A New Approach for Minimally Invasive Access to Severely Calcified Anterior Teeth Using the Guided Endodontics Technique. 2018

Sônia T O Lara-Mendes, and Camila de Freitas M Barbosa, and Vinícius C Machado, and Caroline C Santa-Rosa
Department of Endodontics, Faculty of Dentistry, Universidade de Itaúna, Itaúna, Minas Gerais, Brazil. Electronic address: soniamendes@hotmail.com.

This article describes an endodontic treatment technique performed through a new minimally invasive approach that leads to no tooth damage at the incisal edge and uses cone-beam computed tomographic (CBCT) imaging and 3-dimensional guides. A 26-year-old patient presented with pain in the anterior region of the maxilla and reported having suffered dental trauma 13 years prior. Radiographic examination exhibited no visible root canal on tooth # 9 with a slight thickening in the apical periodontal ligament space. Pulp sensitivity tests produced no response, whereas the percussion test responded positively. CBCT imaging revealed a visible canal space limited to the apical 2-mm section of the root. Guided endodontic access was planned after intraoral scanning of the tooth surface to be used with the CBCT scan. A virtual model was created with the aid of virtual implant software for the surgical access planning in such a way as not to damage the incisal edge of the tooth. The resulting guides were printed. With guides in position over the rubber dam, a mechanical-chemical preparation was performed in the root as soon as the canal was located. Intracanal medication was left for 14 days, after which the root canal was filled gutta-percha and the access cavity sealed. Follow-up was performed 1 year after completion of the treatment. The patient was asymptomatic with periapical tissue within normal limits. The guided endodontic therapy optimized the treatment, having provided a conservative access with no tooth damage at the incisal edge in a safe and predictable way despite the presence of a severely calcified root canal.

UI MeSH Term Description Entries
D007180 Incisor Any of the eight frontal teeth (four maxillary and four mandibular) having a sharp incisal edge for cutting food and a single root, which occurs in man both as a deciduous and a permanent tooth. (Jablonski, Dictionary of Dentistry, 1992, p820) Incisors
D008437 Maxilla One of a pair of irregularly shaped bones that form the upper jaw. A maxillary bone provides tooth sockets for the superior teeth, forms part of the ORBIT, and contains the MAXILLARY SINUS. Maxillae,Maxillary Bone,Bone, Maxillary,Bones, Maxillary,Maxillary Bones,Maxillas
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012390 Root Canal Therapy A treatment modality in endodontics concerned with the therapy of diseases of the dental pulp. For preparatory procedures, ROOT CANAL PREPARATION is available. Therapy, Root Canal,Canal Therapies, Root,Canal Therapy, Root,Root Canal Therapies,Therapies, Root Canal
D012720 Severity of Illness Index Levels within a diagnostic group which are established by various measurement criteria applied to the seriousness of a patient's disorder. Illness Index Severities,Illness Index Severity
D014074 Tooth Calcification The process whereby calcium salts are deposited in the dental enamel. The process is normal in the development of bones and teeth. (Boucher's Clinical Dental Terminology, 4th ed, p43) Calcification, Tooth,Teeth Calcification,Calcification, Teeth,Calcifications, Teeth,Calcifications, Tooth,Teeth Calcifications,Tooth Calcifications
D054893 Cone-Beam Computed Tomography Computed tomography modalities which use a cone or pyramid-shaped beam of radiation. CAT Scan, Cone-Beam,Cone-Beam CT,Tomography, Cone-Beam Computed,Tomography, Volume Computed,CT Scan, Cone-Beam,Cone-Beam Computer-Assisted Tomography,Cone-Beam Computerized Tomography,Volume CT,Volume Computed Tomography,Volumetric CT,Volumetric Computed Tomography,CAT Scan, Cone Beam,CAT Scans, Cone-Beam,CT Scan, Cone Beam,CT Scans, Cone-Beam,CT, Cone-Beam,CT, Volume,CT, Volumetric,Computed Tomography, Cone-Beam,Computed Tomography, Volume,Computed Tomography, Volumetric,Computer-Assisted Tomography, Cone-Beam,Computerized Tomography, Cone-Beam,Cone Beam CT,Cone Beam Computed Tomography,Cone Beam Computer Assisted Tomography,Cone Beam Computerized Tomography,Cone-Beam CAT Scan,Cone-Beam CAT Scans,Cone-Beam CT Scan,Cone-Beam CT Scans,Scan, Cone-Beam CAT,Scan, Cone-Beam CT,Scans, Cone-Beam CAT,Scans, Cone-Beam CT,Tomography, Cone Beam Computed,Tomography, Cone-Beam Computer-Assisted,Tomography, Cone-Beam Computerized,Tomography, Volumetric Computed
D019060 Minimally Invasive Surgical Procedures Procedures that avoid use of open, invasive surgery in favor of closed or local surgery. These generally involve use of laparoscopic devices and remote-controlled manipulation of instruments with indirect observation of the surgical field through an endoscope or similar device. Minimal Access Surgical Procedures,Minimal Surgical Procedures,Minimally Invasive Surgical Procedure,Surgical Procedures, Minimally Invasive,Minimal Surgical Procedure,Minimally Invasive Surgery,Procedure, Minimal Surgical,Procedures, Minimal Access Surgical,Procedures, Minimal Surgical,Procedures, Minimally Invasive Surgical,Surgical Procedure, Minimal,Surgical Procedures, Minimal,Surgical Procedures, Minimal Access,Minimally Invasive Surgeries,Surgeries, Minimally Invasive,Surgery, Minimally Invasive
D021621 Imaging, Three-Dimensional The process of generating three-dimensional images by electronic, photographic, or other methods. For example, three-dimensional images can be generated by assembling multiple tomographic images with the aid of a computer, while photographic 3-D images (HOLOGRAPHY) can be made by exposing film to the interference pattern created when two laser light sources shine on an object. Computer-Assisted Three-Dimensional Imaging,Imaging, Three-Dimensional, Computer Assisted,3-D Image,3-D Imaging,Computer-Generated 3D Imaging,Three-Dimensional Image,Three-Dimensional Imaging, Computer Generated,3 D Image,3 D Imaging,3-D Images,3-D Imagings,3D Imaging, Computer-Generated,3D Imagings, Computer-Generated,Computer Assisted Three Dimensional Imaging,Computer Generated 3D Imaging,Computer-Assisted Three-Dimensional Imagings,Computer-Generated 3D Imagings,Image, 3-D,Image, Three-Dimensional,Images, 3-D,Images, Three-Dimensional,Imaging, 3-D,Imaging, Computer-Assisted Three-Dimensional,Imaging, Computer-Generated 3D,Imaging, Three Dimensional,Imagings, 3-D,Imagings, Computer-Assisted Three-Dimensional,Imagings, Computer-Generated 3D,Imagings, Three-Dimensional,Three Dimensional Image,Three Dimensional Imaging, Computer Generated,Three-Dimensional Images,Three-Dimensional Imaging,Three-Dimensional Imaging, Computer-Assisted,Three-Dimensional Imagings,Three-Dimensional Imagings, Computer-Assisted

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