Retratamento endodôntico cirúrgico de dente com extensa lesão periapical: relato de caso
DOI:
https://doi.org/10.33448/rsd-v11i7.30038Palavras-chave:
Endodontia; Periodontite apical; Apicetomia; Ensino em saúde.Resumo
Este trabalho tem como objetivo descrever um caso clínico de retratamento endodôntico cirúrgico de um incisivo lateral superior (dente 12) apresentando sobreobturação e extensa lesão periapical. Paciente do sexo masculino, foi encaminhado para realizar retratamento endodôntico do dente 12. Ao exame intra-oral observou-se a presença de fistula próximo aos dentes 11 e 12; e obteve-se resposta positiva para os testes de percussão vertical e mobilidade no dente 12. O exame radiográfico mostrou sobreobturação e área radiolúcida extensa associada ao ápice radicular dos dentes 11 e 12. Diante do histórico e dos achados radiográficos, foi solicitado uma tomografia computadorizada de feixe cônico, o qual mostrou grande reabsorção óssea na região apical do dente 12 com perda da cortical óssea vestibular e sobreobturação com transpasse de guta percha pelo ápice dos dentes 11 e 12. Após consultas para retratamento endodôntico falhos, optou-se por realizar um retratamento endodôntico cirúrgico com curetagem apical, apicetomia, obturação retrógrada e obturação intracanal transoperatória no dente 12 e apicetomia com curetagem apical no dente 11. Utilizou-se um cimento reparador biocerâmico Bio-C Repair no selamento apical. Durante acompanhamento radiográfico de 10 meses, podemos observar ausência de sintomatologia dolorosa, de fistula e regressão da lesão periapical. Diante de sintomatologias persistentes após terapias endodônticas convencionais, o endodontista deve considerar o tratamento cirúrgico como solução. Dada as limitações, o correto manejo desse caso pode ser atribuído a técnica cirúrgica escolhida associada ao material reparador utilizado, o qual apresenta excelentes propriedades físico-químicas e biológicas, que, juntos ajudaram a obter o melhor resultado possível.
Referências
Alghamdi, F., Alhaddad, A. J., & Abuzinadah, S. (2020). Healing of Periapical Lesions After Surgical Endodontic Retreatment: A Systematic Review. Cureus, 12(2), e6916. https://doi.org/10.7759/cureus.6916
Al-Haddad, A., & Che Ab Aziz, Z. A. (2016). Bioceramic-Based Root Canal Sealers: A Review. International journal of biomaterials, 2016, 9753210. https://doi.org/10.1155/2016/9753210
Andrade-Junior, C. V., Batista, R. M., Marceliano-Alves, M., Alves, F., & Silva, E. (2016). Efficacy of a new Activation Device in Irrigant Penetration Into Simulated Lateral Canals. European endodontic journal, 1(1), 1–4. https://doi.org/10.5152/eej.2016.16003
Antony, D. P., Thomas, T., & Nivedhitha, M. S. (2020). Two-dimensional Periapical, Panoramic Radiography Versus Three-dimensional Cone-beam Computed Tomography in the Detection of Periapical Lesion After Endodontic Treatment: A Systematic Review. Cureus, 12(4), e7736. https://doi.org/10.7759/cureus.7736
Aveiro, E., Chiarelli-Neto, V. M., de-Jesus-Soares, A., Zaia, A. A., Ferraz, C., Almeida, J., Marciano, M. A., Feres, M., & Gomes, B. (2020). Efficacy of reciprocating and ultrasonic activation of 6% sodium hypochlorite in the reduction of microbial content and virulence factors in teeth with primary endodontic infection. International endodontic journal, 53(5), 604–618. https://doi.org/10.1111/iej.13261
Ballikaya, E., Koc, N., Avcu, N., & Cehreli, Z. C. (2021). The quality of root canal treatment and periapical status of permanent teeth in Turkish children and teens: a retrospective CBCT study. Oral radiology, 10.1007/s11282-021-00570-2. https://doi.org/10.1007/s11282-021-00570-2
Benetti, F., de Azevedo Queiroz, Í. O., Oliveira, P., Conti, L. C., Azuma, M. M., Oliveira, S., & Cintra, L. (2019). Cytotoxicity and biocompatibility of a new bioceramic endodontic sealer containing calcium hydroxide. Brazilian oral research, 33, e042. https://doi.org/10.1590/1807-3107bor-2019.vol33.0042
Benetti, F., Queiroz, Í., Cosme-Silva, L., Conti, L. C., Oliveira, S., & Cintra, L. (2019). Cytotoxicity, Biocompatibility and Biomineralization of a New Ready-for-Use Bioceramic Repair Material. Brazilian dental journal, 30(4), 325–332. https://doi.org/10.1590/0103-6440201902457
Candeiro, G., Moura-Netto, C., D'Almeida-Couto, R. S., Azambuja-Júnior, N., Marques, M. M., Cai, S., & Gavini, G. (2016). Cytotoxicity, genotoxicity and antibacterial effectiveness of a bioceramic endodontic sealer. International endodontic journal, 49(9), 858–864. https://doi.org/10.1111/iej.12523
Chércoles-Ruiz, A., Sánchez-Torres, A., & Gay-Escoda, C. (2017). Endodontics, Endodontic Retreatment, and Apical Surgery Versus Tooth Extraction and Implant Placement: A Systematic Review. Journal of endodontics, 43(5), 679–686. https://doi.org/10.1016/j.joen.2017.01.004
Craveiro, M. A., Fontana, C. E., de Martin, A. S., & Bueno, C. E. (2015). Influence of coronal restoration and root canal filling quality on periapical status: clinical and radiographic evaluation. Journal of endodontics, 41(6), 836–840. https://doi.org/10.1016/j.joen.2015.02.017
Duarte, M., Marciano, M. A., Vivan, R. R., Tanomaru Filho, M., Tanomaru, J., & Camilleri, J. (2018). Tricalcium silicate-based cements: properties and modifications. Brazilian oral research, 32(suppl 1), e70. https://doi.org/10.1590/1807-3107bor-2018.vol32.0070
Duque, J. A., Duarte, M. A., Canali, L. C., Zancan, R. F., Vivan, R. R., Bernardes, R. A., & Bramante, C. M. (2017). Comparative Effectiveness of New Mechanical Irrigant Agitating Devices for Debris Removal from the Canal and Isthmus of Mesial Roots of Mandibular Molars. Journal of endodontics, 43(2), 326–331. https://doi.org/10.1016/j.joen.2016.10.009
Espinoza, I., Conde Villar, A. J., Loroño, G., Estevez, R., Plotino, G., & Cisneros, R. (2021). Effectiveness of XP-Endo Finisher and Passive Ultrasonic Irrigation in the Removal of the Smear Layer Using two Different Chelating Agents. Journal of dentistry (Shiraz, Iran), 22(4), 243–251. https://doi.org/10.30476/DENTJODS.2021.86680.1204
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. https://doi.org/10.1111/j.1365-2591.2006.01180
Fariniuk, L. F., Azevedo, M., Carneiro, E., Westphalen, V., Piasecki, L., & da Silva Neto, U. X. (2017). Efficacy of protaper instruments during endodontic retreatment. Indian journal of dental research: official publication of Indian Society for Dental Research, 28(4), 400–405. https://doi.org/10.4103/ijdr.IJDR_89_16
Fernandes, K., Silva, B., Boer, N. C., Mandarini, D. R., Moreti, L., Kato, A. S., Bueno, C., Limoeiro, A., Pinheiro, S. L., Martin, A. S., & Fontana, C. E. (2020). The Effectiveness of Three Irrigation Systems in the Enterococcus faecalis Reduction after Instrumentation with a Reciprocating Instrument. European journal of dentistry, 14(4), 539–543. https://doi.org/10.1055/s-0040-1714760
Ghilotti, J., Sanz, J. L., López-García, S., Guerrero-Gironés, J., Pecci-Lloret, M. P., Lozano, A., Llena, C., Rodríguez-Lozano, F. J., Forner, L., & Spagnuolo, G. (2020). Comparative Surface Morphology, Chemical Composition, and Cytocompatibility of Bio-C Repair, Biodentine, and ProRoot MTA on hDPCs. Materials (Basel, Switzerland), 13(9), 2189. https://doi.org/10.3390/ma13092189
Gomes, B., & Herrera, D. R. (2018). Etiologic role of root canal infection in apical periodontitis and its relationship with clinical symptomatology. Brazilian oral research, 32(suppl 1), e69. https://doi.org/10.1590/1807-3107bor-2018.vol32.0069
Guerreiro, J., Ochoa-Rodrígez, V. M., Rodrigues, E. M., Chavez-Andrade, G. M., Tanomaru-Filho, M., Guerreiro-Tanomaru, J. M., & Faria, G. (2021). Antibacterial activity, cytocompatibility and effect of Bio-C Temp bioceramic intracanal medicament on osteoblast biology. International endodontic journal, 54(7), 1155–1165. https://doi.org/10.1111/iej.13502.
Karamifar, K., Tondari, A., & Saghiri, M. A. (2020). Endodontic Periapical Lesion: An Overview on the Etiology, Diagnosis and Current Treatment Modalities. European endodontic journal, 5(2), 54–67. https://doi.org/10.14744/eej.2020.42714
Kato, A. S., Cunha, R. S., da Silveira Bueno, C. E., Pelegrine, R. A., Fontana, C. E., & de Martin, A. S. (2016). Investigation of the Efficacy of Passive Ultrasonic Irrigation Versus Irrigation with Reciprocating Activation: An Environmental Scanning Electron Microscopic Study. Journal of endodontics, 42(4), 659–663. https://doi.org/10.1016/j.joen.2016.01.016
Kim, S. G., Malek, M., Sigurdsson, A., Lin, L. M., & Kahler, B. (2018). Regenerative endodontics: a comprehensive review. International endodontic journal, 51(12), 1367–1388. https://doi.org/10.1111/iej.12954
Latham, J., Fong, H., Jewett, A., Johnson, J. D., & Paranjpe, A. (2016). Disinfection Efficacy of Current Regenerative Endodontic Protocols in Simulated Necrotic Immature Permanent Teeth. Journal of endodontics, 42(8), 1218–1225. https://doi.org/10.1016/j.joen.2016.05.004
Li, X., Yoshihara, K., De Munck, J., Cokic, S., Pongprueksa, P., Putzeys, E., Pedano, M., Chen, Z., Van Landuyt, K., & Van Meerbeek, B. (2017). Modified tricalcium silicate cement formulations with added zirconium oxide. Clinical oral investigations, 21(3), 895–905. https://doi.org/10.1007/s00784-016-1843-y
Lo Giudice, R., Nicita, F., Puleio, F., Alibrandi, A., Cervino, G., Lizio, A. S., & Pantaleo, G. (2018). Accuracy of Periapical Radiography and CBCT in Endodontic Evaluation. International journal of dentistry, 2018, 2514243. https://doi.org/10.1155/2018/2514243
Lopes H. P., & Siqueira J. F. (2015). Endodontia: Biologia e Técnica. 4.ed.. Elsevier Editora Ltda.
López-García, S., Lozano, A., García-Bernal, D., Forner, L., Llena, C., Guerrero-Gironés, J., Moraleda, J. M., Murcia, L., & Rodríguez-Lozano, F. J. (2019). Biological Effects of New Hydraulic Materials on Human Periodontal Ligament Stem Cells. Journal of clinical medicine, 8(8), 1216. https://doi.org/10.3390/jcm8081216
Mustafa, M., Alaajam, W. H., Azeim, A. A., Alfayi, N. A., Alqobty, R. M., & Alghannam, S. (2018). Diffusion of calcium hydroxide through dentinal tubules of retreated root canals: An in vitro study. European journal of dentistry, 12(3), 386–392. https://doi.org/10.4103/ejd.ejd_77_18.
Ndiaye, D., Diongue, K., Bane, K., Seck, A., Niang, S. O., Lèye Benoist, F., Ndiaye, D., & Touré, B. (2016). Étude de l’efficacité de l’hypochlorite de sodium à 2,5 %, de la chlorhexidine à 0,5 %, et de l’hydroxyde de calcium sur Candida albicans [Efficacy of sodium hydroxide at 2.5 %, chlorhexidine gluconate at 0.5 % and calcium hydroxide against Candida albicans]. Journal de mycologie medicale, 26(4), 317–322. https://doi.org/10.1016/j.mycmed.2016.04.006
Paños-Crespo, A., Sánchez-Torres, A., & Gay-Escoda, C. (2021). Retrograde filling material in periapical surgery: a systematic review. Medicina oral, patologia oral y cirugia bucal, 26(4), e422–e429. https://doi.org/10.4317/medoral.24262
Parirokh, M., Torabinejad, M., & Dummer, P. (2018). Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part I: vital pulp therapy. International endodontic journal, 51(2), 177–205. https://doi.org/10.1111/iej.12841
Patel, S., Brown, J., Semper, M., Abella, F., & Mannocci, F. (2019). European Society of Endodontology position statement: Use of cone beam computed tomography in Endodontics: European Society of Endodontology (ESE) developed by. International endodontic journal, 52(12), 1675–1678. https://doi.org/10.1111/iej.13187
Pereira, A.S., Shitsuka, D.M., Parreira, F.J., & Shitsuka, R. (2018). Metodologia da pesquisa científica. UFSM. https://repositorio.ufsm.br/bitstream/handle/1/15824/Lic_Computacao_Metodologia-Pesquisa-Cientifica.pdf
Ricucci, D., Russo, J., Rutberg, M., Burleson, J. A., & Spångberg, L. S. (2011). A prospective cohort study of endodontic treatments of 1,369 root canals: results after 5 years. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, 112(6), 825–842. https://doi.org/10.1016/j.tripleo.2011.08.003
Rodríguez, G., Abella, F., Durán-Sindreu, F., Patel, S., & Roig, M. (2017). Influence of Cone-beam Computed Tomography in Clinical Decision Making among Specialists. Journal of endodontics, 43(2), 194–199. https://doi.org/10.1016/j.joen.2016.10.012
Santos-Junior, A. O., De Castro Pinto, L., Mateo-Castillo, J. F., & Pinheiro, C. R. (2019). Success or failure of endodontic treatments: A retrospective study. Journal of conservative dentistry : JCD, 22(2), 129–132. https://doi.org/10.4103/JCD.JCD_507_18
Sanz, J. L., Rodríguez-Lozano, F. J., Llena, C., Sauro, S., & Forner, L. (2019). Bioactivity of Bioceramic Materials Used in the Dentin-Pulp Complex Therapy: A Systematic Review. Materials (Basel, Switzerland), 12(7), 1015. https://doi.org/10.3390/ma12071015
Setzer, F. C., & Lee, S. M. (2021). Radiology in Endodontics. Dental clinics of North America, 65(3), 475–486. https://doi.org/10.1016/j.cden.2021.02.004
Siqueira, J. F., Jr, Rôças, I. N., Ricucci, D., & Hülsmann, M. (2014). Causes and management of post-treatment apical periodontitis. British dental journal, 216(6), 305–312. https://doi.org/10.1038/sj.bdj.2014.200
Silva, E., Carvalho, C. R., Belladonna, F. G., Prado, M. C., Lopes, R. T., De-Deus, G., & Moreira, E. (2019). Micro-CT evaluation of different final irrigation protocols on the removal of hard-tissue debris from isthmus-containing mesial root of mandibular molars. Clinical oral investigations, 23(2), 681–687. https://doi.org/10.1007/s00784-018-2483-1
Solanki, N. P., Venkappa, K. K., & Shah, N. C. (2018). Biocompatibility and sealing ability of mineral trioxide aggregate and biodentine as root-end filling material: A systematic review. Journal of conservative dentistry : JCD, 21(1), 10–15. https://doi.org/10.4103/JCD.JCD_45_17
Souza, D. S., S Silva, A. S., Ormiga, F., Lopes, R. T., & Gusman, H. (2021). The effectiveness of passive ultrasonic irrigation and the easy-clean instrument for removing remnants of filling material. Journal of conservative dentistry : JCD, 24(1), 57–62. https://doi.org/10.4103/JCD.JCD_590_20
Spagnuolo, G., Codispoti, B., Marrelli, M., Rengo, C., Rengo, S., & Tatullo, M. (2018). Commitment of Oral-Derived Stem Cells in Dental and Maxillofacial Applications. Dentistry journal, 6(4), 72. https://doi.org/10.3390/dj6040072
Sun, X., Yang, Z., Nie, Y., & Hou, B. (2022). Microbial Communities in the Extraradicular and Intraradicular Infections Associated With Persistent Apical Periodontitis. Frontiers in cellular and infection microbiology, 11, 798367. https://doi.org/10.3389/fcimb.2021.798367
Torabinejad, M., & White, S. N. (2016). Endodontic treatment options after unsuccessful initial root canal treatment: Alternatives to single-tooth implants. Journal of the American Dental Association (1939), 147(3), 214–220. https://doi.org/10.1016/j.adaj.2015.11.017
Torres, F., Pinto, J. C., Figueira, G. O., Guerreiro-Tanomaru, J. M., & Tanomaru-Filho, M. (2020). A micro-computed tomographic study using a novel test model to assess the filling ability and volumetric changes of bioceramic root repair materials. Restorative dentistry & endodontics, 46(1), e2. https://doi.org/10.5395/rde.2021.46.e2
Toubes, K. S., Tonelli, S. Q., Girelli, C., Azevedo, C., Thompson, A., Nunes, E., & Silveira, F. F. (2021). Bio-C Repair - A New Bioceramic Material for Root Perforation Management: Two Case Reports. Brazilian dental journal, 32(1), 104–110. https://doi.org/10.1590/0103-6440202103568
Tsesis, I., Rosen, E., Taschieri, S., Telishevsky Strauss, Y., Ceresoli, V., & Del Fabbro, M. (2013). Outcomes of surgical endodontic treatment performed by a modern technique: an updated meta-analysis of the literature. Journal of endodontics, 39(3), 332–339. https://doi.org/10.1016/j.joen.2012.11.044
Tülü, G., Kaya, B. Ü., Çetin, E. S., & Köle, M. (2021). Antibacterial effect of silver nanoparticles mixed with calcium hydroxide or chlorhexidine on multispecies biofilms. Odontology, 109(4), 802–811. https://doi.org/10.1007/s10266-021-00601-8
Viana, F. L. P., Sampieri, M. B. d. S., Viana, P. P., Cruz, S. M. L., Vivan, R. R., Duarte, M. A. H., & Vasconcelos, B. C. d. (2021). Análise do pH e da atividade antimicrobiana de um novo medicamento intracanal biocerâmico Bio-C Temp. Research, Society and Development, 10(7). https://doi.org/10.33448/rsd-v10i7.16550
Von Arx, T., Roux, E., & Bürgin, W. (2014). Treatment decisions in 330 cases referred for apical surgery. Journal of endodontics, 40(2), 187–191. https://doi.org/10.1016/j.joen.2013.10.024
Zancan, R. F., Vivan, R. R., Milanda Lopes, M. R., Weckwerth, P. H., de Andrade, F. B., Ponce, J. B., & Duarte, M. A. (2016). Antimicrobial Activity and Physicochemical Properties of Calcium Hydroxide Pastes Used as Intracanal Medication. Journal of endodontics, 42(12), 1822–1828. https://doi.org/10.1016/j.joen.2016.08.017
Zargar, N., Marashi, M. A., Ashraf, H., Hakopian, R., & Beigi, P. (2019). Identification of microorganisms in persistent/secondary endodontic infections with respect to clinical and radiographic findings: bacterial culture and molecular detection. Iranian journal of microbiology, 11(2), 120–128. https://doi.org/10.18502/ijm.v11i2.1073
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Copyright (c) 2022 Larissa Paula Pessoa Dias Andrade; João Jaime Vasconcelos Pereira; Marina Fontenele Oliveira; Marcelle Melo Magalhães ; Maria Larissa Pontes Magalhães ; Tamara de Abreu Souza; Francisca Lívia Parente Viana
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