Apical Surgery: Therapeutic Option for Endodontic Failure

Autores

  • Paulo Otávio Carmo Souza Federal University of Goiás, Dentistry School, Stricto Sensu Graduate Program in Dentistry. SP, Brazil.
  • Carolina Ferrari Piloni de Oliveira Federal University of Goiás, Dentistry School, Stricto Sensu Graduate Program in Dentistry. SP, Brazil.
  • Iussif Mamede-Neto Federal University of Goiás, Dentistry School, Stricto Sensu Graduate Program in Dentistry. SP, Brazil.
  • Amin de Macedo Mamede Sulaimen Alberta University Canada
  • Pedro Luís Alves de Lima Brazilian Association of Dentistry SP, Brazil.
  • Daniel de Almeida Decurcio Federal University of Goiás, Dentistry School, Stricto Sensu Graduate Program in Dentistry. SP, Brazi

DOI:

https://doi.org/10.17921/2447-8938.2018v20n3p185-189

Resumo

Abstract

The aim of this study is present a surgical solution of the case of endodontic root canal failure caused by overfilling, with a history of endodontic retreatment and aesthetic rehabilitation with porcelain veneers. Patient C.F.P.L, 50 years old, female, was looking for treatment complaining of pain. Previous endodontic treatment was reported on tooth 11, and root canal retreatment after 6 months due to the persistence of painful symptomatology. Later, the patient carried out aesthetic rehabilitation with porcelain veneers, and approximately 6 months later the vitro pain related to the tooth 11 occurred again. Radiographic and tomographic images showed obturation of the root canal of the tooth 11 associated with diffuse hypodense area in the periapical region, with overextended endodontic material. The probable clinical diagnosis was symptomatic traumatic apical periodontitis, and apical surgery was proposed as treatment plan. After infiltrative anesthesia, a Newmann incision and split flap were performed, followed by osteotomy with micro-chisel and curettage of the lesion. An apicectomy was performed with Zecrya drill, followed by retro cavity with diamond ultrasonic tip and retrograde obturation with white MTA. After 2 years of follow-up bone neoformation and absence of symptomatology were observed, tooth in function and preservation of aesthetic rehabilitation harmony. Apical surgery is a therapeutic alternative with favorable prognosis for the treatment of endodontic failure, provided that it is correctly indicated and with a wellexecuted surgical protocol.

Keywords: Apicectomy. Periapical Periodontitis. Periapical Granuloma.

Resumo

O objetivo deste estudo é apresentar a resolução cirúrgica de um caso de insucesso endodôntico ocasionado pela sobre obturação do canal radicular, com histórico de retratamento endodôntico e reabilitação estética com facetas cerâmicas. Paciente C.F.P.L, 50 anos, gênero feminino, procurou atendimento odontológico queixando-se de dor. Foi relatado tratamento endodôntico prévio no dente 11, e retratamento do canal radicular após 6 meses devido à persistência de sintomatologia dolorosa. Posteriormente, a paciente passou por reabilitação estética com facetas cerâmicas e, aproximadamente 6 meses após, houve o reaparecimento de dor espontânea relacionada ao dente 11. As imagens radiográficas e tomográficas revelaram obturação do canal radicular do dente 11 associado à área hipodensa difusa na região periapical, com extravasamento de material obturador. O diagnóstico clínico provável foi de periodontite apical sintomática traumática, e plano de tratamento proposto uma cirurgia parendodôntica. Posterior a anestesia infiltrativa, realizou-se incisão do tipo Newmann e retalho dividido, seguido de osteotomia com micro cinzel e curetagen da lesão. A apicectomia foi realizada com broca Zecrya, seguida da confecção da retrocavidade com ponta ultrassônica diamantada e obturação retrógrada com MTA branco. Após 2 anos de proservação foi observada neoformação óssea e ausência de sintomatologia, dente em função e preservação da harmonia da reabilitação estética. A cirurgia parendodôntica é uma alternativa terapêutica com prognóstico favorável para o tratamento do insucesso endodôntico, desde que corretamente indicada e com protocolo cirúrgico bem executado.

Palavras-chave: Apicectomia. Periodontite Periapical. Granuloma Periapical.

Biografia do Autor

Paulo Otávio Carmo Souza, Federal University of Goiás, Dentistry School, Stricto Sensu Graduate Program in Dentistry. SP, Brazil.

Departamento de Ciências Estomatológicas, Faculdade de Odontologia da Universidade Federal de Goiás

Carolina Ferrari Piloni de Oliveira, Federal University of Goiás, Dentistry School, Stricto Sensu Graduate Program in Dentistry. SP, Brazil.

Mestranda em Odontologia, Faculdade de Odontologia – Universidade Federal de Goiás

Iussif Mamede-Neto, Federal University of Goiás, Dentistry School, Stricto Sensu Graduate Program in Dentistry. SP, Brazil.

Doutor em Ciências da Saúde, Faculdade de Medicina – Universidade Federal de Goiás

Amin de Macedo Mamede Sulaimen, Alberta University Canada

Mestre em Implantodontia – Faculdade de Odontologia São Leopoldo Mandic – SP

Pedro Luís Alves de Lima, Brazilian Association of Dentistry SP, Brazil.

Professor de Dentística – Associação Brasileira de Odontologia - Seção Goiás

Daniel de Almeida Decurcio, Federal University of Goiás, Dentistry School, Stricto Sensu Graduate Program in Dentistry. SP, Brazi

Professor de Endodontia – Faculdade de Odontologia da Universidade Federal de Goiás

Referências

Estrela C, Pécora JD, Estrela CRA, Guedes OA, Silva BSF, Soares CJ, et al. Common operative procedural errors and clinical factors associated with root canal treatment. Braz Dent J 2017;28(2):179-90. doi: http://dx.doi.org/10.1590/01036440201702451.

Gilheany PA, Figdor D, Tyas MJ. Apical dentin permeability and microleakage associated with root end resection and retrograde filling. J Endod 1994;20(1):22-6. doi: https://doi. org/10.1016/S0099-2399(06)80022-1

Kim S, Kratchman S. Modern endodontic surgery concepts and practice: a review. J Endod 2006;32(7):601-23. doi: https://doi.org/10.1016/j.joen.2005.12.010

Wang WH, Wang CY, Shyu YC, Liu CM, Lin FH, Lin CP. Compositional characteristics and hydration behavior of mineral trioxide aggregates. J Dent Sci 2010;5(2):53-9. doi: https://doi.org/10.1016/S1991-7902(10)60009-8

von Arx T, Peñarrocha M, Jensen S. Prognostic factors in apical surgery with root-end filling: a meta-analysis. J Endod 2010;36(6):957-73. doi: https://doi.org/10.1016/j. joen.2010.02.026

Pecora GE, Pecora CN. A new dimension in endo surgery: Micro endo surgery. J Conserv Dent 2015;18(1):7-14. doi: https://doi.org/10.4103/0972-0707.148864

Abramovitz I, Better H, Shacham A, Shlomi B, Metzger Z. Case selection for apical surgery: a retrospective evaluation of associated factors and rational. J Endod 2002;28(7):52730. doi: https://doi.org/10.1097/00004770-200207000-00010

Estrela C, Holland R, Estrela CR, Alencar AH, Sousa-Neto MD, Pécora JD. Characterization of successful root canal treatment. Braz Dent J 2014;25(1):3-11. doi: http://dx.doi.org/10.1590/0103-6440201302356

Kojima K, Inamoto K, Nagamatsu K, Hara A, Nakata K, Morita I, et al. Success rate of endodontic treatment of teeth with vital and nonvital pulps: a meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97(1):95-9. doi: https://doi.org/10.1016/j.tripleo.2003.07.006

Schaeffer MA, White RR, Walton RE. Determining the optimal obturation length: a meta-analysis of literature. J Endod 2005;31(4):271-4. doi: https://doi.org/10.1097/01. don.0000140585.52178.78

Nair PN. On the causes of persistent apical periodontitis: a review. Int Endod J 2006;39(4):249-81. doi: https://doi. org/10.1111/j.1365-2591.2006.01099.x

Ricucci D, Rôças IN, Alves FR, Loghin S, Siqueira Junior JF. Apically extruded sealers: fate and influence on treatment outcome. J Endod 2016;42(2):243-9. doi: https://doi. org/10.1016/j.joen.2015.11.020

Santoro V, Lozito P, De Donno A, Grassi FR, Introna F. Extrusion of endodontic filling materials: medico-legal aspects. Two cases. Open Dent J 2009:3:68-73. doi: https:// doi.org/10.2174/1874210600903010068

Faitaroni LA, Bueno MR, Carvalhosa AA, Mendonça EF, Estrela, C. Differential diagnosis of apical periodontitis and nasopalatine duct cyst. J Endod 2011;37(3):403-10. doi: https://doi.org/10.1016/j.joen.2010.11.022

Carvalhosa AA, Estrela CRA, Borges AH, Guedes AO, Estrela C. 10-year follow-up of calcifying odontogenic cyst in the periapical region of vital maxillary central incisor. J Endod 2014;40(10):1695-7. doi: https://doi.org/10.1016/j. joen.2014.04.003

Velvart P, Peters CI, Peters OA. Soft tissue management: flap design, incision, tissue elevation, and tissue retraction. Endod Topics 2005;11(1):78 97. doi: https://doi. org/10.1111/j.1601-1546.2005.00157.x

Taschieri S, Del Fabrro M, Francetti L, Perondi I, Corbella S. Does the Papilla Preservation Flap Technique Induce Soft Tissue Modifications over Time in Endodontic Surgery Procedures? J Endod 2016;42(8):1191-5. doi: https://doi.org/10.1016/j.joen.2016.05.003

Kim S, Pécora G, Rubinstein R. Comparison of traditional and microsurgery in endodontics. Color atlas of microsurgery in endodontics. Philadelphia: Saunders; 2001.

Estrela C, Bammann LL, Estrela CRA, Silva RS, Pécora JD. Antimicrobial and chemical study of MTA, portland cement, calcium hydroxide paste, Sealapex and Dycal. Braz Dent J 2000;11(1):3-9.

Bernabé PF, Gomes-Filho JE, Rocha WC, Nery MJ, OtoboniFilho JA, Dezan-Júnior E. Histological evaluation of MTA as a roote nd filling material. Int Endod J 2007;40(10):75865. doi: https://doi.org/10.1111/j.1365-2591.2007.01282.x

Bernabé PF, Gomes-Filho JE, Cintra LT, Moretto MJ, Lodi CS, Nery MJ, et al. Histologic evaluation of the use of membrane, bone graft, and MTA in apical surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109(2):30914. doi: https://doi.org/10.1016/j.tripleo.2009.07.019

Downloads

Publicado

2018-09-30

Como Citar

1.
Souza POC, Oliveira CFP de, Mamede-Neto I, Sulaimen A de MM, Lima PLA de, Decurcio D de A. Apical Surgery: Therapeutic Option for Endodontic Failure. J. Health Sci. [Internet]. 30º de setembro de 2018 [citado 28º de março de 2024];20(3):185-9. Disponível em: https://journalhealthscience.pgsscogna.com.br/JHealthSci/article/view/5899

Edição

Seção

Artigos