Department of Endodontics, Faculty of Dentistry, Estácio de Sá University, Rio de Janeiro, Brazil.
J Endod. 2011 Aug;37(8):1171-5. doi: 10.1016/j.joen.2011.05.025.
This article describes a case of late failure after endodontic retreatment as characterized by recurrent post-treatment apical periodontitis.
At the time of the initial treatment, the patient presented with acute apical abscess associated with a tooth with pulp necrosis caused by trauma. Four years later, the tooth was retreated because of persistent disease. The follow-up examination 28 months after retreatment showed complete healing.
The patient returned 11 years and 7 months later for bleaching of the discolored tooth, and although the periodontal tissues were clinically and radiographically normal, a fracture line was observed on the mesial aspect of the pulp chamber. Extraction was indicated, but the patient only returned 5 years and 9 months later. Then a radiograph showed recurrent post-treatment apical periodontitis. The tooth was extracted, and histopathologic and histobacteriologic analyses revealed bacterial colonies along the fracture line and colonizing ramifications and accessory canals at the apical root canal system.
Coronal leakage can be regarded as the most reasonable explanation for resurgence of the disease. However, a predisposing overlapping condition in the form of root fracture conceivably favored the penetration of bacteria from saliva and plaque biofilm along the filled root canal.
本文描述了一例根管再治疗后晚期失败的病例，其特征为治疗后根尖周炎复发。
在初次治疗时，患者因外伤导致牙髓坏死并发急性根尖脓肿。4 年后，该牙因持续性疾病而被再治疗。再治疗后 28 个月的随访检查显示完全愈合。
患者 11 年 7 个月后因变色牙漂白而返回，尽管牙周组织临床和影像学均正常，但在牙髓室近中侧观察到一条骨折线。建议拔牙，但患者仅在 5 年 9 个月后返回。随后的 X 线片显示治疗后根尖周炎复发。该牙被拔出，组织病理学和组织细菌学分析显示，细菌沿着骨折线以及根尖根管系统的分枝和副根管形成菌落。
冠方渗漏可被视为疾病复发的最合理解释。然而，根折这种潜在重叠的情况可能有利于细菌从唾液和牙菌斑生物膜沿着填充的根管渗透。
