Access to original canal trajectory after deviation and perforation with guided endodontic assistance.

Procedural accidents are eventualities that may occur during endodontic treatment because of lack of attention to detail or even unforeseeable situations. Knowledge of the root canal anatomy and its variations is a prerequisite for successful endodontic treatment. This case report describes an endodontic treatment where there was an intercurrence, generating deviation and perforation, which was solved with the aid of guided endodontics. A 37 years old, ASA1, was referred to the clinic for localisation and treatment of a calcified canal of the second right upper premolar. The tomographic images revealed the presence of only one canal and deviation with apical perforation. With the help of CBCT and CAD/CAM, it was possible to perform the guided access technique even after deviation and root perforation. Once again, this technique proved to be safe and predictable, allowing for a favourable prognosis in the long term.

A New Approach for Minimally Invasive Access to Severely Calcified Anterior Teeth Using the Guided Endodontics Technique.

This article describes an endodontic treatment technique performed through a new minimally invasive approach that leads to no tooth damage at the incisal edge and uses cone-beam computed tomographic (CBCT) imaging and 3-dimensional guides. A 26-year-old patient presented with pain in the anterior region of the maxilla and reported having suffered dental trauma 13 years prior. Radiographic examination exhibited no visible root canal on tooth # 9 with a slight thickening in the apical periodontal ligament space. Pulp sensitivity tests produced no response, whereas the percussion test responded positively. CBCT imaging revealed a visible canal space limited to the apical 2-mm section of the root. Guided endodontic access was planned after intraoral scanning of the tooth surface to be used with the CBCT scan. A virtual model was created with the aid of virtual implant software for the surgical access planning in such a way as not to damage the incisal edge of the tooth. The resulting guides were printed. With guides in position over the rubber dam, a mechanical-chemical preparation was performed in the root as soon as the canal was located. Intracanal medication was left for 14 days, after which the root canal was filled gutta-percha and the access cavity sealed. Follow-up was performed 1 year after completion of the treatment. The patient was asymptomatic with periapical tissue within normal limits. The guided endodontic therapy optimized the treatment, having provided a conservative access with no tooth damage at the incisal edge in a safe and predictable way despite the presence of a severely calcified root canal.

Guided Endodontic Access in Maxillary Molars Using Cone-beam Computed Tomography and Computer-aided Design/Computer-aided Manufacturing System: A Case Report.

The aim of this study was to describe a guided endodontic technique that facilitates access to root canals of molars presenting with pulp calcifications. A 61-year-old woman presented to our service with pain in the upper left molar region. The second and third left molars showed signs of apical periodontitis confirmed by the cone-beam computed tomographic (CBCT) scans brought to us by the patient at the initial appointment. Conventional endodontic treatment was discontinued given the difficulty in locating the root canals. Intraoral scanning and the CBCT scans were used to plan the access to the calcified canals by means of implant planning software. Guides were fabricated through rapid prototyping and allowed for the correct orientation of a cylindrical drill used to provide access through the calcifications. Second to that, the root canals were prepared with reciprocating endodontic instruments and rested for 2 weeks with intracanal medication. Subsequently, canals were packed with gutta-percha cones using the hydraulic compression technique. Permanent restorations of the access cavities were performed. By comparing the tomographic images, the authors observed a drastic reduction of the periapical lesions as well as the absence of pain symptoms after 3 months. This condition was maintained at the 1-year follow-up. The guided endodontic technique in maxillary molars was shown to be a fast, safe, and predictable therapy and can be regarded as an excellent option for the location of calcified root canals, avoiding failures in complex cases.

Root fracture in patient in the pre-liver transplantation phase / Fratura de raiz em paciente em fase pré-transplante de fígado

ABSTRACT Liver transplantation is the treatment of choice for end-stage liver disease patients, and offers them the possibility of returning to active and longer life. A dental evaluation before transplantation is a recommended prerequisite to avoid oral infections, which can worsen the patient's overall situation. This case report refers to the root fracture of an anterior tooth in a patient who was undergoing dental treatment prior to liver transplantation. On clinical examination, the maxillary right central incisor (11) presented without color change, but with mobility in the buccolingual direction, slight flaring and extrusion, and fistula in the attached gingiva on the distal side of tooth 11. The patient reported that he had suffered a trauma in that region 30 years before. The radiographic examination showed a horizontal fracture of the middle third of the root, associated with bone damage, indicated by a radiolucent area at the distal surface of 11. The proposed treatment consisted of: scraping procedure and straightening of the distal surface, radical endodontic treatment of the coronal portion of the root, subsequent filling with Mineral Trioxide Aggregate and dental immobilization. The clinical and radiographic follow-up at three-monthly intervals allowed us to observe gradual regression of the lesion with bone formation, contributing to maintenance of the patient's general and emotional health, preserving his smile and quality of life.

RESUMO O transplante de fígado é o tratamento de escolha para o estágio final da doença hepática e oferece a possibilidade ao paciente de retorno a uma vida ativa e longa. Uma avaliação dentária antes do transplante é recomendada como pre-requisito para a eliminação de infecções orais, as quais podem piorar o quadro do paciente. Este relato de caso se refere a uma fratura radicular de dente anterior em um paciente em tratamento odontológico prévio ao transplante de fígado. No exame clínico, o incisivo central superior direito (11) apresentava-se sem alteração na coloração mas com mobilidade no sentido vestíbulo-lingual, ligeira vestibularização e extrusão, e fístula na gengiva inserida na distal do 11. O paciente relatou ter sofrido traumatismo na região há mais de 30 anos. Ao exame radiográfico, foi identificada uma linha de fratura radicular horizontal no terço médio, associada à lesão óssea indicada por uma área radiolúcida na superfície distal do 11. O tratamento proposto para o caso envolveu procedimentos de raspagem e alisamento subgengival da superfície distal, o tratamento endodôntico radical da porção coronária radicular com posterior obturação com Agregado Trióxido Mineral e imobilização dental. O acompanhamento clínico e radiográfico, em intervalos de três meses, permitiu observar a regressão gradual da lesão, com formação de osso no local, contribuindo para manutenção do quadro de saúde geral e emocional do paciente, preservando seu sorriso e sua qualidade de vida.