Endodontic treatment in a single session in a patient with special needs under general anesthesia: Case report
Keywords:Endodontics; General anaesthesia; Dental anxiety; Dental care for disabled.
Patients with special needs tend to be defensive or exhibit extreme anxiety reactions during conventional dental attendance, requiring treatment in hospital facility, under general anesthesia. A patient diagnosed with autism was attended at the CAOE clinic (FOA/UNESP). In the clinical and radiographic evaluation, the need for dental procedures was detected, including endodontic treatment. Due to non-cooperation, the patient was referred to the hospital Santa Casa de Misericórdia. This report describes endodontics in a single session of three elements under general anesthesia. After sedation, coronary access of the 3 dental elements was performed, followed by rubber dam absolute isolation. The biomechanical prepare of root canals was performed using a mix technique: cervical/middle third preparation with Gates-Glidden drills and manual files for apical instrumentation, under irrigation of 2.5% sodium hypochlorite. The tooth length and working length were obtained with the aid of foraminal Root ZX II locator. After using 17% EDTA, new irrigation with sodium hypochlorite and drying root canals, the obturation was achieved. A calcium hydroxide-based sealer Sealapex was used with lateral condensation technique, followed by definitive restoration with composite resin. Endodontic treatment, even with the complexities of these conditions, is indicated to avoid extractions, since these patients present early tooth loss due to deficient oral hygiene by lack of motor skills. The survival rate of endodontically treated teeth under general anesthesia was favorable in the literature, as well as reports of improvement in life quality of patients with special needs.
Alsaleh, I., Cousson, P. Y., Nicolas, E., & Hennequin, M. (2012). Is endodontic treatment performed under general anaesthesia technically acceptable? Clinical oral investigations, 16(6), 1599–1606.
Anders, P. L., & Davis, E. L. (2010). Oral health of patients with intellectual disabilities: a systematic review. Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry, 30(3), 110–117.
Bolbolian, M., Golchin, S., & Faegh, S. (2018). In vitro Evaluation of the Accuracy of the Root Zx in the Presence of Naocl 2.5% and Chlorhexidine 0.2. Journal of Clinical and Experimental Dentistry, 10(11), e1054-e1057.
Brailo, V., Janković, B., Lozić, M., Gabrić, D., Kuna, T., Stambolija, V., Verzak, Ž. (2019). Dental Treatment Under General Anesthesia in a Day Care Surgery Setting. Acta Stomatologica Croatica, 53(1), 64-71.
Bueno, C. R., Valentim, D., Marques, V. A., Gomes-Filho, J. E., Cintra, L. T., Jacinto, R. C., & Dezan-Junior, E. (2016). Biocompatibility and biomineralization assessment of bioceramic-, epoxy-, and calcium hydroxide-based sealers. Brazilian oral research, 30(1), S1806-83242016000100267.
Cândido, E. L., Ribeiro, T. R. G., Brito, M. A. F., Rodrigues, S. B., Feitosa, M. D. S., Feitosa, F. P. J., & Freitas, J. F. (2021). Aspectos éticos e trâmites da publicação de relato de caso no Brasil. Research, Socity and Development, 10 (2), 1-5.
Chang, J., & Kim, H. Y. (2017). Prognostic factors of single-visit endodontic and restorative treatment under general anaesthesia for special needs patients. Journal of oral rehabilitation, 44(2), 96–104.
Chang, J., Patton, L. L., & Kim, H. Y. (2014). Impact of dental treatment under general anesthesia on the oral health-related quality of life of adolescents and adults with special needs. European journal of oral sciences, 122(6), 363–371.
Chen, Y. T., Hsu, T. Y., Liu, H., & Chogle, S. (2020). Factors Related to the Outcomes of Cracked Teeth after Endodontic Treatment. Journal of Endodontics, 47(2), 215-220.
Chung, S. H., Chun, K. A., Kim, H. Y., Kim, Y. S., & Chang, J. (2019). Periapical Healing in Single-visit Endodontics under General Anesthesia in Special Needs Patients. Journal of Endodontics, 45(2), 116-122.
Cousson, P. Y., Nicolas, E., & Hennequin, M. (2014). A follow-up study of pulpotomies and root canal treatments performed under general anaesthesia. Clinical oral investigations, 18(4), 1155–1163.
Dougherty N. (2009). The dental patient with special needs: a review of indications for treatment under general anesthesia. Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry, 29(1), 17–20.
European Society of Endodontology (2006). Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. International endodontic journal, 39(12), 921–930.
Figini, L., Lodi, G., Gorni, F., & Gagliani, M. (2008). Single versus multiple visits for endodontic treatment of permanent teeth: a Cochrane systematic review. Journal of endodontics, 34(9), 1041–1047.
Glassman, P., & Miller, C. E. (2003). Preventing dental disease for people with special needs: the need for practical preventive protocols for use in community settings. Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry, 23(5), 165–167.
Haubek, D., Fuglsang, M., Poulsen, S., & Rølling, I. (2006). Dental treatment of children referred to general anaesthesia--association with country of origin and medical status. International journal of paediatric dentistry, 16(4), 239–246.
Hennequin, M., Faulks, D., & Roux, D. (2000). Accuracy of estimation of dental treatment need in special care patients. Journal of dentistry, 28(2), 131–136.
Hui, K. C., Chen, N. N., Koh, E. T., Lam, E. C., Lim, K. C., Sum, C. P., & Society of Endodontists, Singapore (2004). Guidelines for root canal treatment. Singapore dental journal, 26(1), 60–62.
Hulland, S., & Sigal, M. J. (2000). Hospital-based dental care for persons with disabilities: a study of patient selection criteria. Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry, 20(4), 131–138.
Janner, S. F., Jeger, F. B., Lussi, A., & Bornstein, M. M. (2011). Precision of endodontic working length measurements: a pilot investigation comparing cone-beam computed tomography scanning with standard measurement techniques. Journal of endodontics, 37(8), 1046–1051.
Kim, S., & Kratchman, S. (2006). Modern endodontic surgery concepts and practice: a review. Journal of endodontics, 32(7), 601–623.
Lee, P. Y., Chou, M. Y., Chen, Y. L., Chen, L. P., Wang, C. J., & Huang, W. H. (2009). Comprehensive dental treatment under general anesthesia in healthy and disabled children. Chang Gung medical journal, 32(6), 636–642.
Linas, N., Faulks, D., Hennequin, M., Cousson, P.Y. (2019). Conservative and endodontic treatment performed under general anesthesia: A discussion of protocols and outcomes. Special care in dentistry: official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry, 39(5), 453-463.
Maestre C. (1996). The use of general anaesthesia for tooth extraction in young handicapped adults in France. British dental journal, 180(8), 297–302.
Marshall, J., Sheller, B., Mancl, L., & Williams, B. J. (2008). Parental attitudes regarding behavior guidance of dental patients with autism. Pediatric dentistry, 30(5), 400–407.
McCarthy, J., & O'Hara J. Ill-health and intellectual disabilities. (2011). Current opinion in psychiatry, 24(5), 382-6.
Ministério da Saúde. (2008). Saúde Bucal - Cadernos de Atenção Básica n. 17. https://bvsms.saude.gov.br/bvs/publicacoes/saude_bucal.pdf
Mitchell, L., & Murray, J. J. (1985). Management of the handicapped and the anxious child: a retrospective study of dental treatment carried out under general anaesthesia. Journal of paediatric dentistry, 1(1), 9–14.
Naumann, M., Blankenstein, F., Kiessling, S., & Dietrich, T. (2005). Risk factors for failure of glass fiber-reinforced composite post restorations: a prospective observational clinical study. European journal of oral sciences, 113(6), 519–524.
Ng, Y. L., Mann, V., & Gulabivala, K. (2010). Tooth survival following non-surgical root canal treatment: a systematic review of the literature. International endodontic journal, 43(3), 171–189.
Pereira, AS et al. (2018). Metodologia da pesquisa científica. UFSM.
Ravanshad, S., Adl, A., & Anvar, J. (2010). Effect of working length measurement by electronic apex locator or radiography on the adequacy of final working length: a randomized clinical trial. Journal of endodontics, 36(11), 1753–1756.
Schmalz, G., Farack, M., Kottmann, T., Schmidt, J., Krause, F., Ziebolz, D. (2020). Preoperative Dental Examination Might Prevent Unnecessary Tooth Extractions During Dental Treatment of Patients with Disabilities Under General Anaesthesia - Results of a Retrospective Cross-Sectional Study. Oral Health and Preventive Dentistry, 18(1), 139-144.
Skupien, J. A., Opdam, N., Winnen, R., Bronkhorst, E., Kreulen, C., Pereira-Cenci, T., & Huysmans, M. C. (2013). A practice-based study on the survival of restored endodontically treated teeth. Journal of endodontics, 39(11), 1335–1340.
Tsai, C. L., Tsai, Y. L., Lin, Y. T., & Lin, Y. T. (2006). A retrospective study of dental treatment under general anesthesia of children with or without a chronic illness and/or a disability. Chang Gung medical journal, 29(4), 412–418.
World Health Organization. (2012). Relatório mundial sobre a deficiência. https://apps.who.int/iris/bitstream/handle/10665/44575/978856404702 0_por.pdf?sequence=4
How to Cite
Copyright (c) 2021 Ana Maria Veiga Vasques; Carlos Roberto Emerenciano Bueno; Marina Tolomei Sandoval Cury; Ana Claudia Rodrigues da Silva ; Nathalia Evelyn da Silva Machado; Alessandra Marcondes Aranega; Leticía Helena Theodoro; Eloi Dezan-Junior
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.