RESUMO
Introduction: Bioceramic sealers have been gaining prominence in endodontics, meaning a great advance for endodontic therapy, mainly due to their biocompatibility and bioactivity. Objectives: research and discuss the literature about the bioactivity and biocompatibility of bioceramic sealants. Materials and methods: An integrative review was performed. The systematic plan consisted of four steps. In the first stage, a bibliographic survey was carried out in the Capes Periódicos Portal database. The search criteria were articles published between 2017 and 2022, found in the "advanced search" mode, using cross-references with the following keywords: bioceramics sealers AND endodontology AND root canals AND endodontic sealer AND bioactivity AND biocompatibility. Only documents found and published in full were evaluated. In the second stage, the titles and abstracts of the articles were read. In the third stage, a selection was made of those containing 3 to 5 keywords and a wording equal to or close to the proposed keywords. The fourth step consisted of reading the texts in full, followed by checking for duplicity and building a table with the collected information. Results: In view of the research carried out, 23 articles were obtained in the first stage. After reading the titles and abstracts, 21 articles were obtained. After selecting those containing 3 to 5 keywords, 10 articles met the criteria. One article was deleted due to duplicates. 9 articles met the exclusion and inclusion criteria and were selected to be part of the integrative review. Discussion: The selected studies in this literature review showed that bioceramic endodontic sealants perform well in endodontic therapy. Conclusion: To advance in its clinical application, more in vivo and in vitro studies with precise methods are needed to obtain more reliable data about its properties.
RESUMO
BACKGROUND: Experimental studies are controversial regarding the effects of radiotherapy for head and neck cancer (HNC) on the dental pulp. Therefore, a systematic review of clinical studies is necessary to investigate whether alterations in pulp status occur. OBJECTIVES: To evaluate the evidence on radiotherapy for HNC and pulp status. METHODS: A systematic search of articles published until November 2021 was performed in the MEDLINE/PubMed, Cochrane Library, Web of Science (All Databases), Scopus, EMBASE, and Open Grey databases. The eligibility criteria were based on the PICOS strategy, as follows: (P) vital teeth of adult patients with intraoral and/or oropharyngeal cancer; (I) radiotherapy; (C) control group or values of the same tooth before radiotherapy (basal values); (O) pulpal status after radiotherapy; and (S) clinical studies. The Cochrane Risk of Bias in Nonrandomized Studies of Interventions tool was used to assess the quality of the included studies. Meta-analyses were performed using fixed and random effects. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. RESULTS: Six studies were included for qualitative analysis. Five were classified as serious risk of bias and one as moderate risk of bias. Four studies reported altered pulp responses to cold thermal tests after radiotherapy initiation. Meta-analyses were performed using three included studies. From these, all were included in the meta-analysis for pulp response values to cold sensitivity test immediately after radiotherapy initiation (risk ratio: 0.00 [CI: 0.00, 0.02], p < .00001; I2 = 0%); and two in the meta-analysis for pulp response values to cold sensitivity test after 4-5 months of radiotherapy (risk ratio: 0.01 [CI: 0.00. 0.06], p < .00001; I2 = 0%). Two reported progressively higher readings to pulp response in the electrical test after radiotherapy initiation (mean difference: -11.46 [-13.09, -9.84], p < .00001; I2 = 68%). Two studies demonstrated a pulp oxygen saturation (SpO2 ) decrease at the end of radiotherapy; and an increase after 4-6 months of radiotherapy beginning. And other demonstrated normal dental pulp SpO2 4-6 years after treatment. GRADE analysis presented a moderate certainty of evidence. DISCUSSION: This review verified that radiotherapy for HNC causes significant alterations on the dental pulp responses, but does not seem to induce pulp necrosis. Significant limitations regarding controlling for confounding factors, classification of interventions, and measurement of outcomes were verified, evidencing the need for well-designed studies. CONCLUSIONS: This systematic review demonstrated that radiotherapy for HNC induced significant changes in the pulp response with moderate quality of evidence. Such altered responses cannot determine pulp status accurately.