AGUDIZACIONES ENDODONTICAS: “FLARE-UPS” (PARTE I)
Palabras clave:
Agudización, Tratamiento endodóntico, Infección del conducto radicular
Resumen
La agudización endodóntica se caracteriza por el desarrollo de dolor, edema o ambos, posterior a una intervención endodóntica. Generalmente, los factores causantes son: daño mecánico, químico y/o microbiano a la pulpa o tejidos perirradiculares. De todos ellos, los microorganismos son indiscutiblemente el mayor agente etiológico de las agudizaciones. Se presentan varios regímenes de tratamiento para el alivio del dolor durante la terapia endodóntica que incluyen el alivio de la oclusión, premedicación, drenaje y medicaciones sistémicas y dentro del conducto radicular. El objetivo de este primer artículo fue realizar una revisión de la literatura acerca de su definición, incidencia y posibles factores desencadenantes. En la segunda parte se tratará la etiopatogenia y la adopción de medidas preventivas apropiadas para reducir significativamente la incidencia de este indeseable fenómeno clínico.
[Torres OL. Agudizaciones endodónticas: “Flare ups” (Parte I). Revista Ustasalud Odontología 2007; 6: 123 - 130]
Referencias
1. Siquiera JF. Microbial causes of endodontic flare-ups. Int Endod J 2003; 36: 453 – 463.
2. Seltzer S, Naidorf IJ. Flare-ups in endodontics: I Etiological factors. J Endod 2004; 30: 476 – 481.
3. Seltzer S, Naidorf IJ. Flare-ups in endodontics: II. Therapeutic measures. J Endod 2004; 30: 482 – 484.
4. Richard W, Fouad A. Endodontic interappoiment flareups: A prospective study of incidence and related factors. J Endod 1992; 18: 172 – 177.
5. Goldman M, Rankin C, Mehlman R, Santa C. The immunologic implications and clinical management of the endodontic flare-up. Compend Contin Educ Dent 1988; 10: 126 – 130.
6. Matusow RJ. Acute pulpal-alveolar cellulitis syndrome IV. Exacerbations during endodontic treatment: A clinical study of specific microbial isolates and their etiologic role. Part 1. Oral Surg Oral Med Oral Pathol 1986; 61: 90 – 95.
7. Abbott A, Koren L, Morse D, Sinai I, Doo R, Furst MA. Prospective randomized trial on efficacy of antibiotic prophylaxis in asymptomatic teeth with pulpal necrosis and associated periapical pathosis. Oral Surg Oral Med Oral Pathol 1988; 66: 722 – 733.
8. Trope M. Relationship of intracanal medicaments to endodontic flare-ups. Endod Dent Traumatol 1990; 6: 226 – 229.
9. Torabinejad M, Walton RE. Urgencias endodónticas. En: Walton RE, Torabinejad M. Endodoncia Principios y Práctica Clínica. Ed. Interamericana. McGraw-Hill. México. 1991; p. 311 - 315.
10. Rimmer A. The flare-up index: a quantitative method to describe the phenomenon. J Endod 1993; 19: 255 – 256.
11. Genet JM, Wesselink PR, Thoden van Velze SK. The incidence of preoperative and postoperative pain in endodontic therapy. Int Endod J 1986; 19: 221 – 229.
12. Barnett F, Tronstad L. The incidence of flare-ups following endodontic treatment. J Dent Res 1989; 68 (special issue): 1253.
13. Balaban FS, Skidmore AE, Griffin JA. Acute exacerbations following initial treatment of necrotic pulp. J Endod 1984; 10: 78 – 81.
14. Fox J, Atkinson JS, Dinin AP. Incidence of pain following one-visit endodontic treatment. Oral Surg Oral Med Oral Pathol 1970; 30: 123 – 130.
15. Mulhern JM, Patterson SS, Newton CW, Ringel AM. Incidence of postoperative pain after one-appointment endodontic treatment of asymptomatic pulpal necrosis in single-rooted teeth J Endod 1982; 8: 370 – 375.
16. Genet JM, Hart AAM, Wesselink PR, Thoden van Velzen SK. Preoperative and operative factors associated with pain after the first endodontic visit. Int Endod J l987; 20: 53 – 64.
17. Naidorf IJ. Endodontic flare-ups: bacteriological and immunological mechanisms. J Endod 1985; 11: 462 – 464.
18. Seltzer S, Bender IB, Ehrenreich J. Incidence and duration of pain following endodontic therapy. Oral Surg Oral Med Oral Pathol 1961; 14: 74 – 82.
19. Clem WH. Posttreatment endodontic pain. J Am Dent Assoc 1970; 81: 1166 – 1170.
20. O‘Keefe EM. Pain in endodontic therapy: preliminary study. J Endod 1976; 2: 315 – 319.
21. Maddox DL, Walton RE, Davis CO. Incidence of posttreatment endodontic pain related to medicaments and other factors. J Endod 1977; 3: 447.
22. Sundqvist G. Bacteriological studies of necrotic dental pulps. Umeå University Odontological Dissertations Nº 7. University of Umeå, Sweden. 1976: 1 – 94.
23. Yoshida M, Fukushima H, Yamamoto K, Ogawa K, Toda T, Sagawa, H. Correlation between clinical symptoms and microorganisms isolated from root canals of teeth with periapical pathosis. J Endod 1987; 13: 24 – 28.
24. Trope M. Flare-ups rate of single-visit endodontics. Int Endod J 1991; 24: 24 - 26.
25. Eleazer, P.; Eleazer, K. Flare up rate in pulpally necrotic molars in one-visit versus two-visit endodontic treatment. J Endod 1998; 24: 614 – 616.
26. Grossman LI. Endodontic emergencies. Oral Surg Oral Med Oral Pathol 1977; 43: 948 – 953.
27. Seltzer S. Endodoncia Consideraciones biológicas de los procedimientos endodónticos Ed. Mundi. Argentina. 1979; p. 199 - 345.
28. Bender IB, Seltzer S, Tashman S, Meloff G. Dental procedures in patients with rheumatic heart disease. Oral Surg Oral Med Oral Pathol 1963; 16: 446.
29. Baumgartner JC, Heggers JP, Harrison JW. Incidence of bacteremias related to endodontic procedures. II. Surgical endodontics. J Endod 1977; 3: 399 - 402.
30. Wittgow W, Sabiston C. Microorganisms from pulpal chambers of intact teeth with necrotic pulps. J Endod 1975; 1: 168 – 171.
31. Morse DR, Furst ML, Belott RM, Lefkowitz RD, Spritzer IB, Sideman BH. A prospective randomized trial comparing periapical instrumentation to intracanal instrumentation in cases of asymptomatic pulpal – periapical lesions. Oral Surg Oral Med Oral Pathol 1987; 64: 734 – 741.
32. Goldman M, Rankin C, Mehlman R, Santa C. The immunologic implications and clinical management of the endodontic flare-up. Compendium 1988; 10: 126 – 130.
33. Svetcov SD, DeAngelo JE, McNamara T, Nevins AJ. Serum immunoglobulin levels and bacterial flora in subjects with acute oro-facial swellings. J Endod 1983; 9: 233 – 235.
34. Nevins A, Levine S, Gayer Y, Svetcov S. Sensitization via IgE-mediated mechanism in patients with chronic periapical lesions. J Endod 1985; 11: 228 – 230.
35. Nevins A, Friedman L, DeVita R, Schacter W. Local injection of Benadryl for the prevention of iatrogenic endodontic flare-ups. Endod Dent Traumatol 1988; 4: 90 – 91.
36. Nevins A, Verhelle R, Feldman M, Berman D. Local prophylactic Benadryl injections in an attempt to reduce postinstrumental pain. J Endod 1994; 20: 296 – 298.
37. Fairbourn DR, McWalter GM, Montgomery S. The effect of four preparation techniques on the amount of apically extruded debris. J Endod 1987; 13: 102 -108.
38. Ruiz-Hubard EE, Gutmann JL, Wagner MJ. A quantitative assessment of canal debris forced periapically during root canal instrumentation using two different techniques. J Endod 1987; 13: 554 – 558.
39. Fava LR. A comparison of one versus two appointment endodontic therapy in teeth with non-vital pulps. Int Endod J 1989; 22: 179 – 183.
2. Seltzer S, Naidorf IJ. Flare-ups in endodontics: I Etiological factors. J Endod 2004; 30: 476 – 481.
3. Seltzer S, Naidorf IJ. Flare-ups in endodontics: II. Therapeutic measures. J Endod 2004; 30: 482 – 484.
4. Richard W, Fouad A. Endodontic interappoiment flareups: A prospective study of incidence and related factors. J Endod 1992; 18: 172 – 177.
5. Goldman M, Rankin C, Mehlman R, Santa C. The immunologic implications and clinical management of the endodontic flare-up. Compend Contin Educ Dent 1988; 10: 126 – 130.
6. Matusow RJ. Acute pulpal-alveolar cellulitis syndrome IV. Exacerbations during endodontic treatment: A clinical study of specific microbial isolates and their etiologic role. Part 1. Oral Surg Oral Med Oral Pathol 1986; 61: 90 – 95.
7. Abbott A, Koren L, Morse D, Sinai I, Doo R, Furst MA. Prospective randomized trial on efficacy of antibiotic prophylaxis in asymptomatic teeth with pulpal necrosis and associated periapical pathosis. Oral Surg Oral Med Oral Pathol 1988; 66: 722 – 733.
8. Trope M. Relationship of intracanal medicaments to endodontic flare-ups. Endod Dent Traumatol 1990; 6: 226 – 229.
9. Torabinejad M, Walton RE. Urgencias endodónticas. En: Walton RE, Torabinejad M. Endodoncia Principios y Práctica Clínica. Ed. Interamericana. McGraw-Hill. México. 1991; p. 311 - 315.
10. Rimmer A. The flare-up index: a quantitative method to describe the phenomenon. J Endod 1993; 19: 255 – 256.
11. Genet JM, Wesselink PR, Thoden van Velze SK. The incidence of preoperative and postoperative pain in endodontic therapy. Int Endod J 1986; 19: 221 – 229.
12. Barnett F, Tronstad L. The incidence of flare-ups following endodontic treatment. J Dent Res 1989; 68 (special issue): 1253.
13. Balaban FS, Skidmore AE, Griffin JA. Acute exacerbations following initial treatment of necrotic pulp. J Endod 1984; 10: 78 – 81.
14. Fox J, Atkinson JS, Dinin AP. Incidence of pain following one-visit endodontic treatment. Oral Surg Oral Med Oral Pathol 1970; 30: 123 – 130.
15. Mulhern JM, Patterson SS, Newton CW, Ringel AM. Incidence of postoperative pain after one-appointment endodontic treatment of asymptomatic pulpal necrosis in single-rooted teeth J Endod 1982; 8: 370 – 375.
16. Genet JM, Hart AAM, Wesselink PR, Thoden van Velzen SK. Preoperative and operative factors associated with pain after the first endodontic visit. Int Endod J l987; 20: 53 – 64.
17. Naidorf IJ. Endodontic flare-ups: bacteriological and immunological mechanisms. J Endod 1985; 11: 462 – 464.
18. Seltzer S, Bender IB, Ehrenreich J. Incidence and duration of pain following endodontic therapy. Oral Surg Oral Med Oral Pathol 1961; 14: 74 – 82.
19. Clem WH. Posttreatment endodontic pain. J Am Dent Assoc 1970; 81: 1166 – 1170.
20. O‘Keefe EM. Pain in endodontic therapy: preliminary study. J Endod 1976; 2: 315 – 319.
21. Maddox DL, Walton RE, Davis CO. Incidence of posttreatment endodontic pain related to medicaments and other factors. J Endod 1977; 3: 447.
22. Sundqvist G. Bacteriological studies of necrotic dental pulps. Umeå University Odontological Dissertations Nº 7. University of Umeå, Sweden. 1976: 1 – 94.
23. Yoshida M, Fukushima H, Yamamoto K, Ogawa K, Toda T, Sagawa, H. Correlation between clinical symptoms and microorganisms isolated from root canals of teeth with periapical pathosis. J Endod 1987; 13: 24 – 28.
24. Trope M. Flare-ups rate of single-visit endodontics. Int Endod J 1991; 24: 24 - 26.
25. Eleazer, P.; Eleazer, K. Flare up rate in pulpally necrotic molars in one-visit versus two-visit endodontic treatment. J Endod 1998; 24: 614 – 616.
26. Grossman LI. Endodontic emergencies. Oral Surg Oral Med Oral Pathol 1977; 43: 948 – 953.
27. Seltzer S. Endodoncia Consideraciones biológicas de los procedimientos endodónticos Ed. Mundi. Argentina. 1979; p. 199 - 345.
28. Bender IB, Seltzer S, Tashman S, Meloff G. Dental procedures in patients with rheumatic heart disease. Oral Surg Oral Med Oral Pathol 1963; 16: 446.
29. Baumgartner JC, Heggers JP, Harrison JW. Incidence of bacteremias related to endodontic procedures. II. Surgical endodontics. J Endod 1977; 3: 399 - 402.
30. Wittgow W, Sabiston C. Microorganisms from pulpal chambers of intact teeth with necrotic pulps. J Endod 1975; 1: 168 – 171.
31. Morse DR, Furst ML, Belott RM, Lefkowitz RD, Spritzer IB, Sideman BH. A prospective randomized trial comparing periapical instrumentation to intracanal instrumentation in cases of asymptomatic pulpal – periapical lesions. Oral Surg Oral Med Oral Pathol 1987; 64: 734 – 741.
32. Goldman M, Rankin C, Mehlman R, Santa C. The immunologic implications and clinical management of the endodontic flare-up. Compendium 1988; 10: 126 – 130.
33. Svetcov SD, DeAngelo JE, McNamara T, Nevins AJ. Serum immunoglobulin levels and bacterial flora in subjects with acute oro-facial swellings. J Endod 1983; 9: 233 – 235.
34. Nevins A, Levine S, Gayer Y, Svetcov S. Sensitization via IgE-mediated mechanism in patients with chronic periapical lesions. J Endod 1985; 11: 228 – 230.
35. Nevins A, Friedman L, DeVita R, Schacter W. Local injection of Benadryl for the prevention of iatrogenic endodontic flare-ups. Endod Dent Traumatol 1988; 4: 90 – 91.
36. Nevins A, Verhelle R, Feldman M, Berman D. Local prophylactic Benadryl injections in an attempt to reduce postinstrumental pain. J Endod 1994; 20: 296 – 298.
37. Fairbourn DR, McWalter GM, Montgomery S. The effect of four preparation techniques on the amount of apically extruded debris. J Endod 1987; 13: 102 -108.
38. Ruiz-Hubard EE, Gutmann JL, Wagner MJ. A quantitative assessment of canal debris forced periapically during root canal instrumentation using two different techniques. J Endod 1987; 13: 554 – 558.
39. Fava LR. A comparison of one versus two appointment endodontic therapy in teeth with non-vital pulps. Int Endod J 1989; 22: 179 – 183.
Cómo citar
Torres Borrero, O. (1). AGUDIZACIONES ENDODONTICAS: “FLARE-UPS” (PARTE I). Ustasalud, 6(2), 123-130. https://doi.org/https://doi.org/10.15332/us.v6i2.1809
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