RESUMO
Endodontic treatment in severely calcified canals is always a challenging task because it can result in accidents such as deviations or perforations. Recently, guided endodontics has become an alternative approach for pulp canal calcification, facilitating the location of root canals more predictably through the combined use of cone-beam computed tomographic imaging, oral scanning, and endodontic access guides. Although several reports have shown that guided endodontics is safer, faster and can be performed without an operating microscope and by less experienced operators, the technique has limitations, and iatrogenesis may occur. This article describes the limitations of static-guided endodontics and possible causes of failures. In the present case, not fixing the guide to the bone and inaccuracies generated by manually performing mesh merger software led to root perforation. Endodontic microsurgery was effective in resolving this case and should be considered the treatment of choice when guided endodontics cannot be used safely or when it fails.
Assuntos
Calcificações da Polpa Dentária , Endodontia , Tomografia Computadorizada de Feixe Cônico , Cavidade Pulpar/diagnóstico por imagem , Humanos , Tratamento do Canal Radicular/efeitos adversosRESUMO
Prosthetic dentistry involves functional and esthetic restoration. Some situations require the use of fiber-reinforced composite resin posts that help preserve restorations. However, if the initial treatment fails, a new endodontic intervention may be required for fiber-reinforced composite resin post removal. This procedure can be complex and challenging but can be facilitated with guided endodontics. This clinical report describes the use of a prototyped guide created with virtual planning for fiber-reinforced composite resin post removal. The guide improved patient safety, shortened the treatment time, and eliminated the need for a new restoration.
Assuntos
Resinas Compostas , Técnica para Retentor Intrarradicular , Resinas Compostas/uso terapêutico , Estética Dentária , Vidro , HumanosRESUMO
A 35-year-old woman with a history of pulp canal obliteration (PCO) and apical periodontitis was treated with guided endodontics combined with antimicrobial photodynamic therapy (aPDT). The use of aPDT was paramount to the approach performed, and its application should be encouraged in cases of severely calcified canals when apical patency is unachievable. The combination of these techniques ensured successful clinical, radiographic, and tomographic outcomes at the 1-year follow-up. Key Words: Antimicrobial PDT, guided endodonics, periodontitis, pulp canal obliteration.
Assuntos
Anti-Infecciosos , Endodontia , Periodontite Periapical , Fotoquimioterapia , Adulto , Anti-Infecciosos/uso terapêutico , Cavidade Pulpar , Feminino , Humanos , Periodontite Periapical/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Tratamento do Canal RadicularRESUMO
This study aimed to report a case series and describe the use of guided endodontics in complex symptomatic cases of mandibular and maxillary molars; presenting calcification of all three root canals. The arches of the referred patients were scanned, and high-resolution cone-beam computed tomography (CBCT) imaging was performed. Then, the taken CBCT and tooth scans were aligned and processed using software. A virtual copy of a drill was superimposed onto the scans and evaluated in 3 dimensions. Subsequently, a 3-dimensional (3D) template was designed and printed. Drilling was performed and a radiograph was taken to confirm its position. The canals were reached and endodontic treatment was performed. At the 12-month follow-up, the teeth were completely asymptomatic. The use of guided endodontics in cases of calcification in molars was demonstrated to be a viable and reliable alternative treatment. The technique was based on 3D planning.
RESUMO
This case report describes the use of the guided endodontics for a non-surgical endodontic retreatment of the mandibular molar. A 38-year-old female reported apical swelling and localized pain on the tooth #30, exacerbated when chewing hard food. Periapical radiographic examination showed pulp canal obliteration in the apical third associated with extensive radiolucent area. Cone-beam computed tomography (CBCT) images were requested to support the diagnosis and enable preparation of a surgical guide, used to direct access to the canals that were obliterated and incompletely filled. The follow-up at 24 months radiographically showed completely healed apical area in the involved tooth. This non-surgical technique demonstrated efficacy in case resolution.
RESUMO
The localization of partial or completed root canal obliteration is a challenging task in endodontic practice. Recently, guided endodontics has become an alternative solution for those cases. Although this technique has already been used clinically in managing anterior teeth, in this report, we describe 3 complex clinical scenarios of calcified root canals of 1 molar and 2 premolars using guided endodontics. The clinical cases reported here show that technological evolutions should make guided endodontic procedures more widespread because their execution is relatively fast and safe even in the case of the upper molar. Additionally, 12-month clinical follow-up visits showed the effectiveness of the guided endodontic procedures.
Assuntos
Tomografia Computadorizada de Feixe Cônico , Calcificações da Polpa Dentária/diagnóstico por imagem , Calcificações da Polpa Dentária/cirurgia , Cavidade Pulpar/diagnóstico por imagem , Cavidade Pulpar/cirurgia , Endodontia/métodos , Maxila , Radiografia Dentária , Tratamento do Canal Radicular/métodos , Cirurgia Assistida por Computador/métodos , Idoso , Dente Pré-Molar , Feminino , Seguimentos , Humanos , Imageamento Tridimensional , Pessoa de Meia-Idade , Dente Molar , Fatores de Tempo , Resultado do TratamentoRESUMO
This dental technique describes a protocol for adhesive fiber post removal using a prototyped endodontic guide. The removal of an adhesive fiber post is an important step for endodontic retreatment and the resolution of prosthetic problems. Computer-aided design and computer-aided manufacturing (CAD-CAM) technology was used to generate guides with prototyping and is a useful tool for fiber post removal.
Assuntos
Desenho Assistido por Computador , Cimentos DentáriosRESUMO
PURPOSE: The mandibular canal is a significant anatomical structure in implant dentistry, and cone beam computed tomography (CBCT) is an important diagnostic image modality in this field of dentistry. The aim of this study was to evaluate the frequencies of anatomic variations and lesions affecting the mandibular canal in CBCT images of the mandible produced for dental implant planning. METHODS: This cross-sectional study evaluated a sample of 250 CBCT examinations (500 mandibular canals). The inclusion criterion was CBCT examinations of the mandible requested for dental implant planning. The presence of anatomic variations and lesions affecting the mandibular canal was evaluated in the CBCT examinations. Moreover, the buccolingual position of the mandibular canal was evaluated in the molar region and in the ramus region. The CBCT exams were evaluated by one observer. The data were analyzed using descriptive and analytical statistics. The one-way ANOVA test was employed to compare the age between the anatomic variations. A paired t test was used to compare the buccolingual position between the molar region and the ramus region. Differences were considered significant when p values were lower than 0.05. RESULTS: The anatomic variations detected were large-diameter mandibular incisive canal (51.6 %), ramification (12 %), and accessory mental foramen (3.2 %). No difference was observed in the age of the patients between the anatomic variations (p > 0.05). The identified lesions included hypomineralization of the canal walls (20.8 %), idiopathic osteosclerosis (8.8 %), osteolytic lesions (3.2 %), iatrogenic perforation of the mandibular canal (2.8 %), and fibro-osseous lesions (1.6 %). The distance between the mandibular canal and the vestibular cortical bone was higher in the molar region than in the ramus region (p < 0.05). CONCLUSIONS: Anatomic variations and lesions affecting the mandibular canal were common findings in the CBCT images of the mandible produced for dental implant planning. An awareness of these alterations is important for dentistry because some of them might require treatment, change oral surgery planning and difficult inferior alveolar nerve anesthetic block.
Assuntos
Tomografia Computadorizada de Feixe Cônico , Mandíbula/anatomia & histologia , Doenças Mandibulares/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Variação Anatômica , Estudos Transversais , Implantação Dentária Endóssea , Feminino , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente , Interpretação de Imagem Radiográfica Assistida por ComputadorRESUMO
BACKGROUND: Metallothionein and p53 proteins have been associated with tumoral evolution and resistance against therapy. Experimentally, the former may modulate the activity of tumor suppressor protein through zinc exchange. However, there is no information on the relationship of these proteins in oral cancer. PATIENTS AND METHODS: Immunohistochemical detection of metallothionein and p53 antigens was performed in 100 oral squamous cell carcinomas. Results were compared to evaluate possible relationships between them and the disease-specific survival. RESULTS: Mean cellular indexes of positivity were 66.5% and 52.5% for metallothionein and p53, respectively, and a positive correlation was found between them. Frequent nuclear metallothionein immunolocalization was associated to increased p53 expression. Concomitant overexpression of both antigens predicted shorter survival for patients with advanced disease. CONCLUSION: These results corroborate the speculated association between metallothionein and p53 and suggest that simultaneous assessment of these proteins may be useful to evaluate aggressiveness of oral cancer.