Magnificación en Periodoncia / Magnification in Periodontics

RESUMEN: Esta revisión sobre magnificación en periodoncia presenta la evidencia disponible sobre el tema. Dentro de este trabajo se incluyen: principios y prestaciones de la magnificación, ventajas y desventajas de los diferentes sistemas, características de los instrumentos de microcirugía, ergonomía, trastornos músculo esqueletales, resultados clínicos, cicatrización, percepción de los pacientes y habilidades clínicas necesarias. El objetivo del trabajo fue comprender el funcionamiento de la magnificación, comparar la microcirugía (cirugía con magnificación) vs macro cirugía (cirugía sin magnificación) en función de la ergonomía, la cicatrización y los resultados clínicos. Comparar las ventajas y desventajas de las lupas vs microscopio y conocer las habilidades necesarias para su utilización. Se realizó una búsqueda bibliográfica manual, las bases consultadas fueron: PubMed, Biblioteca Cochrane, EMBASE, Scopus, Science Direct, SciELO. La búsqueda fue sin límites temporales o de idiomas. Se incluyeron investigaciones, revisiones bibliográficas y metaanálisis, también se realizó rastreo de citas. Se recabaron un total de 251 artículos de los cuales se seleccionaron 43 para la revisión. Los artículos fueron revisados por los autores y aceptados por consenso para su discusión. En conclusión trabajar con magnificación aporta ventajas en todos los aspectos estudiados en esta revisión y en la percepción de los pacientes. Si se comparan las lupas con el microscopio, éste ultimo es mejor en cuanto a ergonomía, iluminación, posibilidades de documentación y mayor aumento. Incorporar la magnificación requiere entrenamiento, esta revisión expone los fundamentos por los cuales dicho esfuerzo se traduce en beneficios mayores.

ABSTRACT: This review on magnification in periodontics presents the available evidence on the subject, comprising principles and benefits of magnification, advantages and disadvantages of different systems, characteristics of the instruments in microsurgery, ergonomics, musculoskeletal disorders, clinical results, healing, perception of patients and necessary clinical skills. Objective: to understand the operation of magnification, to compare microsurgery (surgery with magnification) vs macro surgery (surgery without magnification) based on ergonomics, healing, and clinical results. Compare the advantages and disadvantages of loupes vs microscope and know the skills necessary to use them. Material and Method: a manual bibliographic search was carried out, the databases consulted were: PubMed, Cochrane Library, EMBASE, Scopus, Science Direct, SciELO. The search was without time or language limits. Research, literature reviews, and meta-analysis were included, and citation tracking was also done. Results: a total of 251 articles were collected, of which 43 were selected for the review. The articles were reviewed by the authors and accepted by consensus for discussion. Conclusion: working with magnification provides advantages in all the aspects studied in this review and in the perception of the patients. If the magnifying glasses are compared with the microscope, the latter is better in terms of ergonomics, lighting, documentation possibilities and higher magnification. Incorporating magnification requires training, this review expound the justification for which such effort translates into greater benefits.

Effect of magnification during post space preparation on root cleanness and fiber post bond strength

Abstract The aim of this study was to evaluate the effect of magnification during post space preparation on root cleanness and on fiber post bond strength. Methods: Thirty human central upper incisors with similar root canal in size and shape were selected, decoronated to 15 mm and endodontically filled. The teeth were assigned into 3 groups (n=10), according to the method of magnification during post space preparation inspection: Control, using naked eye; loupe, using a dental surgical 3x magnifying glass; surgical microscope, using a 6x surgical microscope. The roots were scanned by using micro-CT before and after post space preparation for residue remnants evaluation. Fiber posts were cemented using self-adhesive resin cement (Rely X U200, 3M-ESPE). Two 1-mm-thick slices from the cervical, medium and apical thirds were submitted to a push-out test (PBS). Failures modes were classified. PBS data were analyzed by using two-way ANOVA with repeated measurement and the Tukey test. The significance level was set at 5%. The method of visualization had no effect on PBS (p=0.556). The cervical region had higher values than apical region irrespective of the inspection method (p=0.012). Adhesive failure between the resin cement and dentin was the prevalent failure mode for all groups. Micro-CT analysis showed no difference on root cleanness into the root canal after post space preparation. The use of magnification devices as loupe and microscope while performing post space do not improve the PBS and did not affect sealer remain of decoronated anterior teeth.

Resumo Avaliar o efeito do método de visualização durante o preparo do espaço do pino sobre o remanescente de material obturador endodôntico e sobre a resistência adesiva do pino de fibra de vidro. Trinta incisivos centrais superiores humanos com canal radicular circular foram selecionados, foram desobstruídos a 15 mm e obturados. Os dentes foram divididos em 3 grupos (n=10), de acordo com o método de ampliação utilizado para inspeção do preparo: Controle, usando olho nu; lupa, usando uma lupa cirúrgica 3x cirúrgica; microscópio cirúrgico, usando um microscópio cirúrgico 6x. As raízes foram digitalizadas usando micro-CT antes e após a preparação do espaço para avaliação de resíduos remanescentes. Os pinos de fibra foram cimentados com cimento resinoso autoadesivo (RelyX U200, 3M-ESPE). Duas fatias de 1 mm de espessura dos terços cervical, médio e apical foram submetidas ao teste push-out (PBS). Os padrões de falhas foram classificados. Os dados de PBS foram analisados ​​usando análise de variância em dois fatores com medição repetida e o teste de Tukey. O nível de significância foi estabelecido em 5%. Resultados: O método de visualização não teve efeito no PBS (p=0,556). A região cervical apresentou valores maiores que a região apical, independentemente do método de inspeção (p=0,012). A falha adesiva entre o cimento resinoso e a dentina foi o modo de falha prevalente para todos os grupos. A análise de micro-CT não mostrou diferença na limpeza da raiz no canal radicular após a preparação do espaço do pino. Conclusão: O uso de dispositivos de ampliação como lupas e microscópios durante a realização de preparo não melhora o PBS e não afetou a permanência do material obturador remanescente de dentes anteriores.