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

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Publicado

2018-09-30

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