Endodontic surgery, case follow-up. There are cases where we need to analyze the treatment alternatives taking into account several factors.
This patient was referred by a colleague after attempting to access the calcified root canal of tooth 42. The patient had an acute periapical abscess and a periapical radiolucent radiographic image. After clinical examination, the use of an access guide was considered unwise, due to the size of the tooth, which was very small and delicate, and because the crown was already worn.
The treatment chosen was then the sealing of the coronary space with MTA and paraendodontic surgery and backpreparation and obturation also with MTA.
Postoperatively, besides clinical absence of signs and symptoms and normal tissues, radiographically shows tissue repair in progress. The patient was oriented for further proservation in 1 year.
https://ferrariendodontia.com.br/cirurgia-canal-calcificado/
The endodontic therapy presents several challenges during its realization, the main one being the anatomical complexity. The total elimination of microorganisms responsible for the development or maintenance of a periapical lesion is infeasible, precisely because they are present within a tangled system of root canals. Endodontic treatment therefore aims to reduce as much as possible this microbial contingent to levels favorable to repair.
Bacteria organize themselves in biofilms to enhance their antimicrobial resistance and pathogenicity. The elimination of these communities occurs mainly through the mechanical action of endodontic instruments. However, these instruments are not able to touch all canal walls, and therefore the use of auxiliary chemical substances capable of dissolving organic matter, among which sodium hypochlorite stands out, is essential for the elimination of intraradicular biofilm. Other alternatives to intensify control of endodontic infection are the use of different substances as intracanal medication, activation of irrigating solutions, and photodynamic therapy. Even so, complete eradication of endodontic infection has not yet been achieved.
Faced with a primary endodontic failure, three treatment possibilities are usually considered (in order of preference): endodontic retreatment, para-endodontic surgery and exodontics, followed by the installation of a dental implant. The paraendodontic surgery represents an alternative for cases of failure after retreatment or for the resolution of errors and accidents that occurred previously.
In many situations, patients and professionals have doubts about the best alternative to be instituted when comparing endodontic surgery with extraction followed by implant placement. In these cases, the cost-benefit of both procedures must be well evaluated. Certain factors may contribute to this decision, among which are the patient's age, systemic and financial conditions, the location and proximity of the tooth to important anatomical structures, the amount of remaining bone, the root length and the extent of periapical lesion (if present).
Systematic reviews and meta-analysis point to an increase in the success rates of para-endodontic surgeries when performed under the "light of operating microscopy" and using retro-obturator materials, mainly mineral trioxide aggregate (MTA). Thus, the procedure is able to prolong the maintenance of teeth in the oral cavity, postponing the installation of implants. Iqbal and Kim, in 2008,17 observed that, whenever possible, patients preferred to keep their natural teeth by using different alternatives (treatment, retreatment and para-endodontic surgery) rather than replacing them with implants.
In: Machado R. Endodontics. Biological and technical principles. Chapter: Paraendodontic surgery. Ed. Gen, 2022.
