Souza Ronaldo Araújo, Silva-Sousa Yara T Corrêa, Colombo Suely, Lago Maurício, Duarte Marco Antonio Hungaro, Pécora Jesus Djalma
Graduate Department, Dental School, University of Ribeirão Preto, SP, Brazil.
Braz Dent J. 2012;23(5):608-11. doi: 10.1590/s0103-64402012000500024.
Besides the risk of filling material extrusion throughout the apex, a satisfactory apical seal can be difficult to achieve in canals with open apices or iatrogenic enlargements of the apical constriction. These situations pose a challenge to root canal filling. This paper describes the root canal filling of a maxillary right canine with an overinstrumented apex, complete loss of the apical stop, extensive canal transportation and apical periodontitis. A 5 mm calcium hydroxide apical plug was placed before root canal filling. The plug was made by soaking paper points with saline, dipping the points in calcium hydroxide powder and then applying it to the apex several times, until a consistent apical plug was obtained. The canal was then irrigated with saline in order to remove any residual calcium hydroxide from the root canal walls, dried with paper points and obturated with an inverted #80 gutta-percha cone and zinc oxide-eugenol based sealer by the lateral condensation technique. An 8-year radiographic follow-up showed formation of mineralized tissue sealing the apical foramen, apical remodeling and no signs of apical periodontitis.
除了存在充填材料通过根尖孔穿出的风险外，在根尖孔开放或医源性扩大根尖狭窄的根管中，很难实现满意的根尖封闭。这些情况对根管充填构成挑战。本文描述了一例上颌右侧尖牙根管充填病例，该患牙存在过度预备的根尖、根尖止点完全丧失、广泛的根管偏移以及根尖周炎。在根管充填前放置了一个5毫米的氢氧化钙根尖屏障。该屏障的制作方法是：将纸尖浸泡在盐水中，然后蘸取氢氧化钙粉末，再多次将其涂抹于根尖，直至获得均匀一致的根尖屏障。然后用盐水冲洗根管，以去除根管壁上残留的氢氧化钙，用纸巾吸干，并用侧向加压技术，用倒锥度80号牙胶尖和氧化锌丁香油类封闭剂进行充填。8年的影像学随访显示，根尖孔有矿化组织形成以封闭根尖孔，根尖区有重塑现象，且无根尖周炎迹象。
