Challenges and perspectives in endodontic treatment of older adults: a narrative literature review
DOI:
https://doi.org/10.22491/1983-7550-53-1-O5Keywords:
Geriatric dentistry, Aged, Endodontics, Root canal therapy, Cone-beam computed tomography, Printing, Three-dimensionalAbstract
This study aimed to discuss the main challenges of endodontic treatment in older adults, as well as to analyze clinical and technological strategies that may contribute to safer and more predictable management. This is a narrative literature review, with searches conducted in the PubMed, SciELO, and Google Scholar databases using Portuguese and English terms related to aging, endodontic treatment, pulpal calcification and pulp canal obliteration, comorbidities, polypharmacy, dental operating microscopy, and cone-beam computed tomography (CBCT). Relevant publications addressing the biological, clinical, and technological aspects of endodontic treatment in older adults were selected. The literature indicates that age-related changes in the dentin-pulp complex, combined with a higher prevalence of systemic diseases and the concomitant use of multiple medications, influence treatment planning, procedural safety, and prognosis, requiring comprehensive clinical assessment and, when necessary, a multidisciplinary approach. From an operative perspective, canal calcification and narrowing increase the difficulty of canal location and instrumentation, raising the risk of deviations and perforations. Technologies such as CBCT, magnification, and ultrasonic tips enhance diagnosis and access, while digital approaches, including static guided endodontics and dynamic navigation, may improve efficiency and preservation of tooth structure. However, these techniques depend on adequate infrastructure, operator training, and control of potential sources of error. In conclusion, endodontic treatment in older adult patients is feasible and can be conservative when individualized, although further standardized clinical studies are needed to guide specific protocols for this population.
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