ABSTRACT
Background: To outline the current evidence on root morphological changes after enlarging the apical foramen with NiTi instruments. Material and Methods: A search was performed in the Virtual Health Library, PubMed, EMBASE, Scopus, Web of Science, Science Direct and SciELO databases, in addition to a manual search in Google Scholar, between January 2017 and October 2023. Articles published in English that describe in vitro studies investigating root morphological changes after instrumentation 1 mm beyond the major apical foramen were included. The quality of evidence in the included studies was also analyzed. Results: The search retrieved 367 articles. Of these, four studies were eligible for data synthesis and analysis, all of them in vitro studies. Synthesis of the results of these in vitro studies showed a larger number of root morphological changes such as experimental dentinal microcraks in samples submitted to instrumentation beyond the apical foramen when compared to micro-CT images obtained before preparation. Conclusions: The in vitro studies analyzed in this scoping review indicate that instrumentation beyond the major foramen of the root canal, promotes morphological changes in this area and that the adoption of standardized methodologies would not only increase the accurate detection and characterization of these changes but also facilitate the application of these findings in clinical trials and patient care. Key words:Endodontics, apical morphology, root canal preparation.
ABSTRACT
Endodontic management of teeth afflicted with pulp canal obliteration faces a challenge due to the heightened risk of complications including excessive wear, perforation, and suboptimal chemomechanical preparation. This report aims to elucidate the clinical endodontic strategy employed in addressing pulp canal obliteration after a history of dental trauma and an associated periradicular lesion in an upper lateral incisor. A patient visited the dental emergency department with symptoms of apical swelling, acute persistent pain, and discoloration of tooth 22. Following comprehensive clinical evaluation and cone-beam computed tomography, the diagnosis of pulp canal obliteration involving the cervical and middle thirds of the tooth, alongside an acute periradicular abscess was established. Root canal was accessed using tomographic image planning, augmented by loupe magnification and ultrasonic instrumentation. Precise identification of the access cavity was radiographically confirmed, preceded by thorough irrigation with 2.5% sodium hypochlorite and subsequent cervical and middle third preparation. Verification of the working length by an electronic apex locator ensured precise apical preparation, followed by passive ultrasonic irrigation to optimize disinfection and to enhance penetrability of intracanal calcium hydroxide medication, administered for 15 days to eliminate microbial invasion. Upon resolution of symptoms, root canal obturation employing thermo-mechanical compaction and coronal sealing with composite resin was accomplished. Radiographic assessment after a one-year interval presented evidence of lesion regression and bone repair. Subsequent cone-beam computed tomography imaging at the three-year follow-up confirmed complete healing of the periradicular tissues, attesting to the efficacy of the endodontic intervention.
