Reimplante intencional: que procedimento é esse que pode salvar dentes? Dois relatos de caso em longo prazo / Intentional replantation: What kind of approach is this that can save teeth? Two long term case reports

Introdução: A manutenção da dentição natural é preferível na maioria dos casos. Muito embora hoje em dia se possa contar com os implantes dentários, em casos com prognóstico menos limitado a preservação dos dentes ainda é mais aconselhável que os implantes. A Endodontia, e todas as suas possibilidades terapêuticas existentes, intenta e faz o papel de especialidade que tem como princípio prevenir ou eliminar a periodontite apical, dando condições de reparo e saúde ao periodonto apical e tecido ósseo. Com o advento tecnológico dos últimos anos, os tratamentos de canal se tornaram muito mais previsíveis e isso se reflete no aumento dos índices de sucesso, tanto de tratamentos primários quanto de retratamentos. Contudo, existem casos que falham, mas esses casos não são o fim da linha para o dente. Entre as manobras existentes para se reintervir em dentes que tiveram um tratamento que fracassou, são possíveis a microcirurgia endodôntica apical ou o reimplante intencional. Método: A manobra de reimplante intencional consiste de várias etapas cirúrgicas que vão desde a extração do elemento dental até a reposição de volta ao seu alvéolo. Neste artigo foram descritos dois casos clínicos limítrofes que foram tratados por meio desse procedimento. Resultados: Os casos apresentaram resultados excelentes, como remissão das lesões apicais, reparo ósseo e permanência dos elementos em boca, com acompanhamento de longo prazo (2 e 11 anos). Conclusões: Com altos índices de sucesso já relatados na literatura, essa modalidade de tratamento precisa ser mais explorada e divulgada no Brasil, principalmente entre alunos de pós-graduação e especialistas em Endodontia, pois comprovadamente pode evitar a indicação desnecessária de implantes dentais (AU).

Introduction: The maintenance of natural dentition is preferable in most of cases. However, nowadays it is possible to use dental implants in cases where prognosis is very limited. Endodontics and all of its therapeutic modalities play an important role, which has, in principle, to prevent or eliminate apical periodontitis providing better conditions for wound healing of periapical and bone tissues. In the past few years, with technological advances, root canal treatment became more predictable and this can be seen reflected in the increase of success rates of primary treatment as well as non-surgical retreatment. Nevertheless, some cases can failure but, it is not the end for the tooth, once some therapeutic approaches are possible, like apical microsurgery or intentional replantation. Method: Intentional replantation is an approach in which some surgical steps are done, since the dental extraction until its repositioning back to the socket. In this article two bordering cases were described. Results: 2 and 11 years follow-up confirm the favorable results of this technique. Both cases with no apical lesion, bone healing and dental elements developing their natural functions. Conclusions: The high successful rates described in the literature give to this treatment approach an important face, and that should be more explored and disclosed in Brazil, specially between specialists and post-graduation students, once can avoid unnecessary dental implants (AU).

Intentional reimplantation of left lower second molar as an alternative to extraction: a case report / Reimplante intencional del segundo molar inferior como alternativa a la extracción: reporte de caso

In patients who need endodontic re-treatment, and where the prognosis for surgical or non-surgical re-treatment is poor or treatment may be risky, one alternative is to opt for extraction of the affected tooth and replacement by an implant. However treatment by intentional reimplantation (IR) is also a possibility. The object of the present study was to present a case of a patient aged 71 years who needed endodontic re-treatment, where IR treatment was selected. The patient reported spontaneous pain which disappeared completely with the use of analgesics. This tooth had previously been treated endodontically around 1 year earlier, and no pain was reported in the first two months after treatment.Nonetheless, about 3 months before the present consultation, intensity of the symptoms had increased with a sensation of pressure in the apical-coronal direction. Cone-beam computerised tomography (CBCT) showed a periapical lesion in tooth 3.7. Based on the clinical and imaging examinations, acute apical periodontitis was diagnosed in tooth 3.7.The tooth was treated by IR. It was carefully extracted and inspected for cracks or perforations. It was treated under the microscope with root resection, and then retrograde obturation was carried out with bioceramic material. The tooth was then repositioned in its alveolus. It was immobilised for 15 days, after which the patient could return gradually to normal masticatory function. In the 6 months check-up the patient presented no pain or sensitivity to percussion. No root resorption or periapical radiolucency was observed in the periapical X-ray. We conclude that IR is an alternative to extraction followed or not by prosthetic treatment, for patients who need endodontic re-treatment. The treatment presents good levels of success, and of acceptance by the patient.

En pacientes que necesitan de retratamiento endodóntico y el retratamiento quirúrgico o no quirúrgico tiene un pronóstico desfavorable o puede ser riesgoso, se puede optar por la extracción del diente afectado y su reemplazo por implante o se puede elegir el tratamiento mediante la técnica de reimplante intencional (RI). El objetivo del presente estudio fue presentar un caso de paciente de 71 años con necesidad de retratamiento endodóntico, donde se optó por la realización del RI. Paciente relatava dolor espontáneo que desaparecia completamente con el uso de analgésicos. Este diente ya había sido tratado endodónticamente hace alrededor de 1 año, y el paciente noreportó dolor en los primeros dos meses después del tratamiento.No obstante, hace aproximadamente 3 meses la intensidad de los síntomas aumentó, junto con la sensación de presión en el sentido ápice-corona. La tomografía computarizada cone-beam (TCCB) mostró lesión periapical en el diente 3.7. Basado en el examen clínico e imagenológico se diagnosticó periodontitis apical aguda en el diente 3.7.Para el tratamiento se realizó la técnica de RI, siendo extraído el diente cuidadosamente, e inspeccionado a fin de localizar fisuras o perforaciones. El diente fue tratado bajo microscopio y se realizó la resección de la raíz. Se realizó la obturación retrógrada con material biocerámico. Enseguida el diente fue reposicionado en su alveolo, la inmovilización fue realizada durante 15 días y la paciente logró retornar gradualmente a su función masticatoria. En el seguimiento de 6 meses la paciente no presentó dolor o sensibilidad a la percusión. En la radiografía periapical no se observó resorción radicular o radiolucencia periapical. Concluimos que el RI en pacientes que necesitan retratamiento endodóntico es una alternativa a la realización de la exodoncia seguida o no, de tratamiento protético, donde existe una buena aceptación por parte del paciente y éxito en el tratamiento.