Techlogical advances in endodontics resuing the preservation of natural teeth: Case peport

relato de caso

Abstract

The deposition of dentin along the root walls is a natural aging process and normally spreads slowly over the years. In certain cases, such as dental trauma, autotransplantation, or orthodontic treatment, this deposition of hard tissue may unexpectedly accelerate, resulting in rapid narrowing or complete closure of the root canal space. Given the great variability and unpredictability of endodontic treatments in calcified canals, the level of difficulty of these therapies becomes high. Faced with these difficulties, and with the introduction of technology into endodontic practice, such as cone bean computed tomography, intraoral scanning and surgical planning in software, negotiation concepts and instruments were developed, especially designed to deal with this challenge. . In clinical practice and with support from the literature, it is possible to describe two endodontic techniques and their specificities. One in which the technology called “microsonics” is used, which involves the use of an operating microscope associated with the use of ultrasonic inserts and the second in which another technology called EndoGuide (EG) is used. In this second type of technique, a 3D model is created, allowing the drill access to the specific measurement where the canal light is located. Several studies investigate the success rates of EG versus conventional freehand methods, and, as a result, show that EG achieves success rates and has advantages in preserving the tooth substance. The objective of this work is to report a clinical case in which the EG technique was used to negotiate a root canal with a severe degree of calcification by postgraduate students. Case description: Female patient, 56 years old, was referred to the Endodontics Specialization Clinic at IES - Instituto de Estudos da Saúde Sérgio Feitosa, for endodontic treatment of tooth 12. She was asymptomatic. Radiographically, it showed intense calcification of the root canal and the presence of a periapical lesion. At the first consultation, a clinical and radiographic evaluation was carried out and a computed tomography was requested with EndoGuide planning. Endodontic treatment was carried out in two sessions. This was the first session for coronary opening and negotiation of the root canal, using the EG with drill 1.3 from NEODENT. End of exploration and instrumentation of the conduit was carried out using magnification with a surgical microscope, type K manual files and Logic 2 rotary files (Easy and Bassi). Placement of UltraCal (ULTRADENT) indwelling dressing for 23 days. In the second session, the indwelling dressing was cleaned followed by the end of cleaning and agitation of 2.5% NaClO/EDTA/2.5% NaClO with the Easy Clean tips (Easy and Bassi). To fill the root canal, gutta percha cones (ODOUS De DEUS) and Sealer Plus resin filling cement (MK Life) were used using the Lateral Condensation technique. In this way, endodontic treatment was completed successfully. Conclusions: The use and association of new technological resources in endodontics, such as the EndoGuide and magnification with microscopes, makes the professional easier to operate and safer in complex cases, thus increasing their chance of success in endodontic treatment and maintenance of the natural tooth in the mouth.