Influencia de la Permeabilización del Conducto sobre el Desarrollo del Dolor Postoperatorio: Una Revisión Sistemática.

Abstract

Objetivo Valorar la influencia de la realización de la permeabilidad del conducto sobre la aparición y la intensidad del dolor postoperatorio. Material y Método En marzo del 2020 se realizó una búsqueda bibliográfica en 4 bases de datos electrónicas, PubMed, Scopus, Dialnet y Scielo. También realizamos una búsqueda manual en las referencias bibliográficas de los artículos elegidos. Los estudios clínicos incluidos, valoraron la aparición y la intensidad del dolor postoperatorio después de la preparación del conducto radicular sin realizar el paso preliminar de la permeabilización del conducto, así como realizando la permeabilización del conducto utilizando distinta cinemática, es decir, limas manuales o limas rotatorias bajo movimiento continuo o reciprocante. Resultados De los 51 artículos identificados, sólo 4 fueron los que cumplieron los requisitos y por lo tanto los que fueron incluidos en el análisis de los resultados. Con una muestra total de 708 pacientes. 2 de los estudios concluyeron que la aparición del dolor era menos frecuente y con una resolución más rápida, cuando la permeabilización del conducto se realizaba con limas rotatorias que cuando se realizaba con limas manuales y no se encontraban diferencias significativas entre ambos grupos una vez pasado los siete primeros días tras el tratamiento. 1 de los estudios valora que existe más dolor postoperatorio cuando no se realiza el paso preliminar de la permeabilización, al realizar el tratamiento de conducto, que cuando se realiza con limas rotatorias. Un último estudio sólo compara la realización de la permeabilización de conducto entre dos limas rotatorias de movimiento continuo, obteniendo como resultado que el grupo de pacientes realizado con limas HyFlexEDM presenta menos dolor que el grupo de pacientes realizado con limas Pathfile. De todas las limas valoradas, sólo se ha valorado una de movimiento reciprocante, por lo que los datos no son concluyentes para poder diferencias entre ambos movimientos.

Objective: To assess the influence of the realization of the glide path on the appearance and the intensity of the postoperative pain. Materials and methods: A search was performed in June 2019 in four electronic databases, PubMed, Scopus, Dialnet, Scielo. The bibliographic references of the eligible articles were also hand-searched. The included clinical studies assessed the appearance and the intensity of postoperative pain after the root canal preparation without performing the preliminary step of the glide path, as well as performing the glide path using other kinematics, that is, manual, continuous rotary or reciprocating instruments. Results: From 51 identified articles, only 4 met the requirements and therefore the ones that were included in the analysis of the results. With a total sample of 708 patients. Two of the studies concluded that the appearance of the pain was less frequent and with a faster resolution when the glide path was performed by rotary instruments than when it was performed with manual instruments. Besides, no significant differences were found between the two groups after the first seven days after the treatment. One of the studies values that when making the root canal treatment, there is more postoperative pain when the glide path is not performed than when it is performed whit rotatory instruments. A last study only compared the performance of the glide path between two continuous rotatory instruments, obtaining as a result that the group of patients in which it was performed using HyFlexEDM instruments presented less pain than the group in which it performed with Pathfile instruments. Of all the instruments evaluated, there is only one of reciprocating movement. Thus, the data are not conclusive in order to be able to differentiate the continuous or reciprocating instruments. Due to the limited number of studies and the fact that each one used methodological difference, a statistical analysis was not performed comparing the appearance of the postoperative pain between the different instruments used to perform the glide path. Conclusion: The appearance and the intensity of the pain is greater when the glide path is not performed or when it is performed with manual instruments (as opposed to rotatory instruments). Mechanical, chemical and microbiological injuries to periapical tissues are regarded as the main causes of acute periapical inflammation. Irritants such as infected debris However, due to the complexity of the study of postoperative pain because of the high number of variables that influence its appearance, new studies with a strategic design are necessary to clarify the relationship between postoperative pain and the kinematics of the performance of the glide path.