Eficácia de soluções anestésicas e diferentes condutas clínicas para o manejo de molares inferiores com pulpite irreversível: uma revisão sistematizada da literatura
DOI:
https://doi.org/10.22456/2177-0018.128114Palavras-chave:
Endodontia, Anestesia, Nervo mandibular, Medicação pré-anestésicaResumo
Objetivo: Dificuldades anestésicas podem decorrer de cenários de infecção e inflamação, como são os casos de pulpite irreversível. Logo, o propósito da presente revisão sistematizada foi auxiliar o clínico a alcançar anestesia profunda durante o tratamento de urgência endodôntica de molares mandibulares com pulpite irreversível. Materiais e métodos: Foram selecionados via PubMed, ensaios clínicos randomizados realizados com pacientes com pulpite irreversível em molares mandibulares procurando atendimento de urgência. Estes deveriam avaliar o sucesso anestésico através do relato de dor durante a abertura coronária e/ou instrumentação dos canais radiculares. Dois desfechos primários distintos eram alvo deste estudo (soluções anestésicas e condutas alternativas). Para soluções anestésicas, foram incluídos 18 estudos, e para condutas alternativas, 10 estudos. Revisão de literatura: Diversas estratégias têm sido investigadas para aumentar o percentual de sucesso anestésico, como o uso de técnicas complementares ao bloqueio do nervo alveolar inferior (BNAI), o aumento do volume de anestésico ou do vasoconstritor, o tamponamento das soluções e condutas alternativas. Discussão: Constatou-se que não há diferença na taxa de sucesso no BNAI e para técnicas anestésicas complementares para os diferentes agentes anestésicos. Além disso, a maior concentração de adrenalina, o aumento do volume da solução utilizada, substâncias capazes de tamponar a solução anestésica, a administração ou injeção de anti-inflamatórios, a crioterapia e o óxido nitroso também parecem melhoram as taxas de sucesso anestésico. Conclusão: Diversos métodos alternativos parecem promissores para potencializar uma anestesia profunda, e devem ser mais bem investigados para a adoção de parâmetros em prol de seu emprego definitivo.
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Copyright (c) 2022 Lucas Nunes Cechin, Israel Bangel Carlotto, Guilherme Pauletto, Sidnei Flores de Pellegrin, Carlos Alexandre Sousa Bier
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