Morphological alterations of the apical foramen after foraminal enlargement: a systematic review of ex vivo studies

Authors

  • Isabella Figueiredo Assis Macedo Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Odontologia Restauradora. Belo Horizonte, MG, Brazil. https://orcid.org/0000-0001-9891-5935
  • Alexandre Henrique dos Reis-Prado Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Odontologia Restauradora. Belo Horizonte, MG, Brazil. https://orcid.org/0000-0002-5866-7137
  • Gabriela da Costa Ferreira Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Odontologia Restauradora. Belo Horizonte, MG, Brazil. https://orcid.org/0000-0002-5184-6415
  • Gustavo Oliveira Campos Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Odontologia Restauradora. Belo Horizonte, MG, Brazil. https://orcid.org/0000-0002-0584-3176
  • Isabella da Costa Ferreira Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Odontologia Restauradora. Belo Horizonte, MG, Brazil. https://orcid.org/0000-0001-5477-5942
  • Francine Benetti Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Odontologia Restauradora. Belo Horizonte, MG, Brazil. https://orcid.org/0000-0002-5459-353X
  • Isabella Faria da Cunha Peixoto Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Odontologia Restauradora. Belo Horizonte, MG, Brazil. https://orcid.org/0000-0002-2261-8333
  • Warley Luciano Fonseca Tavares Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Odontologia Restauradora. Belo Horizonte, MG, Brazil. https://orcid.org/0000-0003-2077-927X
  • Ana Cecília Diniz Viana Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Odontologia Restauradora. Belo Horizonte, MG, Brazil. https://orcid.org/0000-0002-5987-0540

DOI:

https://doi.org/10.4322/bds.2023.e4065

Abstract

Foraminal enlargement has been recommended to optimize the disinfection of infected root canals, although some authors still claim that the foramen should be kept in its original shape and position. This study aimed to evaluate morphological alterations of apical foramen after foraminal enlargement through a systematic review. An electronic search was conducted until April 2022. Ex vivo studies evaluating influence of foraminal enlargement in the morphologic changes of apical foramen were included. Studies without a control group or available full text were excluded. Foraminal deformation and area increase were considered as primary outcomes. Risk-of-bias assessment was performed according to a modified Joanna Briggs Institute’s Checklist. From 702 studies retrieved, five were eligible. Most studies used single-rooted teeth, and rotary systems for instrumentation ranging from – 2 mm to + 1 mm to the apex. All studies found increased major foramen deformation after foraminal enlargement. Among four studies that evaluated foraminal area, all found increased area after foraminal enlargement. Insufficient data for touched/untouched walls by instruments and dentinal microcrack formation was observed. A low risk of bias was found. Foraminal enlargement during root canal preparation seems to increase deformation and major apical foramen area. Future investigations with standardized methodologies are encouraged.

KEYWORDS

Apical foramen; Endodontics; Root canal preparation; Root canal therapy; Tooth apex.

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Published

2023-12-20

Issue

Vol. 26 No. 4 (2023): Oct - Dec / 2023 - Published Oct 2023

Section

Systematic Review

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