Felicidad en aristoteles
Páginas: 10 (2263 palabras)
Publicado: 8 de abril de 2010
The importance of apical patency and cleaning of the apical foramen on root canal preparation
Ronaldo Araújo SouzaI, II, III
Correspondence
ABSTRACT
The apical limit of root canal instrumentation has always been a matter of great controversy. Despite the large number of published studies on this subject, a consensus has not yet been reached. In fact, the recent discussion on apical patency andcleaning of the apical foramen, as well as the incorporation of these procedures to the endodontic treatment, seem to have raised even more polemics. It is likely that all this polemics has its roots in the lack of interrelation between the theoretical knowledge of pulp stump and periapical tissues and the real clinical practice. By addressing the most important aspects of this theme, this paperaims to present news concepts about the importance of apical patency and cleaning of the apical foramen during root canal preparation.
Key Words: root canal therapy, apical limit, apical patency, cleaning of the apical foramen.
RESUMO
INTRODUCTION
The apical limit of root canal instrumentation is still a very controversial topic in Endodontics (1,2). The possibility of aggressions toapical and periapical tissues has supported the principle of the working length staying short of the radiographic apex (3-6).
Although some authors still advocate that it is possible to establish, by tactile sensibility, the CDJ (cementodentinal junction) limit as the ideal point where root canal preparation should end, it has been demonstrated that this procedure leads to several errors (7).Different working lengths have been proposed, but the most widely accepted approach seems to be choosing a working length of 1 mm coronal to the root apex. According to these concepts, the cemental canal should not be instrumented (3-5).
Currently, the role of microorganisms in pulpal and periapical diseases is well known, and the anaerobic bacteria are recognized as important pathogens. Despite thedivergences concerning their percentage, the predominance of anaerobic microorganisms in the apical third, including the cemental canal, is a common trait in most studies (8,9). This understanding has brought about important changes for endodontic therapy. Some authors have supported the idea that the cemental canal should be included in root canal instrumentation, which means that, in many cases,the endodontic treatment should not be limited to a point located 1 mm short of the root apex, but should instead be extended to the full canal length (10,11). Although there is a recent trend to accept this approach in some cases of teeth with periapical lesion, in fact, the apical limit of instrumentation in teeth with necrotic and vital pulps is still a source of discussion and controversy inthe several areas of Endodontics.
In cases of periapical lesion, recognizing the presence of microorganisms in the cemental canal (8), and even in the lesion itself (9), has contributed to spread the acceptation of cleaning and debridement of the apical foramen during root canal instrumentation. Nevertheless, the possible existence of a vital pulp stump in cases of necrotic pulp withoutperiapical lesion has precluded the full acceptation of these procedures by endodontists and researchers.
On the other hand, the major concern during root canal therapy of teeth with vital pulp has been to preserve the vitality of the pulp stump. For this reason, several authors have recommended that the working length should be determined 1-2 mm short of the radiographic root apex (3-5).
Addressingthe many issues related to this topic is the scope of this paper.
DISCUSSION
The literature has referred to apical patency with certain frequency (1,3-5,10-14) and occasionally to cleaning of the apical foramen (10,11). Because the definitions of these procedures are often misunderstood, it is essential to address the differences between them, before any discussion is undertaken.
During root...
Ronaldo Araújo SouzaI, II, III
Correspondence
ABSTRACT
The apical limit of root canal instrumentation has always been a matter of great controversy. Despite the large number of published studies on this subject, a consensus has not yet been reached. In fact, the recent discussion on apical patency andcleaning of the apical foramen, as well as the incorporation of these procedures to the endodontic treatment, seem to have raised even more polemics. It is likely that all this polemics has its roots in the lack of interrelation between the theoretical knowledge of pulp stump and periapical tissues and the real clinical practice. By addressing the most important aspects of this theme, this paperaims to present news concepts about the importance of apical patency and cleaning of the apical foramen during root canal preparation.
Key Words: root canal therapy, apical limit, apical patency, cleaning of the apical foramen.
RESUMO
INTRODUCTION
The apical limit of root canal instrumentation is still a very controversial topic in Endodontics (1,2). The possibility of aggressions toapical and periapical tissues has supported the principle of the working length staying short of the radiographic apex (3-6).
Although some authors still advocate that it is possible to establish, by tactile sensibility, the CDJ (cementodentinal junction) limit as the ideal point where root canal preparation should end, it has been demonstrated that this procedure leads to several errors (7).Different working lengths have been proposed, but the most widely accepted approach seems to be choosing a working length of 1 mm coronal to the root apex. According to these concepts, the cemental canal should not be instrumented (3-5).
Currently, the role of microorganisms in pulpal and periapical diseases is well known, and the anaerobic bacteria are recognized as important pathogens. Despite thedivergences concerning their percentage, the predominance of anaerobic microorganisms in the apical third, including the cemental canal, is a common trait in most studies (8,9). This understanding has brought about important changes for endodontic therapy. Some authors have supported the idea that the cemental canal should be included in root canal instrumentation, which means that, in many cases,the endodontic treatment should not be limited to a point located 1 mm short of the root apex, but should instead be extended to the full canal length (10,11). Although there is a recent trend to accept this approach in some cases of teeth with periapical lesion, in fact, the apical limit of instrumentation in teeth with necrotic and vital pulps is still a source of discussion and controversy inthe several areas of Endodontics.
In cases of periapical lesion, recognizing the presence of microorganisms in the cemental canal (8), and even in the lesion itself (9), has contributed to spread the acceptation of cleaning and debridement of the apical foramen during root canal instrumentation. Nevertheless, the possible existence of a vital pulp stump in cases of necrotic pulp withoutperiapical lesion has precluded the full acceptation of these procedures by endodontists and researchers.
On the other hand, the major concern during root canal therapy of teeth with vital pulp has been to preserve the vitality of the pulp stump. For this reason, several authors have recommended that the working length should be determined 1-2 mm short of the radiographic root apex (3-5).
Addressingthe many issues related to this topic is the scope of this paper.
DISCUSSION
The literature has referred to apical patency with certain frequency (1,3-5,10-14) and occasionally to cleaning of the apical foramen (10,11). Because the definitions of these procedures are often misunderstood, it is essential to address the differences between them, before any discussion is undertaken.
During root...
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