RESUMO
Endodontic management of teeth afflicted with pulp canal obliteration faces a challenge due to the heightened risk of complications including excessive wear, perforation, and suboptimal chemomechanical preparation. This report aims to elucidate the clinical endodontic strategy employed in addressing pulp canal obliteration after a history of dental trauma and an associated periradicular lesion in an upper lateral incisor. A patient visited the dental emergency department with symptoms of apical swelling, acute persistent pain, and discoloration of tooth 22. Following comprehensive clinical evaluation and cone-beam computed tomography, the diagnosis of pulp canal obliteration involving the cervical and middle thirds of the tooth, alongside an acute periradicular abscess was established. Root canal was accessed using tomographic image planning, augmented by loupe magnification and ultrasonic instrumentation. Precise identification of the access cavity was radiographically confirmed, preceded by thorough irrigation with 2.5% sodium hypochlorite and subsequent cervical and middle third preparation. Verification of the working length by an electronic apex locator ensured precise apical preparation, followed by passive ultrasonic irrigation to optimize disinfection and to enhance penetrability of intracanal calcium hydroxide medication, administered for 15 days to eliminate microbial invasion. Upon resolution of symptoms, root canal obturation employing thermo-mechanical compaction and coronal sealing with composite resin was accomplished. Radiographic assessment after a one-year interval presented evidence of lesion regression and bone repair. Subsequent cone-beam computed tomography imaging at the three-year follow-up confirmed complete healing of the periradicular tissues, attesting to the efficacy of the endodontic intervention.
RESUMO
The current study aims to report a case of invasive cervical resorption in a maxillary left central incisor with a history of dental trauma. After thorough clinical and tomographic evaluations, cervical cavitation, an irregularity in the gingival contour and crown discoloration were observed. Furthermore, presence of an extensive and well-defined area of invasive cervical resorption with pulp communication was discovered. The suggested diagnosis was asymptomatic irreversible pulpitis. The resorption area was treated with the complete removal of granulation tissue, sealed with light-curing glass ionomer cement. Then, the chemo-mechanical preparation and obturation of the root canal were performed. After two years of clinical follow-up and cone-beam computed tomography examination, there were no clinical signs and symptoms, the filling of the resorption area remained intact, and no hypodense image in the cervical region of tooth #21 could be detected. The management reported in this case presented a possible viable treatment for invasive cervical resorption, provided that correct diagnosis is made.
