observed. A low risk
was found in the risk of bias analysis of eligible studies. Within the limitations of this
review, it is noted that foraminal enlargement during root canal preparation seems to
increase the deformation and area of the apical foramen, especially when the working
length exceeds the limit of the greater foramen by at least one millimeter. However, it
was not possible to conclude whether there is a conservative but effective protocol for
foraminal enlargement due to the great methodological heterogeneity of the studies.
Future investigations with standardized methodologies are encouraged in order to
provide more robust evidence.