Parirokh Masoud, Hatami Nima
Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran.
Iran Endod J. 2022 Summer;17(3):156-160. doi: 10.22037/iej.v17i3.37496.
Connective tissues in lateral canals mostly remain vital even after pulp necrosis of the main canals. However, lateral canals may become necrotic following the pulp necrosis of the main root canal or after root canal therapy. This case report presents a maxillary central incisor with a necrotic lateral canal and a sinus tract that initially showed healing following the primary endodontic treatment but showed infection after fiber-post placement and permanent restoration with composite resin. Tracing the sinus tract did not reveal the reason for the infection; however, cone beam computed tomography (CBCT) confirmed a lateral radiolucency of the maxillary right central incisor as the only reason for the return of the infection. A conservative re-treatment approach was performed, replacing the fiber post with gutta-percha and root canal sealer. Successful outcome was achieved with a conservative approach; however, it took some time for the sinus tract to heal. In the case of lateral canal infection, sealing the main root canal space could heal the lesion even without lateral canal negotiation. If the main root canal seal is disturbed, re-cleaning and obturating the main root canal could be successful.
即使主根管发生牙髓坏死，侧支根管内的结缔组织大多仍保持活力。然而，在主根管牙髓坏死或根管治疗后，侧支根管可能会发生坏死。本病例报告介绍了一例上颌中切牙，其侧支根管坏死并伴有窦道，该患牙在初次根管治疗后最初显示愈合，但在纤维桩置入及复合树脂永久修复后出现感染。追踪窦道未发现感染原因；然而，锥形束计算机断层扫描（CBCT）证实上颌右中切牙的侧方透射影是感染复发的唯一原因。采用了保守的再治疗方法，用牙胶和根管封闭剂替换纤维桩。通过保守方法取得了成功；然而，窦道愈合需要一些时间。对于侧支根管感染，即使不处理侧支根管，封闭主根管空间也可使病变愈合。如果主根管封闭受到干扰，再次清理和充填主根管可能会成功。
