Endodoncia guiada Para el manejo de Canales Obliterados, Reporte de Caso / Guided Endodontic Treatment for the Management of Obliterated Pulp Canals. A Case Report

RESUMEN: El objetivo: de este reporte es presentar el tratamiento endodóntico de un diente ante-rior con obliteración del canal radicular, con la ayuda de la endodoncia guiada. Paciente masculino sin antecedentes médicos relevante, y en tratamiento ortodóntico. Diente 2.1 con historia de traumatismo dento-alveaolar y presencia de dolor a la percusión. En la TCHC se observa obliteración total del canal radicular en el tercio cervical y medio y un área de radiolucidez apical. Diagnóstico: Periodontitis apical Sintomática. Tratamiento: Terapia de canal No vital, con planificación virtual y guía endodóntica. Se utilizó el programa de acceso gratuito, Bluesky Plan®, para la planifica-ción digital de la guía endodóntica. El tratamiento se realizó en dos citas. Conclusión: el uso de tecnología para la resolución de casos de alta complejidad en endodoncia, podría ayudar a mejorar el pronóstico de estos dientes y ser una alternativa más segura para reducir la posibilidad de perforación y preservar estructura dental.

ABSTRACT: The aim: of this case report is to present the endodontic treatment of an anterior tooth with an obliterated pulp canal, with the help of guided endodontics. Male patient with no relevant medical history, currently with orthodontic treatment. Tooth 2.1 had a history of dental trauma and presented tenderness to percussion. The CBCT exam showed a completely obliterated root canal in the cervical and middle third, and apical radiolucency. Diagnosis: Symptomatic Apical Periodontitis. Treatment: Root canal treatment with virtual planning and endodontic guide. Bluesky Plan® free access program was used for the digital planning of the endodontic guide. The treatment: was made in two sessions. Conclusion: the use of technology for the resolution of high complexity cases in endodontics could help improve the prognosis of these teeth and be a safer alternative to reduce the possibility of perforation and preserve more tooth structure.

Case Reports in Maxillary Posterior Teeth by Guided Endodontic Access.

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.

Guided Endodontic Access of Calcified Anterior Teeth.

Pulp canal calcification is characterized by the deposition of calcified tissue along the canal walls. As a result, the root canal space can become partially or completely obliterated. Recently, "guided endodontics" has been reported as an alternative solution in cases of partial or completed canal obliteration. Although this technique can enhance minimally invasive access to the calcified canal, it has been shown that the incisal surfaces are often removed during the access of anterior teeth. This report describes 2 cases of guided endodontics using conventional palatal access in calcified anterior teeth and discusses the applicability of this approach in cases of pulp canal calcification with apical periodontitis and acute symptoms. The method demonstrated high reliability and permitted proper root canal disinfection expeditiously, without the unnecessary removal of enamel and dentin in the incisal surface.

Microguided Endodontics: Accuracy of a Miniaturized Technique for Apically Extended Access Cavity Preparation in Anterior Teeth.

INTRODUCTION: The aim of this study was to assess the accuracy of guided endodontics in mandibular anterior teeth by using miniaturized instruments. This technique is designed to treat teeth with pulp canal calcifications and narrow roots by using a printed template that guides a bur to the calcified root canal. METHODS: Sixty sound mandibular anterior teeth were used in 10 mandibular models. Preoperative surface and cone-beam computed tomography scans were matched by using the coDiagnostix software. Virtual planning was performed for the access cavities, and templates were used for guidance. The templates were produced by a three-dimensional printer. Two operators performed the access cavities. A postoperative cone-beam computed tomography scan was superimposed on the virtual plan, and the deviation was measured in 3 dimensions and angles. Descriptive statistical analyses were performed, and 95% confidence intervals were calculated for both operators and each measured aspect. RESULTS: The deviations between the planned- and prepared-access cavities were low, with means ranging from 0.12 to 0.13 mm for different aspects at the base of the bur and 0.12 to 0.34 mm at the tip of the bur. The mean of angle deviation was 1.59°. A considerable overlap of the 95% confidence intervals indicated no significant difference between the operators. The mean treatment time, including planning and preparation, was approximately 10 minutes per tooth. CONCLUSIONS: Microguided endodontics provides an accurate, fast, and operator-independent technique for the preparation of apically extended access cavities in teeth with narrow roots such as mandibular incisors.

Combined endodontic and surgical treatment of a three-rooted maxillary first premolar.

A case is reported in which endodontic treatment of a maxillary first premolar was complicated by the fact that the tooth had three roots. One of the roots was completely calcified and therefore could not be negotiated with endodontic files. There was a large periapical lesion associated with the tooth and this was surgically removed. During the surgical procedure a retrograde cavity was prepared on the calcified root using ultrasonic instruments and this was filled using Super EBA cement. Twelve months later the tooth was asymptomatic and the periapical tissues had completely healed.

Removal of calcified attached denticle with a pulsed dye laser. A case report.

This article presents the removal of an attached pulp denticle with the use of a pulsed dye laser. The quartz fiber was introduced in the root canal and placed in direct contact with the free border of the denticle. Thirty-two pulses were necessary to fragment the pulp stone. A scanning electron-microscopic study shows a sharp section at the base of the pulp stone.

Surgical treatment of a three-rooted maxillary second premolar. Report of a case.

This article discusses surgical treatment of a maxillary second premolar with three roots. Conventional endodontic therapy was not possible because of complete calcification of the root canal systems. Apicoectomies and retrograde amalgam filling were performed on all roots, resulting in successful treatment.