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Tratamento endodôntico seguro

Tratamento endodôntico seguro www.ferrariendodontia.com.br Resumo da palestra durante o Encontro de Endodontia do Prof. José Luiz Lage-Marques, da Universidade de São Paulo. Tratamento endodôntico seguro em relação ao forame e aos procedimentos extraforaminais, patência apical e alargamento foraminal. In: Ferrari et al. Three Dimensional mapping of the root apex: distances between apexes and anatomical structures and external cortical plates. Braz. Oral Res. 2021;35:e022. IntroductionTooth pulp can be injured due to a variety of irritants, and rootcanal treatment (RCT) may be indicated in some cases to restore teethwellness.1,2,3 However, teeth are positioned near sensitive anatomicalstructures, such as the maxillary sinus and mandibular canal4,5,6,7,8,9,10,11,12,13,14,15,16,17 and the buccal and lingual cortical plates.4,7,10,14,18,19,20,21,22,23 Thus,the endodontic diagnosis and treatment planning of such cases requiregreater attention by the endodontist. Chemical, physical and biological injuriesaffect these sensitive anatomical areas during rootcanal treatment, ranging from minor severity withspontaneous resolution to more severe accidentsrequiring surgical intervention, including sodiumhypochlorite overflow, endodontic instrumentfracture, debris and obturation cement extrusion, andlabio-mandibular paresthesia, among others.24,25,26,27,28A technique of particular concern is apical foramenwidening, which allows a great amount of chemicaland mechanical intrusion in the periapical area duringinstrumentation,29,30 whereas instrumentation shouldnot advance beyond the apical foramen.31For many years, an electronic apex locator wasconsidered an accurate device to locate the rootapex.32 However, it was proved that this accuracywas affected by the proximity of teeth to certainanatomical structures.33,34Periapical radiographic examination is usuallyused during the diagnosis and treatment of theroot canal; however, it does not provide an adequateestimate of the apical position anatomically.35 Conebeam computed tomography (CBCT) is the mostsuitable resource, since it provides a three-dimensionalview of the dental anatomy, and its relationshipwith adjacent anatomical regions, thus enablingoverlapping structures to be viewed and eliminatingimage distortions.36This inaccuracy in determining the root canalworking length, and the distance between the apicalforamen and the close anatomical structures mayresult in injury to these structures. Therefore, the aimof this study was to determine the mean distancesbetween the apexes of the maxillary posteriorteeth and the inferior wall of the maxillary sinus,determine the mean distances between the apexesof the mandibular posterior teeth and the superiorborder of the mandibular canal, and measure theproximity between the root apexes of whole teethin relation to the adjacent cortical plates Tratamento endodôntico seguro