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DOI: https://doi.org/10.15332/us.v7i1.1201

TRATAMIENTO NO QUIRÚRGICO DE UNA EXTENSA LESIÓN PERIAPICAL RELACIONADA CON UNA SOBREXTENSIÓN DE LA OBTURACIÓN CON CONOS DE GUTAPERCHA

Humberto Ferreira Arquez

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Resumen

Paciente masculino de 18 años de edad, sin antecedentes médicos o sistémicos que contribuyan al caso. Un examen clínico y radio-gráfico reveló una extensa lesión periapical, tumefacción intraoral, fistula; relacionada con una sobre-extensión de la obturación con conos de gutapercha en el diente 21, conducto radicular amplio y falta de constricción apical. El paciente reportó una historia previa de trauma dental que involucró este cuadrante. El diagnóstico fue de una periodontitis apical crónica supurativa del diente 21. Durante la desobturación del conducto radicular fue drenado a través del conducto un exudado sanguinolento y un exudado seroso amarillo. Seguido a la preparación biomecánica un apósito de hidróxido de calcio fue aplicado y reemplazado 3 veces en un período de 12 meses. Las características clínico-patológicas demostraron resolución de la lesión durante este período. Un tapón apical con MTA blanco fue colocado en la porción apical del conducto radicular. Una semana después el conducto fue obturado con gutapercha. Los exámenes clínico-radiográficos a los 16 meses revelaron normal contorno del hueso y una significativa resolución de la radiolucidez apical. El propósito de este artículo fue reportar la reparación de una extensa lesión periapical de origen endodóntico manejada con un trata-miento no quirúrgico.
[Ferreira H. Tratamiento no quirúrgico de una extensa lesión periapical relacionada con una sobrextensión de la obturación con conos de gutapercha. Ustasalud Odontología 2008; 7: 61 - 68]


Palabras clave

Hidróxido de calcio; MTA; Extensa lesión periapical; Retratamiento

Referencias


Andreasen JO, Bakland LK, Matras RC, Andreasen FM. Traumatic intrusion of permanent teeth. Part 1. An epidemiological study of 216 intruded permanent teeth. Dent Traumatol 2006; 22: 83 - 89.

Stanley HR, Weisman MI, Michanowicz AE, Bellizzi R. Ischemic infarction of the pulp: sequencial degenerative changes of the pulp after traumatic injury. J Endod 1978; 4: 325 - 335.

Soares JA, Queiroz CES. Patogenesia periapical – aspectos clínicos, radiográficos e tratamento da reabsorção óssea e radicular de origem endodontia. Jornal Brasileiro de Endodontia 2001; 2: 124 – 135.

Soares JA, Leonardo MR, Tanomaru Filho M, Silva LAB, Ito IY. Effect of biomechanical preparation and calcium hydroxide pastes on the anti-sepsis of root canal systems in dogs. J Appl Oral Sci 2005; 13: 93 - 100.

Sjogren U, Fidgor D, Persson S, Sundqvist G. Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis. Int Endod J 1997; 30: 297 – 306.

Nair PNR. New perspectives on radicular cysts: do they heal? Int Endod J 1998; 31: 155 - 160.

Nair PNR, Pajarola G, Schroeder HE. Types and incidence of human periapical lesions obtained with extracted teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 81: 93 – 102.

Nair PNR, Sjogren U, Sundqvist G. Cholesterol crystals as an etiological factor in non-resolving chronic inflammation: an experimental study in guinea pigs. Eur J Oral Sci 1998; 106: 644 - 650.

Baumgartner JC, Cuenin PR. Efficacy of several concentrations of sodium hypochlorite for root canal irrigation. J Endod 1992; 18: 605 – 612.

Bystrom A, Sundqvist G .Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy. Scand J Dent Res 1981; 89: 321 – 328.

Bystrom A, Sundqvist G. The antibacterial action of sodium hypochlorite and EDTA in 60 cases of endodontic therapy. Int Endod J 1985; 18: 35 – 40.

Peters LB, van Winkelhoff AJ, Buijs JF, Wesselink PR. Effects of instrumentation, irrigation and dressing with calcium hydroxide on infection in pulpless teeth with periapical bone lesions. Int Endod J 2002; 35: 13 – 21.

Pérez-Heredia M, Ferrer-Luque CM, González-Rodríguez MP, Martín-Peinado FJ, González-López S. Decalcifying effect of 15% EDTA, 15% citric acid,5% phosphoric acid and 2.5% sodium hypochlorite on root canal dentine. Int Endod J 2008; 41: 418 - 423.

Dogan H, Calt S. Effects of chelating agents and sodium hypochlorite on mineral content of Root dentin. J Endod 2001; 27: 578 – 580.

Zehnder M. Root canal irrigants. J Endod 2006; 32: 389 - 398.

Murphy WK, Kaugars GE, Collet WK, Dodds RN, Va R. Healing of periapical radiolucencies alters nonsurgical endodontic therapy. Oral Surg Oral Med Oral Pathol 1991; 71: 620 - 624.

Lalonde ER. A new rationale for the management of the periapical granulomas and cysts. An evaluation of histopathological and radiographic findings. J Am Dent Assoc 1970; 80: 1056 – 1059.

Morse DR, Patnik IW, Schacterlie GR. Electrophoretic differentiation of radicular cysts and granulomas. Oral Surg Oral Med Oral Pathol 1973; 35: 239 – 242.

Caliskan MK. Prognosis of large cyst-like periapical lesions following nonsurgical root canal treatment: a clinical review. Int Endod J 2004; 37: 408 – 416.

Winstock D. Apical disease: an analysis of diagnosis and management with special reference to root lesion resection and pathology. Ann R Coll Surg Engl 1980; 62: 171 - 179.

Spatafore CM, Griffin JA, Keyes GG, Wearden S, Skidmore AE. Periapical biopsy report: an analysis over 10-year period. J Endod 1990; 16: 239 – 241.

Melo MES, Ruiz PA, Amorin RFB, Freitas RA, Carvalho RA, Souza LB. Estudo imunohistoquímico das células do sistema imune em cistos periapicais de dentes tratados ou não endodonticamente. Brazilian Oral Research 2004; 18: 51.

Lee MT. Conservative endodontic management of teeth associated with extensive periapical pathology: report of two cases. Aust Endod J 2004; 30: 103 - 109.

Kusgoz A, Yildirim S, Gokalp A. Nonsurgical endodontic treatments in molar teeth with large periapical lesions in children: 2-year follow-up. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104: 60 - 65.

Caliskan MK, Nonsurgical retreatment of teeth with periapical lesions previously managed by either endodontic or surgical intervention Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100: 242 - 248.

Oztan MD. Endodontic treatment of teeth associated with a large periapical lesion. Int Endod J 2002; 35: 73 – 78.

Soares JA, Brito-Junior M, Silveira FF, Nunes E, Santos SMC. Favorable response of an extensive periapical lesion to root canal treatment. J Oral Sci 2008; 50: 107 - 111.

Weiger R, Rosendahl R, Löst C. Influence of calcium hydroxide intracanal dressings on the prognosis of teeth with endodontically induced periapical lesion. Int Endod J 2000; 33: 219 – 226.

Çaliskan MK, Sen BH. Endodontic treatment of teeth with apical periodontitis using calcium hydroxide: a long-term study. Endod Dental Traumatol 1996; 12: 215 – 221

Pitt Ford TR. Surgical treatment of apical periodontitis. En: Orstavik D, Pitt Ford TR. Essential Endodontology. Prevention and Treatment of Apical Periodontitis. Malden (MA): Blackwell Science; 1998. p. 278 - 300.

Fava LRG. Calcium hydroxide in endodontic retreatment after two nonsurgical and two surgical failures: report of a case. Int Endod J 2001; 34: 72 - 80.

Rocha WC, Estrela C. Cirurgia em endodontia. En: Estrela C, Figueiredo JAP. Endodontia Princípios Biológicos e Mecânicos. São Paulo (Brasil): Artes Medicas; 1999. p. 317 - 365.

Engstrom B, Hard AF, Segerstad L, Ramström G, Frostell G. Correlation of positive cultures with the prognosis for root canal treatment. Odontol Revy 1964; 15: 257 - 270.

Molven O. The frequency, technical standard and results of endodontic therapy. Nor Tannlaegeforen Tid 1976; 86: 142 - 147.

Molven O, Halse A. Success rates for gutta-percha and Kloroperka N- root fillings made by undergraduate students: radiographic findings after 10-17 years. Int Endod J 1988; 21: 243 - 250.

Sjogren U, Hagglund B, Sundqvist G, Wing K. Factors affecting the long-term results of endodontic treatment. J Endod 1990; 16: 498 - 504.

Rud J, Andreasen JO. A study of failures after endodontic surgery by radiographic, histologic, and steromicroscopic methods. Int J Oral Surg 1972; 1: 311 - 328.

Persson G. Prognosis of reoperation after apicectomy: a clinical radiological investigation. Swed Dent J 1973; 66: 49 – 67.

Danin J, Stromberg T, Forsgren H, Linder LE, Ramskold LO. Clinical management of nonhealing periradicular pathosis. Surgery versus endodontic retreatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 82: 213 - 217.

Harty FJ, Parkins BJ, Wengraf AM. The success rate of apicectomy: a retrospective study of 1016 cases. Br Dent J 1970; 129: 407 -413.

Hirsch JM, Ahlstrom U, Henrikson PA, Heyden G, Peterson LE. Periapical surgery. Int J Oral Surg 1979; 8: 173 - 185.

Rud J, Andreasen JO, Jensen JEM. A follow-up study of 1,000 cases treated by endodontic surgery. Int J Oral Surg 1972; 1: 215 - 228.

Nordenram A, Svardstrom G. Results of apicectomy. A clinical radiological examination. Swed Dent J 1970; 63: 593 - 604.

Block RM, Bushell A, Grossman LI, Langeland K. Endodontic surgical retreatment - a clinical and histopathologic study. J Endod 1979; 3: 101 - 115.

Kleier DJ. Nonsurgical retreatment of a postsurgical endodontic failure. J Endod 1984; 10: 577 -579.

Moiseiwitsch JRD, Trope M. Nonsurgical root canal therapy treatment with apparent indications for rootend surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 86: 335 - 340.

Moor RJ, Witte JC. Periapical lesions accidentally filled with calcium hydroxide. Int Endod J 2002; 35: 946 - 958.

Natkin E, Oswald RJ, Carnes LI. The relationship of lesion size to diagnosis, incidence and treatment of periapical cysts and granulomas. Oral Surg Oral Med Oral Pathol 1984; 57: 82 – 89.

Nair PNR, Sjogren U, Schumacher E, Sundqvist G. Radicular cysts affecting a root-filled human tooth: a long-term post-treatment follow-up. Int Endod J 1993; 26: 225 – 233.

Bhaskar SN. Nonsurgical resolution of radiculer cysts. Oral Surg Oral Med, Oral Pathol 1972; 34: 458 – 468.

Morse DR, Wolfson E, Schacterlie GR. Nonsurgical repair of electrophoretically diagnosed radicular cysts. J Endod 1975; 1: 158 – 163.

Lalonde ER, Luebke RG. The frequency and distribution of periapical cysts and granulomas. Oral Surg Oral Med Oral Pathol 1968; 25: 861 – 868.

Bender IB. A commentary on General Bhaskar’s hypothesis. Oral Surg Oral Med Oral Pathol 1972; 34: 469 – 476.

Rees JS. Conservative management of a large maxillary cyst. Int Endod J 1997; 30: 64 – 67.

Strindberg LZ. The dependence of the result of pulp therapy on certain factors. An analytic study based on radiographic and clinical follow-up examinations. Acta Odontologica Scandinavian 1956; 14: 1 – 175.

Ribeiro ACJ, Gouveia BE, Leite CA. Estudo histopatológico das lesões periapicais: levantamento epidemiológico. Brazilian Oral Research 2004; 18: 70 [abstract Ib027].

Rafter M. Apexification: a review. Dent Traumatol 2005; 21: 1 - 8.

Seltzer S. Endodontology: Biologic Considerations in Endodontic Procedures, 2nd. ed. Philadelphia: Lea & Febiger; 1988.

Tronstad L, Andreasen JO, Hasselgren G, Kristerson L, Riis I. pH changes in dental tissues alter root canal filling with calcium hydroxide. J Endod 1981; 7: 17 - 21.

Seux D, Couble ML, Hartmann DJ, Gauthier JP, Magloire H. Odontoblast-like cytodifferentiation of human dental pulp cells in vitro in the presence of calcium hydroxidecontaining cement. Arch Oral Biol 1991; 36: 117 - 128.

Safavi KE, Nichols FC. Effect of calcium hydroxide on bacterial lipopolysaccharide. J Endod 1993; 19: 76 - 78.

Torabinejad M, Chiavian N. Clinical application of mineral trioxide aggregate. J Endod 1993; 25: 197 - 205.

Shabahang S, Torabinejad M. Treatment of teeth with open apices using mineral trioxide aggregate. Pract Periodontics Aesthet Dent 2000; 12: 315 - 320.

Maroto M, Barberia E, Planells P, Vera V. Treatment of a non-vital immature incisor with mineral trioxide aggregate (MTA). Dent Traumatol 2003; 19: 217 - 221.

Koh ET, McDonald F, Pitt Ford TR, Torabinejad M. Cellular response to mineral trioxide aggregate. J Endod 1998; 24: 543 - 547.

Holland R, de Souza V, Nery MJ, Otoboni Filho JA, Bernabe PF, Dezan Junior E. Reaction of rat connective tissue to implanted dentin tubes filled with mineral trioxide aggregate or calcium hydroxide. J Endod 1999; 25: 161 - 166.

Torabinejad M, Hong CU, Pitt Ford TR, Kettering JD. Antibacterial effects of some root end filling materials. J Endod 1995; 21: 403 - 406.

Arens DE, Torabinejad M. Repair of furcal perforations with mineral trioxide aggregate: two case reports. Oral Surg Oral Med Oral Pathol Endod Radiol 1996; 82: 84 - 88.

Holland R, Filho JA, de Souza V, Nery MJ, Bernabe PF, Junior ED. Mineral trioxide aggregate repair of lateral root perforations. J Endod 2001; 27: 281 - 284.

Menezes R, Bramante CM, Letra A, Carvalho VG, Garcia RB. Histologic evaluation of pulpotomies in dog using two types of mineral trioxide aggregate and regular and White Portland cements as wound dressings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 98: 376 - 379.

Torabinejad M, Smith PW, Kettering JD, Pitt Ford TR. Comparative investigation of marginal adaptation of mineral trioxide aggregate and other commonly used root-end filling materials. J Endod 1995; 21: 295 - 299.

Xavier CB, Weismann R, de Oliveira MG, Demarco FF, Pozza DH. Root-end filling materials: apical microleakage and marginal adaptation. J Endod 2005; 31: 539 - 542.

Felippe WT, Felippe MCS, Rocha MJC. The effect of mineral trioxide aggregate on the apexification and periapical healing of teeth with incomplete root formation. Int Endod J 2006; 39: 2 - 9.

Leimburg ML, Angeretti A, Ceruti P, Lendini M, Pasqualini D, Berutti E. MTA obturation of pulpless teeth with open apices: bacterial leakage as detected by polymerase chain reaction assay. J Endod 2004; 30: 883 - 886.

De-Deus G, Petruccelli V, Gurgel-Filho E, Coutinho-Filho T. MTA versus Portland cement as repair material for furcal perforations: a laboratory study using a polymicrobial leakage model. Int Endod J 2006; 39: 293 - 298.

Bystrom A, Happonen RP, Sjogren U, Sundquvist G. Healing of periapical lesion of pulpless teeth after endodontic treatment with controlled asepsis. Endod Dent Traumatol 1987;3: 58 -83.

Shah N. Nonsurgical management of periapical lesions: a prospective study. Oral Surg Oral Med Oral Pathol 1988; 66: 365 - 371.

Çaliskan MK, Sen BH. Endodontic treatment of teeth with apical periodontitis using calcium hydroxide: a long-term study. Endod Dent Traumatol 1996; 12: 215 – 221.

Çaliskan MK, Türkün M. Periapical repair and apical closure of a pulpless tooth using calcium hydroxide. Oral Surg Oral Med Oral Pathol 1997; 84; 683 – 686.

Sjögren U, Figdor S, Spångberg L, Sundqvist G. The antimicrobial effect of calcium hydroxide as a short-term intracanal dressing. Int Endod J 1991; 24: 119 – 25.


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