RESUMEN
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.
Asunto(s)
Compuestos de Aluminio/efectos adversos , Compuestos de Calcio/efectos adversos , Cuerpos Extraños/etiología , Óxidos/efectos adversos , Periodontitis Periapical/cirugía , Materiales de Obturación del Conducto Radicular/efectos adversos , Tratamiento del Conducto Radicular/efectos adversos , Silicatos/efectos adversos , Ápice del Diente/patología , Adulto , Compuestos de Aluminio/uso terapéutico , Apicectomía/métodos , Bismuto/uso terapéutico , Compuestos de Calcio/uso terapéutico , Hidróxido de Calcio/uso terapéutico , Fístula Dental/cirugía , Fístula Dental/terapia , Combinación de Medicamentos , Femenino , Estudios de Seguimiento , Cuerpos Extraños/cirugía , Gutapercha/uso terapéutico , Humanos , Incisivo/patología , Óxidos/uso terapéutico , Periodontitis Periapical/terapia , Piezocirugía/métodos , Retratamiento , Obturación Retrógrada/métodos , Materiales de Obturación del Conducto Radicular/uso terapéutico , Preparación del Conducto Radicular/métodos , Silicatos/uso terapéutico , Diente no Vital/cirugía , Diente no Vital/terapia , Insuficiencia del TratamientoRESUMEN
Endodontic treatment of mandibular molars is challenging because of variable root canal morphology. The nonsurgical endodontic management of a mandibular first molar presenting an independent middle mesial canal is reported. After coronal access, additional clinical inspection of the mesial canals' orifices and their interconnecting groove using an endodontic explorer and 4.5× loupes enabled the identification of the middle mesial canal orifice. All root canals were chemomechanically prepared and filled. The tooth was asymptomatic and functional after 4 years of followup. Cone beam computed tomography (CBCT) images revealed normal periapical status and three-dimensional (3D) anatomical aspects of the root canal system.
RESUMEN
Despite the advantages of cone-beam computed tomography (CBCT), the images provided by this diagnostic tool can produce artifacts and compromise accurate diagnostic assessment. This paper describes an endodontic treatment of a maxillary molar where CBCT images suggested the presence of a nonexistent third root canal in the palatal root. An endodontic treatment was performed in a first maxillary molar with palatal canals, and the tooth was restored with a cast metal crown. The patient returned four years later presenting with a discomfort in chewing, which was reduced after occlusal adjustment. CBCT was prescribed to verify additional diagnostic information. Axial scans on coronal, middle, and apical palatal root sections showed images similar to a third root canal. However, sagittal scans demonstrated that these images were artifacts caused by root canal fillings. A careful interpretation of CBCT images in root-filled teeth must be done to avoid mistakes in treatment.