RESUMO
Absence of periapical healing after orthograde retreatment using an apical plug with mineral trioxide aggregate (MTA) can require surgical intervention. A patient with a root-filled maxillary central incisor with chronic apical periodontitis and sinus tract was referred for endodontic retreatment. Excessive apical enlargement was verified, indicating an MTA apical plug placement; however, an unintentional extrusion of MTA occurred during this step. The root canal was filled with gutta-percha and sealer, and periodic recalls were scheduled. The sinus tract was observed after six months and the lesion remained unaltered, although the extruded MTA had resorbed; therefore, an apicoectomy and retrograde root-end filling with MTA were performed. Absence of sinus tract, normal clinical aspect, and complete repair of the lesion were observed at the two-year follow-up.
Assuntos
Compostos de Alumínio/efeitos adversos , Compostos de Cálcio/efeitos adversos , Corpos Estranhos/etiologia , Óxidos/efeitos adversos , Periodontite Periapical/cirurgia , Materiais Restauradores do Canal Radicular/efeitos adversos , Tratamento do Canal Radicular/efeitos adversos , Silicatos/efeitos adversos , Ápice Dentário/patologia , Adulto , Compostos de Alumínio/uso terapêutico , Apicectomia/métodos , Bismuto/uso terapêutico , Compostos de Cálcio/uso terapêutico , Hidróxido de Cálcio/uso terapêutico , Fístula Dentária/cirurgia , Fístula Dentária/terapia , Combinação de Medicamentos , Feminino , Seguimentos , Corpos Estranhos/cirurgia , Guta-Percha/uso terapêutico , Humanos , Incisivo/patologia , Óxidos/uso terapêutico , Periodontite Periapical/terapia , Piezocirurgia/métodos , Retratamento , Obturação Retrógrada/métodos , Materiais Restauradores do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/métodos , Silicatos/uso terapêutico , Dente não Vital/cirurgia , Dente não Vital/terapia , Falha de TratamentoRESUMO
Active implant periapical lesion (IPL) is a rare lesion which has been reported as one of the causes of dental implant failures. Usually, an affected implant shows radiolucency in the apical area, while remaining clinically stable. IPL is often accompanied by symptoms of pain, swelling, tenderness, and fistulation. In this paper, we describe two cases of IPL with very unusual findings which led to implant failure. A large IPL associated with an inflammatory cyst in the anterior maxilla, and a mandibular IPL resulting in an extra-oral fistula are presented. The etiology and treatment approaches for IPL are discussed.
Assuntos
Implantes Dentários/efeitos adversos , Falha de Restauração Dentária , Peri-Implantite/patologia , Periodontite Periapical/etiologia , Adulto , Fístula Cutânea/etiologia , Fístula Cutânea/cirurgia , Fístula Dentária/etiologia , Fístula Dentária/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peri-Implantite/cirurgia , Periodontite Periapical/cirurgia , Cisto Radicular/etiologia , Cisto Radicular/cirurgiaRESUMO
Two patients presented with complaints of recurrent drainage of purulent exudate from sinus tracts, inflammation and pain after endodontic re-treatment of the maxillary left (Case 1) and right (Case 2) lateral incisors. The periapical lesions persisted after apical curettage, apicectomy and root-end filling with silver amalgam. Radiographic examination exposed the poor quality of the endodontic treatments and the silver amalgam root-end fillings, which were associated with periapical radiolucent areas in both teeth. The sinus tract persisted after root canal cleaning and shaping, followed by a calcium hydroxide root canal dressing. The root-end fillings were periapically dislodged with endodontic K-files, and showed progressive displacement by sinus tracts up to elimination in the oral cavity. Follow ups of 42 and 65 months post procedure revealed clinical disappearance of the symptoms, sinus tracts and exudates, and radiographs revealed that the repair process of the periapical radiolucent areas was quite advanced.
Assuntos
Hidróxido de Cálcio/uso terapêutico , Amálgama Dentário/efeitos adversos , Fístula Dentária/cirurgia , Abscesso Periapical/cirurgia , Materiais Restauradores do Canal Radicular/uso terapêutico , Raiz Dentária/cirurgia , Adulto , Apicectomia/métodos , Fístula Dentária/tratamento farmacológico , Fístula Dentária/etiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Feminino , Humanos , Incisivo/patologia , Incisivo/cirurgia , Maxila , Abscesso Periapical/tratamento farmacológico , Abscesso Periapical/etiologia , Retratamento , Materiais Restauradores do Canal Radicular/efeitos adversos , Obturação do Canal Radicular/efeitos adversos , Obturação do Canal Radicular/métodos , Raiz Dentária/patologia , Falha de Tratamento , Resultado do TratamentoRESUMO
AIM: To report the simultaneous endodontic and surgical treatment of a tooth associated with Oehlers type III dens invaginatus and a persistent periapical lesion, which comprised root-end resection, root-end filling and application of a calcium hydroxide barrier placed on the resected dentine surface. SUMMARY: Three root canals were identified in a tooth with a type III dens invaginatus, which presented with a necrotic pulp, wide foraminal opening and extensive periapical lesion, and with a previous history of acute abscess, intracanal exudate and fistula. After root canal preparation followed by intracanal application of calcium hydroxide pastes, the clinical-pathological status persisted. After periapical curettage and root-end resection, the root canals were filled, followed by root-end filling with Sealer 26 mixed with zinc oxide powder to a clay-like consistency. Calcium hydroxide paste was then applied over the exposed dentinal surface forming a covering over the root apex. At the 20-month follow-up examination the patient had no symptoms and no fistula; advanced periapical bone repair was obvious on the radiograph. KEY LEARNING POINTS: Because of the variable morphology and extent of invagination, type III dens invaginatus represents a challenge for conventional treatment, often leading to the need for a surgical approach. Sealer 26 thickened with zinc oxide powder provided satisfactory clinical properties for use as a root-end filling material. Application of a calcium hydroxide barrier over the resected root-end is a potential treatment option to encourage tissue repair.
Assuntos
Hidróxido de Cálcio , Dens in Dente/complicações , Necrose da Polpa Dentária/terapia , Periodontite Periapical/cirurgia , Obturação Retrógrada/métodos , Materiais Restauradores do Canal Radicular , Adolescente , Apicectomia , Bismuto , Fístula Dentária/complicações , Fístula Dentária/cirurgia , Necrose da Polpa Dentária/complicações , Necrose da Polpa Dentária/cirurgia , Feminino , Humanos , Incisivo , Maxila , Periodontite Periapical/complicações , Óxido de ZincoRESUMO
AIM: To describe the usefulness of periosteal grafts as barriers for bone regeneration in periradicular surgery when advanced periodontal breakdown occurs. SUMMARY: The treatment of advanced periodontal breakdown as a result of an associated endodontic lesion constitutes a multifaceted challenge to the clinician. If the source of the irritation cannot be removed by orthograde endodontic treatment, nonsurgical and surgical endodontic/periodontal intervention may be required. Two cases with suppurative chronic apical periodontitis with apicomarginal communication are described. Clinical and radiological evaluations were completed immediately prior to surgery, a week later and every 2 months after surgery for 10 months. Both patients were treated using split-thickness flaps and lateral displacement of the periosteum prior to suturing, in order to close the communication between the oral and the periapical surroundings. A remission of the clinical signs and symptoms, and successful healing in the short-term were achieved in these cases. KEY LEARNING POINTS: Periapical and periodontal lesions are closely related through pathways of communication. Disruption of the cortical plate and the presence of dentoalveolar sinus tracts can have a deleterious effect on the regeneration process after periradicular surgery. The adoption of supplementary periodontal surgical techniques may help to solve some of the difficulties in the healing process in periradicular surgery. Periosteal grafts have been shown to have the potential to stimulate bone formation when used as a graft material.
Assuntos
Fístula Dentária/cirurgia , Regeneração Tecidual Guiada/métodos , Membranas Artificiais , Procedimentos Cirúrgicos Bucais/métodos , Abscesso Periapical/cirurgia , Periósteo/transplante , Adulto , Regeneração Óssea , Fístula Dentária/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Abscesso Periapical/complicações , Obturação RetrógradaRESUMO
AIM: To examine the surfaces of a root tip removed during surgical endodontic treatment for the presence of microorganisms. SUMMARY: The present clinical case illustrates an endodontic retreatment of a maxillary premolar tooth with a fistula and periapical reaction. The case was under treatment for 1 year, during which an intracanal medicament was replaced several times. As the lesion did not decrease and exudate was persistent through the fistula and root canal, root end resection with root end filling was performed. Microbiological samples were collected from the fistula, where Propionibacterium acnes, a species associated with endodontic failures, was detected by appropriate anaerobic technique. The resected root apex was observed by scanning electron microscopy (SEM), which revealed cocci and fungal forms surrounding one of the foramina. After 12 months, the periapical lesion had reduced.
Assuntos
Apicectomia , Fístula Dentária/cirurgia , Doenças Periapicais/cirurgia , Adulto , Dente Pré-Molar/microbiologia , Fístula Dentária/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Microscopia Eletrônica de Varredura , Doenças Periapicais/microbiologia , Propionibacterium acnes/isolamento & purificação , Retratamento , Obturação Retrógrada , Tratamento do Canal Radicular , Ápice Dentário/microbiologiaRESUMO
Se estudia la efectividad del propoleo para irrigar zonas intervenidas quirurgicamente en pacientes con distintas afecciones bucales. En las ulceras bucales, la disminucion del dolor y la cicatrizacion fue mas rapida que en el grupo donde se aplico el balsamo de Chostakovski. Se concluye que las propiedades antimicrobianas, hemostaticas y antiinflamatorias del propoleo favorecieron una recuperacion mas rapida y mejor de los tejidos en el posoperatorio de los pacientes intervenidos quirurgicamente, que en aquellos del grupo control. Asimismo, se obtuvo una regresion mas rapida de los sintomas dolorosos y una mejor curacion de las ulceras al comparar los resultados en ambos grupos
Assuntos
Humanos , Alveoloplastia , Apicectomia , Bálsamos/farmacologia , Bálsamos/uso terapêutico , Extração Dentária , Fístula Dentária/cirurgia , Própole/farmacologia , Própole/uso terapêutico , Estomatite Aftosa/tratamento farmacológico , Dente Impactado/cirurgiaRESUMO
Procedeu-se a um tombamento de 2.259 prontuários de pacientes atendidos na disciplina de cirurgia e traumatologia bucomaxilofacial da Faculdade de Odontologia - Campus de Araçatuba, para se verificar a localização, causas, medicações utilizadas, técnica cirúrgica empregada, resultado cirúrgico e histopatológico, em casos de fístulas buco-sinusais. Os resultados foram analisados, orientando-se o tratamento com e sem secreção purulenta