ABSTRACT
Operative procedural errors must be well analyzed in order to avoid influence negatively the root canal treatment (RCT) prognosis. The successful RCT prevents tooth loss and avoids pain and apical periodontitis. This review aimed to categorize common operative procedure errors and clinical factors associated with RCT. Based on this, will be approached common errors of procedures within the clinical operative sequence: endodontic treatment planning, pulp and periapical disease diagnosis, anaesthesia, access cavity preparation, isolation with rubber dam, root canal preparation, root canal filling and retreatment, restoration of endodontically treated teeth, postoperative pain, follow up of endodontically treated teeth. The professional must remind that in each phase of RCT an operative error may have adverse implication on prognosis, and these errors characterize risk factors to failure. The knowledge of probable operative procedural errors and its consequences are essentials to avoid future problems to the tooth health.
Subject(s)
Root Canal Therapy/methods , Cone-Beam Computed Tomography , Humans , Patient Care Planning , X-Ray MicrotomographyABSTRACT
O processo natural de remodelação óssea ocorre através de atividadescelulares, mediada principalmente por osteoblastos e osteoclastos.A interrupção desse processo pode levar a ocorrência de alterações como a osteonecrose. A osteonecrose é causada por diversos fatores, dentre eles locais e sistêmicos, destacando-se o uso de medicamentos e radioterapia. A osteonecrose dos maxilares associada ao uso de bisfosfonatos (ONB) é caracterizada pela presença de um osso necrótico exposto na cavidade bucal, por mais de 8 semanas, em pacientes tratados com este medicamento, sem o histórico de terem sido submetidos à radioterapia de cabeça e pescoço. Já osteorradionecrose (ORN), em conseqüência da radioterapia para tratamento de neoplasias malignas, reduz o potencial de vascularização do tecido ósseo, afetando a atividadecelular, a formação de colágeno e a capacidade de reparo do tecido, podendo levar à necrose. A ONB e ONR apresentam como principais sinais e sintomas: dor intensa, edema, parestesia, infecções, ulceração dos tecidos moles e alterações radiográficas. Por apresentarem características semelhantes, clinicamente a diferenciação entre a ONB e ORN se dá apenas pela história de uso ou não de bisfosfonatos. Este trabalho teve como objetivo abordar um caso sem precedentes, em que descreveu-se a recidiva de uma osteonecrose mandibular, após o debridamento cirúrgico e a infusão de PRP, em uma paciente que posteriormente foi submetida à radioterapia de cabeça e pescoço para tratamento de um caso de reincidência de um mieloma múltiplo (MM).
The natural bone remodeling process occurs mediated by osteoblasts and osteoclasts. Disturbances in this process may lead to osseous changes as osteonecrosis. Osteonecrosis is caused by several factors, including local and systemic factors, highlighting the use of drugs or radiation. The Bisphonates related osteonecrosis of the jaw (BRONJ) is characterized by the presence of an exposed necrotic bone in the oral cavity for more than 8 weeks in patients treated with this drug, with no history of being subjected to radiotherapy. Osteoradionecrosis (ORN), as a result of radiotherapy, reduces the vascularization potencial of bone, affectingcellular activity, the collagen formation and the capacity of tissue repair, leading to necrosis. As signs and symptoms of BRONJ and ONR is described: intense pain, edema, paresthesia, infection, ulceration, soft tissue and radiographic changes. Because they have similar characteristics, clinical differentiation between the BRONJ and ORN is given only by the history of bisphosphonates intake. This study aimed to discuss an unprecedented case in which was described an mandibular osteonecrosis relapse, after surgical debridement and the PRP infusion, in a patient who has subsequently submitted to radiotherapy for the treatment of a recurrence of multiple myeloma (MM) in head and neck region.
