Passive ultrasonic irrigation, EndoActivator system and XP-endo Finisher R as additional cleaning techniques to remove residual filling materials from flattened root canals.

Background: The effectiveness of endodontic retreatment essentially depends on the cleaning and/or disinfection processes. In this context, the removal of root canal filling materials plays a crucial role. Aims: To assess the efficacy of passive ultrasonic irrigation (PUI), EndoActivator system (EAS), and XP-endo Finisher R (XPEFR) as additional cleaning techniques to remove the remaining root canal filling materials from flattened root canals. Subjects and Methods: Thirty-six similar flattened distal root canals of extracted human first lower molars were selected by micro-computed tomography (micro-CT) and then instrumented and filled. After the initial retreatment procedures, the residual volume of root canal filling materials was assessed by micro-CT (V1). Then, the specimens were divided into three groups (n. 12), according to the additional cleaning technique and submitted to another micro-CT scan (V2). Statistical Analysis Used: Analysis of variance and Games-Howell tests (P < 0.05). Results: The percentage reduction in the residual volume of root canal filling materials reached by PUI, EAS, and XPEFR was 28.38%, 28.12%, and 43.52%, respectively, considering the total space of the root canal (P > 0.05). In the apical third, these values were 20.05%, 21.54%, and 48.82% (P < 0.05). Conclusions: Additional cleaning techniques enabled removing a greater amount of root canal filling material from flattened distal root canals of extracted human first lower molars. Considering the total space of the root canal, there were no statistically relevant differences among the groups. In the apical third, XPEFR performed better.

Tratamento cirúrgico de perfuração radicular com obturação simultânea do canal radicular ­ relato de caso / Surgical treatment of a root perforation with simultaneous filling of root canal ­ case report

O insucesso do tratamento endodôntico é descrito como a persistência de sinais clínicos e radiográficos e da sintomatologia dolorosa pós-tratamento. O tratamento (cirúrgico ou não cirúrgico) e o prognóstico dependem da causa e das condições presentes do dente. O objetivo deste estudo foi relatar um caso clínico de fracasso de um tratamento endodôntico associado a uma perfuração radicular, relatando sua etiologia, diagnóstico, tratamento e acompanhamento. Paciente de 32 anos, sexo masculino, compareceu à clínica de Endodontia da Faculdade de Odontologia de Bauru, com queixa de desconforto na região de incisivo lateral superior direito, para avaliação. O exame radiográfico revelou presença de lesão periapical e obturação insatisfatória, enquanto que o exame clínico demonstrou presença de bolsa periodontal, discreta mobilidade, sensibilidade à percussão vertical e à palpação apical. O exame tomográfico mostrou perfuração na região vestibular da raiz associada a um extravasamento de material obturador, sugerindo ser a causa do fracasso do tratamento endodôntico primário. A cirurgia foi indicada como intervenção. A perfuração foi cirurgicamente exposta, limpa e selada com SuperEBA, enquanto que o canal foi simultaneamente retratado e obturado. No final, um enxerto ósseo e uma membrana foram utilizados para estimular uma regeneração tecidual guiada da região. Em um acompanhamento clínico e radiográfico de 4 anos, demonstrou-se reparo satisfatório do tecido ósseo com ausência de sintomatologia dolorosa. O diagnóstico preciso e o tratamento cirúrgico com obturação simultânea do canal radicular foram determinantes para o reparo satisfatório da lesão periapical e remissão dos sinais e sintomas de inflamação (AU).

The insucess of the endodontic treatment is described as the persistence of clinical and radiographic signs and painful symptomatology post-treatment. Its therapy (non-surgical and surgical treatment) and prognosis depend on the cause and tooth conditions. The aim of this study was report a case of an endodontic treatment failure associated with a root perforation retreating its etiology, diagnosis, management, and overcome. A 32-years old male patient was reffered to clinic of endodontics in Bauru School of Dentistry with complaint of discomfort in the region of maxillary right lateral incisor for evaluation. The radiographic revealed the presence of periapical lesion and unsatisfactory filling, while the clinical examination revealed the presence of periodontal pocket, discrete mobility, sensitivity to vertical percussion and to apical palpation. The tomographic examination showed a perforation on vestibular region of the root associated with filling material extravasation suggesting it be the cause of the failure of the primary endodontic treatment. The surgery was indicated as intervention. The perforation was surgically exhibited, cleaned up, and sealed with SuperEBA, while the root canal was simultaneously retreated and filled. Finally, a bone grafting and a membrane insertion were performed to induce tissue regeneration of the region. Four years follow up x-ray and clinical exam showed satisfactory repair of the hard tissue with absence of painful symptomatology. The correctly diagnosis and the surgical treatment with simultaneous filling of root canal were determinant for satisfactory repair of periapical lesion and the resolution of inflammation signs and symptomatology (AU).