Use of bioceramic cement for root perforation treatment –Case Report.

relato de caso

Abstract

The use of bioceramics in dentistry, especially for root drilling, has become increasingly common due to their beneficial properties: biocompatibility, dimensional stability, antimicrobial properties, sealing properties and bioactivity.  Teeth with old and extensive amalgam restorations tend to accumulate more tertiary dentin, due to the stress caused by chewing forces. Therefore, fissures found during inspection with a straight tip probe often suggest the embouchure of canals, which are supposed to have been naturally obliterated by the reactional dentin process, especially if other canals also present a certain degree of atresia during the catheterization process. root perforations occur. Endodontics using bioceramic cements has preserved the dental element, restoring its health and function. Clinical case description: Patient MSDAGS, 63 years old, healthy, without systemic diseases, attended the dentist's office, complaining of intermittent pain in element 26. On clinical examination, an extensive class II amalgam restoration was observed. Pulp sensitivity tests were carried out, where the dental element presented acute pain to vertical and horizontal percussion and to the cold thermal test, suggestive of a tooth with symptomatic pulpitis. A thorough inspection of the restoration was also carried out, where slight thickening was observed between the tooth and the amalgam, suggesting possible infiltration.During the periodontal probing examination, the element in question showed healthy gums, ruling out the possibility of a possible vertical fracture or possible periodontal diseases. As a complementary examination, a periapical x-ray was performed, where we concluded that the tooth in question was indicated for endodontics. The patient, aware of her clinical condition, agreed to us carrying out the treatment.  Therefore, treatment began at the same appointment, with local anesthesia being performed using the posterior superior alveolar nerve block technique and papillary anesthesia, in order to provide greater comfort to the patient during treatment, to adapt a clamp for absolute isolation. .  Coronary access surgery was subsequently performed, removing all of the amalgam, leaving only part of the distal wall. A long-shank drill, type 1014, was used. Removal and smoothing of walls and angles with an endo-z drill. Then, absolute isolation was carried out with a type 26 wingless clamp. The element was properly isolated and ready to continue the treatment, followed by a straight tip probe, where a careful inspection of the entrance to the channels was carried out to identify their respective mouths. . The palatine, buccal and mesiobuccal canals were initially located and a small fissure in the region between the mesiobuccal and palatal canals was found, suggesting that it was the mesiobuccal canal 2. After completing this step of locating the canals, abundant irrigation was performed. of the pulp chamber with a 5 ml hypodermic syringe (ultradent), needle with side exit (MKlife) flooding the pulp chamber and canal mouth with 2.5% NaOCl (Chloro Rio Rioquímica).  Subsequently, catheterization was carried out at least 5mm from the apparent length of the tooth with a #10 (Kendo) and #15 (Kendo) K-type manual file. We then proceeded to the stage of pre-widening the cervical and middle thirds with a rotary file of the Orifice shapeper type, always with abundant irrigation and aspiration between each file change. During clinical examination, it was noted that the mesiovestibular canal (MV2) presented excessive bleeding, which did not stop with irrigation of the same with saline and calcium hydroxide powder. The canals were filled with intracanal medication using calcium hydroxide paste and the chamber was provisionally sealed with flow-type resin. The patient was notified about the situation and she agreed to undergo a cone beam computed tomography exam so that we could investigate the possible reason for the incessant bleeding. In a second moment, with the computed tomography, it was observed through the evaluation of the tomographic sections that the region where the mesiobuccal canal 2 was supposed to be had a deviation, probably caused during the initial instrumentation.  Once the cause of the bleeding has been discovered, we begin the repair process. The remaining canals were instrumented with a 25.06 #25mm reciprocating file and apical refinement with a 35.04 #25mm reciprocating file, always with abundant irrigation and aspiration at each file change.  After instrumentation, the agitation protocol (PUI) of the irrigating (NaOCl) and chelating (EDTA) solution was carried out with a contra-angle and easy clean (easy) plastic file, drying the canals with an endodontic sucker (ssplus) and absorbent paper cones. . We started to fill the canals using resin-type endodontic cement and the FM single cone technique calibrated at #35 (ODOUS). Channels duly filled, we set out to seal the diversion. Washing and abundant irrigation with lime water were carried out, while the repair bioceramic cement was manipulated. After being manipulated, it was inserted and accommodated in the deviation with a vertical presser and its mouth sealed with glass ionomer and flow-type resin. Filling the pulp chamber with sterile sponge and sealing with flow-type resin. A final periapical radiograph was performed where the canals were properly instrumented, filled and the root perforation was sealed. Result: Completely asymptomatic patient, tooth with no periapical lesion with positive prognosis and referred for prosthetic rehabilitation.  Case concluded on 06/25/2024, patient informed about the entire process and determined to return every 6 months for routine evaluations and continuation of the repair.  Final considerations: The use of bioceramics represents a significant advance in dentistry, offering effective and safe solutions for the treatment of root perforations due to excellent biocompatibility, antimicrobial properties, and promotion of tissue regeneration.