ABSTRACT
Se presenta un caso clínico de fractura radicular del tercio medio, de pieza 2.1 con desplazamiento de los cabos de fractura. Es tratado con un novedoso procedimiento terapéutico, mediante la utilización de un biomaterial de tercera generación osteoconductor, osteogénico y osteoinductor. Se obtiene la reparación del tejido conectivo interproximal y la formación de tejido calcificado (AU)
We present a clinical case of root fracture of the middle third, piece 2.1 with displacement of the fracture ends. It is treated with a novel therapeutic procedure, using a thirdgeneration osteoconductive, osteogenic and osteoinductive biomaterial. Interproximal connective tissue repair and calcified tissue formation are obtained (AU)
Subject(s)
Humans , Male , Adolescent , Tooth Fractures/therapy , Tooth Root/injuries , Biocompatible Materials , Regenerative Endodontics/methods , Osteogenesis , Root Canal Obturation/instrumentation , Tooth Root/diagnostic imaging , Wound Healing/physiology , Dental Fistula/radiotherapy , Dentition, PermanentABSTRACT
ABSTRACT@#Oronasal fistulae are common complication following palatoraphy. There are several surgical procedures to repair oronasal fistulae. However, conventional oronasal fistulae closure technique is not always possible, especially when the surrounding tissue is replaced by fibrotic tissue due to previous palatoraphy. Tissue defects in oronasal fistulae should be replaced with tissues providing good vascularisation such as pedicle tongue flap. A case of pedicle tongue flap used to close oronasal fistulae was reported. Eleven-year-old girl, presented with oronasal fistulae and bilateral alveolar cleft after previous palatoraphy. The oronasal fistulae were closed with pedicled tongue flap. The healing was uneventful, and the division of the pedicle tongue flap was done three weeks later and closed primarily. There was no dehiscence of the wound and masticatory functions were recorded. Vascularised flap such as pedicle tongue flap is a preferred technique to close oronasal fistulae after palatoraphy.
Subject(s)
Dental Fistula , Surgical FlapsABSTRACT
Les fistules cutanées des dents et des maxillaires sont une des complications majeures de l'infection. La localisation dépend d'éléments anatomiques comme le rapport relatif des lésions avec les tables osseuses, le tissu cellulaire et les plans musculoaponévrotiques. Les étiologies correspondantes sont nombreuses avec dans un ordre croissant d'importance les dents nécrosées ou un échec de traitement canalaire, les parodontolyses, les inclusions et les nécroses osseuses. Le diagnostic différentiel est conséquent, les erreurs sont courantes! Elles se soldent par des échecs de traitement qui peuvent être délétères pour les tissus. D'où l'intérêt de bien conduire l'examen clinique afin de poser un diagnostic précis permettant de réaliser un traitement étiologique approprié et rapide
Subject(s)
Dental Fistula/diagnosis , Dental Fistula/etiology , Maxilla , Morocco , Odontogenic Tumors , ToothABSTRACT
ABSTRACT: Osteomyelitis is an infection that affects bone and bone marrow, it occurs due to inoculation of microorganisms either directly or by continuous accumulation through a hematogenous way. Female patient, 64 years old, presenting an increase of volume of the parotid masseteric region and right submandibular region, with approximately two weeks of evolution, which had a slightly fluctuating, hyperemic and hyperthermic indurated consistency; the patient complained of severe pain. CT scan and biopsy was indicated. It is imperative to identify the causative agent; the use of antibiotics must be complemented by surgical treatment to eliminate the possibility of a remaining infection.
RESUMEN: La osteomielitis es un proceso infeccioso que afecta al hueso y medula ósea y que se produce debido a la inoculación de microorganismos ya sea de manera directa, por continuidad o bien por medio de la vía hematógena. Paciente femenino de 64 años de edad que presentaba aumento de volumen en región submandibular derecha refiriendo dolor intenso con evolución de 2 semanas aproximadamente, el cual era de consistencia indurada ligeramente fluctuante, hiperémico e hipertérmico; la paciente se quejaba de dolor intenso, se indicó TC y biopsia. En estos casos para tener éxito en el tratamiento el uso de antibióticos debe complementarse con desbridamiento quirúrgico, aunado a un seguimiento estrecho para descartar la posibilidad de una infección remanente.
Subject(s)
Humans , Female , Middle Aged , Osteomyelitis/diagnosis , Mandibular Diseases/diagnosis , Osteomyelitis/surgery , Osteomyelitis/drug therapy , Osteonecrosis/diagnosis , Periapical Abscess/diagnosis , Suppuration , Radiography, Panoramic , Mandibular Diseases/surgery , Mandibular Diseases/drug therapy , Tomography, X-Ray Computed , Chronic Disease , Dental Fistula/diagnosis , Debridement , Controlled Before-After Studies , Anti-Bacterial Agents/therapeutic useABSTRACT
La existencia de una íntima conexión entre el conducto radicular y el ligamento periodontal, ha dado lugar a lo que se conoce como relaciones endoperiodontales. Esto se debe a la presencia de varias vías anatómicas de comunicación entre ambas entidades: el foramen apical, los forámenes laterales pertenecientes a conductos accesorios y conductillos dentinarios en zonas de ausencia del cemento dentario protector. Los microorganismos y sus agentes tóxicos tienen la capacidad de afectar ambos tejidos en esa interrelación física y biológica. El diagnóstico diferencial entre enfermedad endodóntica y periodontal es de vital importancia para la elección del tratamiento y el pronóstico a distancia.
The intimate connection between the root canal and theperiodontal ligament generates a concept that is known asendo-periodontal relationships. This is due to the presence ofseveral anatomical communications between them: apical foramen,lateral foramina and dentinal tubules denuded of theircementum coverage. Microorganisms and their toxic agentscan affect both tissues due to this physical and biological interrelation.Proper differential between endodontic and periodontaletiology is vital to the accurate choice of treatment andfor the long term prognosis.
Subject(s)
Humans , Dental Pulp Cavity/anatomy & histology , Dental Pulp Diseases/physiopathology , Periodontal Diseases/physiopathology , Periodontal Ligament/anatomy & histology , Diagnosis, Differential , Dental Fistula/complications , Dental Fistula/diagnosis , Dental Pulp Cavity/microbiology , Dental Pulp Necrosis/microbiology , Periodontal Diseases/microbiology , Periodontal Pocket/microbiology , Retreatment/methods , Root Canal Therapy/methodsABSTRACT
A cutaneous sinus tract of odontogenic origin occurs when purulent by-products of dental pulp necrosis spread along the path of least resistance from the root apex to the skin on the face. Patients presenting with this condition usually visit a dermatologist first, as the lesion can mimic various dermatologic pathologies, ranging from an epidermal cyst to basal cell carcinoma. The location of the sinus in the head and neck region should lead the dermatologist to seek a dental origin in order to avoid misdiagnosis. The lesion may persist for long periods before a correct diagnosis is made and the odontogenic source is treated appropriately. Herein, we report a case of a cutaneous sinus tract of odontogenic origin.
Subject(s)
Humans , Carcinoma, Basal Cell , Dental Fistula , Dental Pulp Necrosis , Diagnosis , Diagnostic Errors , Epidermal Cyst , Head , Neck , Pathology , SkinABSTRACT
Objectives: Primary teeth work as guides for the eruption of permanent dentition, contribute for the development of the jaws, chewing process, preparing food for digestion, and nutrient assimilation. Treatment of pulp necrosis in primary teeth is complex due to anatomical and physiological characteristics and high number of bacterial species present in endodontic infections. The bacterial presence alone or in association in necrotic pulp and fistula samples from primary teeth of boys and girls was evaluated. Material and Methods: Necrotic pulp (103) and fistula (7) samples from deciduous teeth with deep caries of 110 children were evaluated. Bacterial morphotypes and species from all clinical samples were determined. Results: A predominance of gram-positive cocci (81.8%) and gram-negative coccobacilli (49.1%) was observed. In 88 out of 103 pulp samples, a high prevalence of Enterococcus spp. (50%), Porphyromonas gingivalis (49%), Fusobacterium nucleatum (25%) and Prevotella nigrescens (11.4%) was observed. Porphyromonas gingivalis was detected in three out of seven fistula samples, Enterococcus spp. in two out of seven samples, and F. nucleatum, P. nigrescens and D. pneumosintes in one out of seven samples. Conclusions: Our results show that Enterococcus spp. and P. gingivalis were prevalent in necrotic pulp from deciduous teeth in boys from 2 to 5 years old, and that care of the oral cavity of children up to five years of age is important. .
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Dental Fistula/microbiology , Dental Pulp Necrosis/microbiology , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Tooth, Deciduous/microbiology , Age Factors , Chi-Square Distribution , DNA, Bacterial/analysis , Dental Pulp Cavity/microbiology , Gram-Negative Bacteria/genetics , Gram-Positive Bacteria/genetics , Polymerase Chain Reaction , Reference Values , Sex FactorsSubject(s)
Humans , Male , Adult , Cutaneous Fistula/diagnosis , Dental Fistula/diagnosis , Cheek , Diagnosis, DifferentialABSTRACT
One-step apexification using mineral trioxide aggregate (MTA) has been reported as an alternative treatment modality with more benefits than the use of long-term calcium hydroxide for teeth with open apex. However, orthograde placement of MTA is a challenging procedure in terms of length control. This case series describes the sequence of events following apical extrusion of MTA into the periapical area during a one-step apexification procedure for maxillary central incisor with an infected immature apex. Detailed long-term observation revealed complete resolution of the periapical radiolucent lesion around the extruded MTA. These cases revealed that direct contact with MTA had no negative effects on healing of the periapical tissues. However, intentional MTA overfilling into the periapical lesion is not to be recommended.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Aluminum Compounds , Apexification , Methods , Calcium Compounds , Dental Fistula , Therapeutics , Dental Pulp Necrosis , Therapeutics , Drug Combinations , Follow-Up Studies , Foreign Bodies , Gutta-Percha , Therapeutic Uses , Incisor , Pathology , Longitudinal Studies , Oxides , Periapical Abscess , Therapeutics , Root Canal Filling Materials , Root Canal Obturation , Root Canal Preparation , Methods , Silicates , Tooth Apex , Pathology , Treatment Outcome , Wound Healing , PhysiologyABSTRACT
Introdução: as fístulas odontogênicas são canais que se originam de um sítio de inflamação dentária e que drenam para as regiões orofacial e do pescoço. Uma das causas mais frequentes para a formação de fístulas odontogênicas é a presença de cáries ou de trauma dentário, com invasão bacteriana do tecido pulpar e posterior necrose pulpar. Objetivo: relatar a história clínica de uma paciente atendida na Faculdade de Odontologia da UESB, apresentando uma fístula cutânea odontogênica. Métodos: paciente de 47 anos de idade, apresentou-se ao serviço de endodontia da UESB queixando-se de uma fístula extrabucal, localizada na região esquerda da face. Depois de consultas a clínicos gerais, otorrinolaringologistas e oftalmologistas, a paciente procurou o atendimento odontológico. Ao exame radiográfico, constatou-se uma lesão cariosa no elemento 22, com presença de patologia periapical. O tratamento endodôntico foi proposto e realizado em única sessão. Resultados: três dias depois, a fístula já havia regredido, restando apenas um cicatriz no local por causa da retração tecidual para o fechamento do orifício de abertura da lesão. Dois meses depois, o exame radiográfico apontou uma formação óssea na região apical do elemento dentário. Conclusão: torna-se evidente a relevância do conhecimento dessa condição por cirurgiões-dentistas e médicos para a correta condução do diagnóstico e do tratamento da patologia
Subject(s)
Humans , Female , Middle Aged , Dental Caries , Endodontics , Cutaneous Fistula/diagnosis , Dental Fistula/diagnosis , Oral FistulaABSTRACT
La fístula dentoalveolar se desarrolla como una ruta de drenaje desde una lesión inflamatoria periapical, siguiendo el camino de menor resistencia, a través de hueso, periostio y mucosa. Puede salir a través de cualquier punto de la mucosa bucal o aún por la piel. Algunos profesionales están convencidos de que la presencia de una fístula indica una lesión seria que requiere cirugía apical e incluso la exodoncia. Sin embargo, su tratamiento tiene buen pronóstico, siendo la indicación correcta una adecuada terapia endodóntica no quirúrgica.
Subject(s)
Humans , Dental Fistula/etiology , Dental Fistula/pathology , Periapical Periodontitis/complications , Dental Fistula/microbiology , Bacterial Infections/microbiology , Prognosis , Root Canal Therapy/methodsABSTRACT
Orocutaneous fistulas or cutaneous sinus, a tract of dental origin, is an uncommon but welldocumented condition that usually requires emergency treatment. Such condition may be misdiagnosed by physicians and dentists and may sometimes be confused with bone and skin tumor, osteomyelitis, congenital fistula, salivary gland fistula, pyogenic granuloma, infected cyst, deep mycotic infection, and other pathologies. A case of facial sinus tract that was initially misdiagnosed by a physician as a nonodontogenic lesion is presented. Nonsurgical endodontic therapy was the treatment of choice for this case. Facial cutaneous sinus tracts must be considered of dental origin. Early diagnosis and prompt treatment minimize patient discomfort and esthetic problems, reducing the possibility of further complications such as sepsis and osteomyelitis.
A fístula orocutânea de origem dentária é uma condição incomum, bem documentada e geralmente requer tratamento de urgência. Esta condição pode ser confundida por médicos e dentistas com lesões ósseas, de pele, nas glândulas salivares, osteomielite, granuloma piogênico, cisto infectado, infecção fúngica, entre outras. Um caso de fístula facial que foi inicialmente diagnosticado por um médico como uma lesão não-odontogênica é apresentado e discutido. O tratamento de escolha foi a endodontia do dente envolvido, sem necessidade de cirurgia. A possibilidade de infecção dentária deve ser considerada em casos de fístula cutânea na região orofacial. O diagnóstico precoce e tratamento imediato podem minimizar o desconforto do paciente e problemas estéticos, além de reduzir a possibilidade de outras complicações, como osteomielite e sepse.
Subject(s)
Adult , Female , Humans , Cutaneous Fistula/diagnosis , Dental Fistula/diagnosis , Dental Pulp Necrosis/complications , Periapical Abscess/complications , Cutaneous Fistula/etiology , Diagnosis, Differential , Dental Fistula/etiologyABSTRACT
Root-end resected teeth with persistent apical periodontitis are usually retreated surgically or a combination of non-surgical and surgical retreatment is employed. However, patients are sometimes unwilling to be subjected to a second surgical procedure. The apical barrier technique that is used for apical closure of immature teeth with necrotic pulps may be an alternative to non-surgically retreat a failed apicoectomy. Mineral trioxide aggregate (MTA) has become the material of choice in such cases because of its excellent biocompatibility, sealing ability and osseoinductive properties. This case report describes the non-surgical retreatment of a failed apicoectomy with no attempt at retrofilling of a maxillary central incisor. White MTA was used to induce apical closure of the wide resected apical area. Four-year follow-up examination revealed an asymptomatic, fully functional tooth with a satisfactory healing of the apical lesion. White MTA apical barrier may constitute a reliable and efficient technique to non-surgically retreat teeth with failed root-end resection. The predictability of such a treatment is of great benefit for the patient who is unwilling to be submitted to a second surgical procedure.
Dentes com periodontite persistente após apicectomia são comumente tratados cirurgicamente ou pela combinação de cirurgia e tratamento não-cirúrgico. Porém, alguns pacientes não aceitam se submeter a um segundo procedimento cirúrgico. A técnica da barreira apical, utilizada para fechamento apical de dentes com ápice aberto com necrose pulpar, pode ser uma alternativa não-cirúrgica para retratamento de casos de apicectomia mal sucedida. O agregado de trióxido mineral (MTA) tornou-se o material de escolha para estes casos devido a sua excelente biocompatibilidade, capacidade de selamento e propriedades osseoindutivas. O relato de caso aqui apresentado descreve o retratamento não-cirúrgico de uma apicectomia mal sucedida, sem retrobturação, de um incisivo central superior. Foi utilizado o MTA branco para induzir o fechamento apical da ampla área de ressecção radicular. O exame de acompanhamento quatro anos após o tratamento mostrou um dente assintomático e totalmente funcional com reparo satisfatório da lesão apical. A barreira apical com MTA branco pode ser uma técnica segura e eficaz para o retratamento não-cirúrgico de dentes com apicectomia mal sucedida. A previsibilidade de tal tratamento é um grande benefício para o paciente que não deseja ser submetido a um novo procedimento cirúrgico.
Subject(s)
Adult , Humans , Male , Aluminum Compounds , Apicoectomy , Apexification/methods , Calcium Compounds , Dental Fistula/therapy , Oxides , Periapical Periodontitis/therapy , Root Canal Filling Materials , Silicates , Tooth Apex/surgery , Drug Combinations , Incisor/surgery , Retreatment , Treatment FailureABSTRACT
Here, we introduce some confusing endodontic cases, which we had experienced in our clinic. The first case had been misdiagnosed as a skin lesion and received extended skin treatment. The second case had been misdiagnosed as a periodontal lesion and received periodontal treatment by two former dentists. The third case exhibited oral malodor and the patient worried about his breath odor for a long period. These three cases have received endodontic treatment in our clinic, and the patients were free from their long-lasting problems. We also discuss other confusing cases with literature mini-review
Subject(s)
Humans , Male , Female , Dental Pulp Cavity , Dental Fistula , Diagnosis, Differential , Periodontal Diseases , Tooth Root , Cutaneous FistulaABSTRACT
A retrospective survey was designed to identify diagnostic subgroups and clinical factors associated with odontogenic pain and discomfort in dental urgency patients. A consecutive sample of 1,765 patients seeking treatment for dental pain at the Urgency Service of the Dental School of the Federal University of Goiás, Brazil, was selected. Inclusion criteria were pulpal or periapical pain that occurred before dental treatment (minimum 6 months after the last dental appointment), and the exclusion criteria were teeth with odontogenic developmental anomalies and missing information or incomplete records. Clinical and radiographic examinations were performed to assess clinical presentation of pain complaints including origin, duration, frequency and location of pain, palpation, percussion and vitality tests, radiographic features, endodontic diagnosis and characteristics of teeth. Chi-square test and multiple logistic regression were used to analyze association between pulpal and periapical pain and independent variables. The most frequent endodontic diagnosis of pulpal pain were symptomatic pulpitis (28.3 percent) and hyperreactive pulpalgia (14.4 percent), and the most frequent periapical pain was symptomatic apical periodontitis of infectious origin (26.4 percent). Regression analysis revealed that closed pulp chamber and caries were highly associated with pulpal pain and, conversely, open pulp chamber was associated with periapical pain (p<0.001). Endodontic diagnosis and local factors associated with pulpal and periapical pain suggest that the important clinical factor of pulpal pain was closed pulp chamber and caries, and of periapical pain was open pulp chamber.
Um estudo retrospectivo foi realizado para identificar fatores clínicos e de diagnóstico associado com a dor de origem odontogênica. Foram selecionados 1765 pacientes que buscaram tratamento para dor odontogênica no Serviço de Urgência da Faculdade de Odontologia da Universidade Federal de Goiás. Os critérios de inclusão foram dor de origem pulpar ou periapical antes do tratamento dentário (mínimo de 6 meses depois da última consulta odontológica), e os critérios de exclusão foram dentes com anomalias de desenvolvimento e falta de informações ou registros incompletos. Avaliações clínicas e radiográficas foram realizadas para se obter as características clínicas de dor, incluindo origem, duração, frequência e localização da dor, testes de palpação, percussão e vitalidade pulpar, aspectos radiográficos, diagnóstico endodôntico e características dos dentes. Os testes qui-quadrado e regressão logística múltipla foram utilizados para verificar a associação entre a dor de origem pulpar e periapical e variáveis independentes. O diagnóstico endodôntico de dor de origem pulpar mais frequente foi pulpite sintomática (28,3 por cento) seguido por pulpalgia hiper-reativa (14,4 por cento), e o mais frequente de dor de origem periapical foi periodontite apical sintomática infecciosa (26,4 por cento). Análise de regressão revelou que câmaras pulpares fechadas e cáries estavam altamente associadas à dor pulpar e, inversamente, câmara pulpar aberta estava associada à dor periapical (p<0,001). O diagnóstico endodôntico e fatores locais associados com dor de origem pulpar e periapical sugerem que os fatores clínicos importantes das dores pulpares foram câmaras pulpares fechadas e cáries, e de dor periapical foi câmara pulpar aberta.
Subject(s)
Adult , Female , Humans , Male , Dental Pulp Diseases/diagnosis , Periapical Diseases/diagnosis , Toothache/diagnosis , Dental Pulp Test , Dental Restoration, Permanent , Dental Restoration, Temporary , Diagnosis, Differential , Dental Caries/diagnosis , Dental Fistula/diagnosis , Pain Measurement , Palpation , Percussion , Post and Core Technique , Periapical Abscess/diagnosis , Periapical Periodontitis/diagnosis , Pulpitis/diagnosis , Retrospective Studies , Risk Factors , Root Canal Therapy , Time Factors , Tooth Fractures/diagnosisABSTRACT
The interrelationship between periodontal and endodontic disease has aroused confusion, queries and controversy. Differentiating between periodontal and endodontic problems can be difficult. A symptomatic tooth may have pain of periodontal and/or pulpal origin. The nature of that pain is often the first clue in determining the etiology of such a problem. Radiographic and clinical evaluation can help clarify the nature of the problem. In some cases, the influence of pulpal pathology may create periodontal involvement. In others, periodontal pathology may create pulpal pathology. This review article discusses the various clinical aspects to be considered for accurately diagnosing and treating endo-perio lesions.
Subject(s)
Clinical Protocols , Dental Fistula/diagnosis , Dental Pulp Diseases/diagnosis , Dental Pulp Diseases/therapy , Diagnosis, Differential , Humans , Periodontal Diseases/diagnosis , Periodontal Diseases/therapy , Periodontal Ligament/pathology , Tooth Apex/pathology , Toothache/diagnosisABSTRACT
Palatal radicular grooves are developmental anomalies of maxillary incisors, which contribute to localized periodontitis resulting in loss of anterior teeth. Palatal radicular grooves, when present, act as a site for plaque accumulation and periodontal infection. They are easily overlooked as etiologic factors, as these grooves are covered by periodontal tissues. The clinician has to be alert and check for variations in the anatomy of the tooth as a cause of pulp necrosis in the anterior segment of the tooth, when other causes are ruled out. Recognition of palatal radicular grooves is critical, especially because of its diagnostic complexity and the problems that may arise if it is not properly interpreted and treated. This case report describes the diagnosis and management of a maxillary lateral incisor with necrotic pulp and localized periodontal destruction, associated with a palatal radicular groove.
Subject(s)
Adult , Dental Fistula/complications , Dental Fistula/etiology , Dental Pulp Necrosis/etiology , Dental Pulp Necrosis/therapy , Female , Humans , Incisor/abnormalities , Maxilla , Periapical Periodontitis/etiology , Periapical Periodontitis/surgery , Root Canal Therapy , Tooth Abnormalities/complications , Tooth Root/abnormalities , Tooth Root/surgeryABSTRACT
Dens invaginatus (DI), commonly known as dens in dente, is a developmental malformation of teeth that most commonly affects permanent maxillary incisor teeth. DI can present in a variety of forms, knowledge of which can usefully help in endodontic diagnosis and treatment. This article reports on an unusual case of DI type III with a periradicular lesion in a mandibular lateral incisor. Non-surgical endodontic treatment was performed and resolution of the periradicular lesion was observed at 1 year follow-up. Clinical considerations and treatment are discussed and reported.
Subject(s)
Adult , Dens in Dente/classification , Dens in Dente/therapy , Dental Fistula/therapy , Dental Pulp Necrosis/therapy , Follow-Up Studies , Humans , Incisor/abnormalities , Male , Mandible , Periapical Diseases/therapy , Root Canal Filling Materials/therapeutic use , Root Canal Irrigants/therapeutic use , Root Canal Preparation/methods , Root Canal Therapy/methodsABSTRACT
O presente trabalho relata o caso clínico de uma paciente com leve sensibilidade e presença de fístula no primeiro pré-molar superior direito, que já tinha sido submetido a tratamento endodôntico com complementação cirúrgica. O exame radiográfico revelou um erro de diagnóstico na identificação do número de canais, uma vez que era possível identificar a presença de três canais e três raízes no referido elemento, sendo que apenas os canais disto-vestibular e palatino encontravam-se preenchidos com material obturador, enquanto o canal mésio-vestibular, além de vazio, tinha no ápice a presença de material radiopaco. Restabeleceu-se uma cavidade de acesso e remoção do material obturador com o auxílio de uma broca de Gates-Glidden número 3, dos terços médio e cervical, e com uma lima do tipo Kerr número 25 combinada com o solvente Eucaliptol, do terço apical. Após a realização do preparo biomecânico pela Técnica Mista Invertida, promoveu-se a renovação de variadas substâncias como curativo de demora, por um período que se estendeu por 30 dias. Contudo, não foi possível observar regressão da fístula, o que motivou a realização da obturação dos canais radiculares promovendo-se um extravasamento proposital de material obturador através do forame apical removido através de uma curetagem apical. Ao longo de 16 meses, um acompanhamento clínico e radiográfico revelou o desaparecimento do trajeto fistuloso, ausência de sensibilidade à palpação e/ou percussão e restauração da dimensão normal do espaço periodontal, caracterizando o sucesso do tratamento realizado.
The present work reports a clinical case of a patient with light sensibility and fistula presence in the right maxillary first premolar that had already been submitted to endodontic treatment with surgical complementation. The radiographic exam revealed a diagnosis misinterpretation in the identification of the number of canals, once it was possible to identify the presence of three canals and three roots in the referred element, and just the distobuccal and palatine canals were filled out with endodontic material, while the mesiobuccal canal, was not only empty, but there was also the presence of radiopaque material in the apex. It was recovered an access cavity and the material was removed through a Gates-Glidden drill number 3, by medium and cervical thirds, and a file type Kerr number 25 combined with the solvent Eucalyptol of the apical third. After the accomplishment of the biomechanical preparation for the Inverted Mixed Technique, the renewal varied substances was promoted as a delay curative, for a period that extended for 30 days. As it was not possible to observe regression of the fistula, the accomplishment of the filling of the root canals was realized and it brought along a deliberate extrude of material through the apical foramen that was removed through a curettage apical. For the next 16 months a clinical and radiographic attendance revealed the disappearance of the fistulous itinerary, a sensibility absence in palpation and/or percussion and restoration of the normal dimension of the periodontal space characterizing the success of the accomplished treatment.