RESUMEN
INTRODUCTION: Dynamic navigation systems are used in dental implantology to optimize the accuracy of dental implant placement. METHODS: A 30-year-old man was seen at the endodontic clinic of the Universidad Autónoma de Yucatán for pain in the left maxillary lateral incisor. A previously treated tooth with symptomatic apical periodontitis was diagnosed. The patient accepted treatment, and after signing an informed consent form, minimally invasive coronal access was performed through a zirconia crown. Then a post removal was performed with an ultrasonic tip to 2 mm before the apical gutta-percha limit, and the removal of material was completed manually with a K-file. RESULTS: This case report demonstrates the use of dynamic navigation to remove a post from under a zirconia crown for the retreatment of a failing root canal procedure. The removal of fiber posts from endodontically treated teeth can present a unique challenge for clinicians. Numerous techniques and instrument kits are recommended for the removal of fiber posts, but the risk of excessive root structure damage is a major concern because the ability to differentiate the color difference between peripheral dentin and a bonded fiber post can complicate the accuracy of the removal. CONCLUSIONS: The dynamic navigation system enabled minimally invasive removal of the fiber post with a high degree of accuracy, thus ensuring that there was no unnecessary removal of root structure. Dynamic navigation using real-time monitoring could reduce the attendant risk of iatrogenic errors in complex treatment cases.
Asunto(s)
Materiales de Obturación del Conducto Radicular , Preparación del Conducto Radicular , Adulto , Cavidad Pulpar , Gutapercha , Humanos , Retratamiento , Tratamiento del Conducto RadicularRESUMEN
El conocimiento preciso de la morfología radicular dental son claves para el éxito en las terapias endodónticas. El objetivo de este estudio fue evaluar las distintas variaciones de la morfología radicular y apical en primeros molares superiores e inferiores de una población maya moderna. Se observaron microfotografías provenientes de 80 primeros molares superiores e inferiores, presentadas en cortes transversales a 1 y 2,5 mm del vértice apical, así como de las porciones 1/3, 1⁄2, 2/3 del largo radicular y en la unión amelocementaria. Se determinó el número de raíces, conductos y configuración de Vertucci, así como forma y medidas de diámetro mayor y menor a 1 mm del vértice apical. El 90 % de primeros molares superiores reportó la presencia de 3 raíces y el 10 % mostró 2. En tanto que el total de primeros molares inferiores (100 %) reportó 2 raíces. En general, en las raíces mesiales prevaleció el Tipo II de Vertucci mientras que en las distales y palatinas la Tipo I. En el corte a 1 mm del vértice apical la forma redonda fue la de mayor prevalencia en los conductos de primeros molares superiores (44,5 %), seguida de la irregular (34,1 %) y la oval (21,4 %); mientras que en los primeros molares inferiores la más prevalente fue la irregular (54, 5 %), seguida de la redonda (23,9 %) y oval (21,6 %). Los diámetros mayor y menor de los conductos mesiales a 1 mm apical midieron 0,46 y 0,23 mm y 0,64 y 0,25 mm en molares superiores e inferiores respectivamente. La frecuencia de MB2 en primeros molares superiores fue del 77,8 %. Los conductos con mayor variabilidad fueron los mesiales. Se observó baja frecuencia de conductos ovales. Los diámetros mayores de los conductos mesiales en general, fueron superiores a 0,45 mm.
Accurate knowledge of dental root morphology is a key to success in endodontic therapies. The aim of this study was to evaluate the different variations of the root and apical morphology in upper and lower first molars of a modern Mayan population. Photomicrographs were taken from 80 upper and lower first molars, presented in cross sections at 1 and 2.5 mm from the apical vertex, as well as from the 1/3, 1⁄2, 2/3 portions of the root length and at the cementoenamel junction. The number of roots, canal and Vertucci`s configuration was determined, as well as the shape and measurements of the major and minor diameters at 1 mm from the apex. In this study 90 % of upper first molars reported the presence of 3 roots and 10 % showed 2, while the total lower first molars (100 %) reported 2 roots. In general, Vertucci`s Type II prevailed in the mesial roots while Type I was prevalent in the distal and palatal ones. In the 1 mm cut of the apical vertex, the round shape was the most prevalent in the canal of the first upper molars (44.5 %), followed by irregular (34.1 %) and oval (21.4 %); while in the first lower molars the most prevalent one was irregular (54.5 %), followed by round (23.9 %) and oval (21.6 %). The major and minor diameters of the mesial canals at 1 mm apical recorded 0.46 and 0.23 mm and 0.64 and 0.25 mm in upper and lower molars respectively. The frequency of MB2 in upper first molars was 77.8 %. The canals with greater variability were the mesial ones. Low frequency of oval canals was observed. The largest diameters of the mesial canal in general were greater than 0.45 mm.
