Odontologia

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Apicectomia e curetagem apical: relato de caso.
(Universidade Brasil, 2024) Santos, Amanda Ferreira Paulo dos; Ana Claudia Rodrigues da Silva
Endodontic treatment failure can be identified through clinical and radiographic evaluations, with symptoms such as spontaneous pain, sensitivity to palpation, vertical percussion pain, swelling, and the presence of periapical lesions. When these signs are detected, endodontic retreatment is usually the first approach; however, if this option is not feasible, periapical surgery may be recommended. The literature describes several techniques for these cases, including periapical curettage, apicoectomy, surgery with retrograde obturation, and retro-instrumentation with retro-obturation. The aim of this study is to report the case of a 41-year-old female patient who sought dental care due to the emergence of an intraoral fistula. After clinical and radiographic examinations, she was diagnosed with chronic periapical abscess in tooth 12. In the first consultation, a coronal access was performed, and root canal instrumentation was carried out up to the apical third, followed by intracanal medication with Ultracal for 15 days. In the second consultation, the persistence of the fistula led to the re-opening of the canal, re-instrumentation, and substitution of the medication, which remained for 30 days. In the third consultation, the regression of the fistula was noted, and the canal was obturated with Sealapex cement. However, after 30 days, the patient returned with the reappearance of the fistula. Given this scenario, periapical surgery was indicated and scheduled, including apicoectomy of the apical third and curettage of the endodontic lesion. Following the procedure, the patient did not report pain upon apical palpation, sensitivity to vertical percussion, spontaneous pain, or recurrence of the fistula during the 7-month postoperative follow-up. conclusion: When conventional endodontic treatment methods are not applicable or complications occur during the procedure, periapical surgery proves to be an effective alternative to preserve the tooth, restoring health, aesthetics, and function to the patient.
Cirurgia parendodôntica: relato de caso
(Universidade Brasil, 2023) Oliveira, Nicole Lauer; Bruzadin, Roberto Nascimento; Silva, Ana Claudia Rodrigues da
The failure of endodontic treatment can be confirmed through clinical and radiographic examinations, with the appearance of spontaneous pain, pain on palpation, vertical percussion, edema and the presence of periapical lesions. Given these signs and symptoms, endodontic retreatment is the first choice and when this is not possible, endodontic surgery is indicated. The main indications for surgery are: difficulty in accessing the root canal through the coronary approach, with the presence of a full metal-ceramic crown and intracanal pin, or calcified root canals with periapical lesions, fractured instruments, deviations, apical perforations and steps. Several techniques are described in the literature, including periapical curettage, apicoectomy, surgery with simultaneous retrograde filling, retro instrumentation with retro-filling are the most used. The objective of this work is to present a case report of a 25-year-old patient who sought out Universidade Brasil after the emergence of intraoral edema. The patient had previous root canal treatment and developed an acute periapical abscess after undergoing internal bleaching. In the 1st session, intraoral drainage and coronary opening were performed with the placement of intracanal medication Formocresol for 48 hours. In the 2nd session, during the removal of the filling material, she found a perforation in the middle third of the root. The filling material was removed to the location of the deviation, and Calcium Hydroxide medication was placed for 20 days. In the 3rd session, the canal was filled with Bio-C Repair (Angelus) and an apicoectomy of the apical third and curettage of the endodontic lesion were performed. The patient did not present pain on apical palpation, vertical percussion, spontaneous pain or edema in the postoperative period and in the 15-day follow-up. The patient will continue to be monitored for evaluation of the repair in the periapical region. When traditional methods of endodontic treatment are not viable, or when there are accidents during the intervention, endodontic surgery is an excellent alternative for maintaining the dental element, promoting health and restoring aesthetics and function to the patient.
Protocolos de irrigação intracanal
(Universidade Brasil, 2023) Oliveira, Hellen Mayne Silva; Silva, Ana Claudia Rodrigues da
Endodontic therapy aims to decontaminate the root canal system in teeth with pulp necrosis in order to eliminate bacteria and prevent periapical infections. Irrigating solution agitation protocols are used to increase the chances of success, favoring the cleaning of sites that are difficult to access, such as accessory canals, apical deltas and dentinal tubules. The aim of this study was to evaluate the irrigants and irrigant solution agitation protocols used in endodontic treatment. A bibliographical survey was carried out, consisting of a search in databases such as Pubmed and Scielo for scientific articles related to the topic. The articles found were read and analyzed and, where relevant, used in the writing of this paper. Sodium hypochlorite is the most widely used in endodontics, in concentrations of 0.5% to 5.25%, it has antimicrobial activity and is effective in dissolving organic tissue. EDTA removes the Smear Layer, unclogging the dentinal tubules, the most commonly used composition is 17%. Another irrigant is Chlorhexidine or Chlorhexidine Digluconate in concentrations of 0.2% to 2.0%. It has antimicrobial activity, but its ability to dissolve organic matter is not effective, so it is more suitable for patients allergic to Sodium Hypochlorite. Among the agitation protocols are Passive Ultrasonic Irrigation (PUI), EasyClean, XPClean and XP-Endo Finisher. Agitation of the irrigation solution increases the chances of success, promoting disinfection of hard-to-reach sites. Among the most commonly used protocols is the combination of 2.5% sodium hypochlorite and 17% EDTA, combined with agitation with PUI and EasyClean.

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