The The use of cone beam computed tomography in the diagnosis and management of endodontic failure: clinical case report
DOI:
https://doi.org/10.5335/rfo.v26i1.10697Keywords:
anatomy, molar tooth, cone beam computed tomographyAbstract
Objective: To describe a clinical case where cone beam computed tomography (CBCT) was used to assist in the diagnosis and better management of endodontic retreatment. Case report: The patient attended the clinic complaining of a fistula in the upper molar region on the right side for approximately two months. Radiographically, the presence of a periapical lesion of element 17 was observed. After confirming the need for retreatment, the patient reported having already undergone two endodontic interventions on this tooth. Thus, it was decided to request a CBCT exam for better diagnosis and case planning. When assessing the CBCT, there was the presence of extensive periapical lesion, presence of empty spaces in the mesiobuccal and palatal canal, gutta percha cone beyond the apex in the distobuccal (DB) canal and location of the mesiopalatal (MP) canal - which had not been previously handled -, rupture of the cortex vestibular and palatal bone. After planning, the patient underwent endodontic retreatment. Then, all the previous filling material were removed, including the gutta-percha by passing into the DB canal, MP was localized and complete instrumentation of all root canals were done. Calcium hydroxide was used as an intracanal medication between appointments. When the regression of the fistula was observed and canals were without exudate, root canal filling was performed. Final considerations: The CBCT allowed the visualization of operative errors pertinent to the case during previous endodontic treatments, which allowed the indication of a new endodontic treatment and the maintenance of the tooth in the dental arch.
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References
using the canal finder system. DtschZahnarztl Z 1990;
45(4):229-32.
2. Baruwa AO, Martins JNR, Meirinhos J, Pereira B, Gouveia
J, Quaresma SA, et al. The influence of missed canals on the
prevalence of periapical lesions in endodontically treated
teeth: a cross-sectional study. J Endod 2020; 46(1):34-9.
3. Pécora JD, Woelfel JB, Sousa Neto MD, Issa EP. Morphology
study of the maxillary molars part ii: internal anatomy. Braz
Dent J 1992; 3(1):53-7.
4. Weine FS, Healey HJ, Gerstein H, Evanson L. Canal configuration in the mesiobuccal root of the maxillary first molar
and its endodontic significance. Oral Surg Oral Med Oral Pathol 1969; 28(3):419-25.
5. Pineda F, Kuttler Y. Mesiodistal and buccolingual roentgenographic investigation of 7275 root canals. Oral Surg Oral
Med Oral Pathol 1972; 33(1):101-10.
6. Kulild JC, Peters DD. Incidence and configuration of canal
systems in the mesiobuccal root of maxillary first and second
molars. J Endod 1990; 16(7):311-7.
7. Hiebert BM, Abramovitch K, Rice D, Torabinejad M. Prevalence of second mesiobuccal canals in maxillary first molars detected using cone-beam computed tomography, direct
occlusal access, and coronal plane grinding. J Endod 2017;
43(10):1711-5.
8. Baratto Filho F, Zaitter S, Haragushiku GA, de Campos EA,
Abuabara A, Correr GM. Analysis of the internal anatomy of
maxillary first molars by using different methods. J Endod
2009; 35(3):337-42.
9. Divito EE, Le KT. Maxillary molar healing after treatment of
an uninstrumented canal with a novel root canal procedure:
a case report. Clin Case Rep 2017; 5(10):1676-81.
10. Witherspoon DE, Small JC, Regan JD. Missed canal systems
are the most likely basis for endodontic retreatment of molars. Tex Dent J 2013; 130(2):127-39.
11. Pereira RS, Rodrigues VAA, Furtado WT, Gueiros S, Pereira
GS, Avila-Campos MJ. Microbial analysis of root canal and
periradicular lesion associated to teeth with endodontic failure. Anaerobe 2017; 48:12-8.
12. Kruse C, Spin-Neto R, Reibel J, Wenzel A, Kirkevang LL.
Diagnostic validity of periapical radiography and cbct for assessing periapical lesions that persist after endodontic surgery. Dentomaxillofac Radiol 2017; 46(7):20170210.
13. Estrela C, Leles CR, Hollanda AC, Moura MS, Pécora JD.
Prevalence and risk factors of apical periodontitis in endodontically treated teeth in a selected population of Brazilian adults. Braz Dent J 2008; 19(1):34-9.
14. Patel S. New dimensions in endodontic imaging. Part. 2. Cone
beam computed tomography. Int Endod J 2009; 42(6):463-75.
15. Ricucci D, Siqueira JF Jr. Fate of the tissue in lateral canals
and apical ramifications in response to pathologic conditions
and treatment procedures. J Endod 2010; 36(1):1-15.
16. Nakata K, Naitoh M, Izumi M, Inamoto K, Ariji E, Nakamura H. Effectiveness of dental computed tomography in diagnostic imaging of periradicular lesion of each root of a multirooted tooth: a case report. J Endod 2006; 32(6):583-7.
17. Peters OA. Current challenges and concepts in the preparation
of root canal systems: a review. J Endod 2004; 30(8):559-67.
18. Siqueira JF Jr, Lima KC, Magalhães FA, Lopes HP, de Uzeda
M. Mechanical reduction of the bacterial population in the
root canal by three instrumentation techniques. J Endod
1999; 25(5):332-5
9. Pérez AR, Alves FRF, Marceliano-Alves MF, Provenzano
JC, Gonçalves LS, Neves AA. Effects of increased apical enlargement on the amount of unprepared areas and coronal
dentine removal: a micro-computed tomography study. Int
Endod J 2018; 51(6):684-90.
20. Andreassen JO. Traumatic injuries the teeth. Copenhagen:
munksg; 1981.
21. Leonardo MRResiRT, Silva LAB, Loffredo LCM. Hidróxido
de cálcio em endodontia: avaliação da alteração do pH e da
liberação de íons cálcio em produtos endodônticos à base de
hidróxido de cálcio. RGO 1992; 40(1):69-72.
22. Souza V, BrinabiPFE, Holland R, Nery MJ, Meric W, Otobon
Filho JA. Tratamento não cirúrgico de dentes com lesões periapicais. RGO 1989; 46(2):39-46.
23. Buck CLNP, Soares AJ, Buck A, Nagata JN, Zaia AA, Souza
Filho FJ. Avaliação de dentes reimplantados submetidos a
um novo protocolo terapêutico. Rev Assoc Paul Cirur Dent
2013; 67(1):22-6.
24. Patel S, Brown J, Pimentel T, Kelly RD, Abella F, Durack C5.
Cone beam computed tomography in endodontics- a review
of the literature. Int Endod J 2019; 52(8):1138-52.
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