Remoção Manual não Cirúrgica de Instrumento Endodôntico Fraturado no Terço Apical de Pré-Molar Superior: Relato de Caso Surgical Manual Removal of Fractured Endodontic Instrument in the Apical Third of Maxillary Premolar: Case Report
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Publicado:
Jun 12, 2020
Palavras-chave:
Instrumento Fraturado., Tratamento Endodôntico., Lesão Perirradicular., Remoção do Instrumento.
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Resumo
A fratura acidental de um instrumento durante o tratamento
endodôntico pode ocorrer devido à falta de conhecimento anatômico
do elemento dentário, ao uso de instrumentos inadequados
ou à falha técnica do operador. O objetivo do presente
estudo foi apresentar um relato de caso clínico da remoção
de um instrumento fraturado no terço apical de um pré-molar
superior. O fragmento localizava-se no terço apical da raiz
vestibular. A primeira tentativa de remoção do fragmento foi
realizada sem sucesso. Após 15 dias, em uma nova tentativa, o
instrumento foi removido com o auxílio de ultrassom e inserto
específico. Entre as sessões, utilizou-se medicação intracanal à
base de hidróxido de cálcio, paramonoclorofenol canforado e
propilenoglicol. Decorridos 15 dias, o dente mostrou-se assintomático
e foi obturado pela técnica da condensação lateral.
Assim, a paciente foi encaminhada para a realização da restauração
definitiva. Após 3 meses, foi observada radiograficamente
a regressão da lesão perirradicular. Conclui-se que a retirada do
fragmento no caso descrito se mostrou uma opção eficiente,
propiciando a manutenção do dente com ausência de sinais e
sintomas.
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Como Citar
Volpato Marques Tookuni, I., Capitanio, M., Jefferson Sevila Versan, H., & Sergio Endo, M. (2020). Remoção Manual não Cirúrgica de Instrumento Endodôntico Fraturado no Terço Apical de Pré-Molar Superior: Relato de Caso. Revista Naval De Odontologia, 47(1), 33-38. https://doi.org/10.29327/25149.47.1-5
Seção
Relatos de caso
Referências
1. Crump MC, Natkin E. Relationship of broken root canal
instruments to endodontic case prognosis: a clinical investigation.
J Am Dent Assoc. 1970 Jun 80(6):1341-7.
2. Bergenholtz G, Lekholm U, Milthon R, Heden G, Odesjö B,
Engström B. Retreatment of endodontic fillings. Scand J Dent
Res. 1979 Jun 87(3):217-24.
3. Spili P, Parashos P, Messer HH. The impact of instrument
fracture on outcome of endodontic treatment. J Endod. 2005
Dec 31(12):845-50.
4. Parashos P, Messer HH. Rotary NiTi instrument fracture
and its consequences. J Endod. 2006 Nov 32(11):1031-43.
5. Parashos P, Messer HH. Questionnaire survey on the use
of rotary nickel-titanium endodontic instruments by Australian
dentists. Int Endod J. 2004 Apr 37(4):249-59.
6. Suter B, Lussi A, Sequeira P. Probability of removing fractured
instruments from root canals. Int Endod J. 2005 Feb
38(2):112-23.
7. Gambarini G. Cyclic fatigue of ProFile rotary instruments
after prolonged clinical use. Int Endod J. 2001 Jul 34(5):386-9.
8. McGuigan MB, Louca C, Duncan HF. Endodontic instrument
fracture: causes and prevention. Br Dent J. 2013 Apr
214(7):341-8.
9. Parashos P, Gordon I, Messer HH. Factors influencing defects
of rotary nickel-titanium endodontic instruments after
clinical use. J Endod. 2004 Oct 30(10):722-5.
10. Serefoglu B, Kaval ME, Micoogullari Kurt S, Çalişkan MK.
Cyclic Fatigue Resistance of novel glide path instruments
with different alloy properties and kinematics. J Endod. 2018
Sep 44(9):1422-24.
11. Kramkowski TR, Bahcall J. An in vitro comparison of torsional
stress and cyclic fatigue resistance of ProFile GT and
ProFile GT Series X rotary nickel-titanium files. J Endod. 2009
Mar 35(3):404-7
12. Yao JH, Schwartz SA, Beeson TJ. Cyclic fatigue of three
types of rotary nickel-titanium files in a dynamic model. J
Endod. 2006 Jan 32(1):55-7.
13. Chhina H, Hans MK, Chander S. Ultrasonics: A novel
approach for retrieval of separated instruments. J Clin Diagn
Res. 2015 Jan 9(1):18-20.
14. Sjogren U, Hagglund B, Sundqvist G, Wing K. Factors affecting
the long-term results of endodontic treatment. J Endod.
1990 Oct 16(10):498-504.
15. Siqueira JF Jr. Aetiology of root canal treatment failure:
why well-treated teeth can fail. Int Endod J. 2001 Jan 34(1):1-
10.
16. Koç C, Kamburoğlu K, Sönmez G, Yılmaz F, Gülen O, Karahan
S. Ability to detect endodontic complications using
three different cone beam computed tomography units with
and without artefact reduction modes: an ex vivo study. Int
Endod J. 2019 May 52(5):725-36.
17. Panitvisai P, Parunnit P, Sathorn C, Messer HH. Impact of
a retained instrument on treatment outcome: a systematic
review and meta-analysis. J Endod. 2010 May 36(5):775-80.
18. McGuigan MB, Louca C, Duncan HF. Clinical decision-
-making after endodontic instrument fracture. Br Dent J.
2013 Apr 214(8):395-400.
19. McGuigan MB, Louca C, Duncan HF. The impact of fractured
endodontic instruments on treatment outcome. Br Dent
J. 2013 Mar 214(6):285-9.
20. Garg H, Grewal MS. Cone-beam Computed Tomography
Volumetric Analysis and Comparison of Dentin Structure
Loss after Retrieval of Separated Instrument by Using
Ultrasonic EMS and ProUltra Tips. J Endod. 2016 Nov
42(11):1693-98.
21. Machtou P, Reit C. Non-surgical retreatment. In: Bergenholtz
G, Hørsted Bindslev P, Reit C, editors. Textbook of
endodontology. 1st ed. Oxford: Blackwell Munksgaard Ltd;
2003. p.300-10.
22. Fu M, Zhang Z, Hou B. Removal of broken files from root
canals by using ultrasonic techniques combined with dental
microscope: a retrospective analysis of treatment outcome. J
Endod. 2011 May 37(5):619-22.
23. Shen Y, Peng B, Cheung GS. Factors associated with the
removal of fractured NiTi instruments from root canal systems.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
2004 Nov 98(5):605-10.
24. Mandel E, Adib-Yazdi M, Benhamou LM, Lachkar T, Mesgouez
C, Sobel M. Rotary Ni-Ti profile systems for preparing
curved canals in resin blocks: influence of operator on instrument
breakage. Int Endod J. 1999 Nov 32(6):436-43.
25. Masserann J. “Entfernen metallischer Fragmente aus Wur38
Revistazelkanälen” (Removal of metal fragments from the root canal).
J Br Endod Soc. 1971 Autumn;5(3):55-9.
26. Ruddle CJ. Micro-endodontic nonsurgical retreatment.
Dent Clin North Am. 1997 Jul 41(3):429-54.
27. Ward JR, Parashos P, Messer HH. Evaluation of an ultrasonic
technique to remove fractured rotary nickel-titanium endodontic
instruments from root canals: clinical cases. J Endod.
2003 Nov 29(11):764-7.
instruments to endodontic case prognosis: a clinical investigation.
J Am Dent Assoc. 1970 Jun 80(6):1341-7.
2. Bergenholtz G, Lekholm U, Milthon R, Heden G, Odesjö B,
Engström B. Retreatment of endodontic fillings. Scand J Dent
Res. 1979 Jun 87(3):217-24.
3. Spili P, Parashos P, Messer HH. The impact of instrument
fracture on outcome of endodontic treatment. J Endod. 2005
Dec 31(12):845-50.
4. Parashos P, Messer HH. Rotary NiTi instrument fracture
and its consequences. J Endod. 2006 Nov 32(11):1031-43.
5. Parashos P, Messer HH. Questionnaire survey on the use
of rotary nickel-titanium endodontic instruments by Australian
dentists. Int Endod J. 2004 Apr 37(4):249-59.
6. Suter B, Lussi A, Sequeira P. Probability of removing fractured
instruments from root canals. Int Endod J. 2005 Feb
38(2):112-23.
7. Gambarini G. Cyclic fatigue of ProFile rotary instruments
after prolonged clinical use. Int Endod J. 2001 Jul 34(5):386-9.
8. McGuigan MB, Louca C, Duncan HF. Endodontic instrument
fracture: causes and prevention. Br Dent J. 2013 Apr
214(7):341-8.
9. Parashos P, Gordon I, Messer HH. Factors influencing defects
of rotary nickel-titanium endodontic instruments after
clinical use. J Endod. 2004 Oct 30(10):722-5.
10. Serefoglu B, Kaval ME, Micoogullari Kurt S, Çalişkan MK.
Cyclic Fatigue Resistance of novel glide path instruments
with different alloy properties and kinematics. J Endod. 2018
Sep 44(9):1422-24.
11. Kramkowski TR, Bahcall J. An in vitro comparison of torsional
stress and cyclic fatigue resistance of ProFile GT and
ProFile GT Series X rotary nickel-titanium files. J Endod. 2009
Mar 35(3):404-7
12. Yao JH, Schwartz SA, Beeson TJ. Cyclic fatigue of three
types of rotary nickel-titanium files in a dynamic model. J
Endod. 2006 Jan 32(1):55-7.
13. Chhina H, Hans MK, Chander S. Ultrasonics: A novel
approach for retrieval of separated instruments. J Clin Diagn
Res. 2015 Jan 9(1):18-20.
14. Sjogren U, Hagglund B, Sundqvist G, Wing K. Factors affecting
the long-term results of endodontic treatment. J Endod.
1990 Oct 16(10):498-504.
15. Siqueira JF Jr. Aetiology of root canal treatment failure:
why well-treated teeth can fail. Int Endod J. 2001 Jan 34(1):1-
10.
16. Koç C, Kamburoğlu K, Sönmez G, Yılmaz F, Gülen O, Karahan
S. Ability to detect endodontic complications using
three different cone beam computed tomography units with
and without artefact reduction modes: an ex vivo study. Int
Endod J. 2019 May 52(5):725-36.
17. Panitvisai P, Parunnit P, Sathorn C, Messer HH. Impact of
a retained instrument on treatment outcome: a systematic
review and meta-analysis. J Endod. 2010 May 36(5):775-80.
18. McGuigan MB, Louca C, Duncan HF. Clinical decision-
-making after endodontic instrument fracture. Br Dent J.
2013 Apr 214(8):395-400.
19. McGuigan MB, Louca C, Duncan HF. The impact of fractured
endodontic instruments on treatment outcome. Br Dent
J. 2013 Mar 214(6):285-9.
20. Garg H, Grewal MS. Cone-beam Computed Tomography
Volumetric Analysis and Comparison of Dentin Structure
Loss after Retrieval of Separated Instrument by Using
Ultrasonic EMS and ProUltra Tips. J Endod. 2016 Nov
42(11):1693-98.
21. Machtou P, Reit C. Non-surgical retreatment. In: Bergenholtz
G, Hørsted Bindslev P, Reit C, editors. Textbook of
endodontology. 1st ed. Oxford: Blackwell Munksgaard Ltd;
2003. p.300-10.
22. Fu M, Zhang Z, Hou B. Removal of broken files from root
canals by using ultrasonic techniques combined with dental
microscope: a retrospective analysis of treatment outcome. J
Endod. 2011 May 37(5):619-22.
23. Shen Y, Peng B, Cheung GS. Factors associated with the
removal of fractured NiTi instruments from root canal systems.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
2004 Nov 98(5):605-10.
24. Mandel E, Adib-Yazdi M, Benhamou LM, Lachkar T, Mesgouez
C, Sobel M. Rotary Ni-Ti profile systems for preparing
curved canals in resin blocks: influence of operator on instrument
breakage. Int Endod J. 1999 Nov 32(6):436-43.
25. Masserann J. “Entfernen metallischer Fragmente aus Wur38
Revistazelkanälen” (Removal of metal fragments from the root canal).
J Br Endod Soc. 1971 Autumn;5(3):55-9.
26. Ruddle CJ. Micro-endodontic nonsurgical retreatment.
Dent Clin North Am. 1997 Jul 41(3):429-54.
27. Ward JR, Parashos P, Messer HH. Evaluation of an ultrasonic
technique to remove fractured rotary nickel-titanium endodontic
instruments from root canals: clinical cases. J Endod.
2003 Nov 29(11):764-7.