Miranda Candeiro George Táccio, Parente Viana Francisca Lívia, Camelo Paiva Hermano, Luiz Caldeira Celso, Faga Iglecias Elaine, Gavini Giulio
Post-graduation Program Dental Sciences, University Center Christus, Fortaleza, Ceará, Brazil.
Post-graduation Program in Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil.
Iran Endod J. 2019 Summer;14(3):235-239. doi: 10.22037/iej.v14i3.24911.
The failures in endodontic treatments are often related to anatomical variations. Some anatomical changes in anterior teeth occur in patients with cleft lip and palate. This paper aims to report the endodontic retreatment of a maxillary central incisor with two roots and two canals on a patient who presents cleft lip and palate. A male patient, 11-year-old, reported pain when chewing related to the left maxillary central incisor tooth (tooth 21) which featured a sinus tract after primary endodontic treatment. In periapical radiograph, it was observed an alteration on the anatomy of the root on the tooth 21, which featured a radiolucent area on the dental apex and had been properly endodontically treated. In cone-beam computed tomography (CBCT) images the presence of an accessory root in the palatal region was observed, that had not been prepared, or filled. Thus, the non-treated accessory canal was instrumented with the crown-down technique and filled with gutta-percha and endodontic sealer. After 1 year of follow-up, the patient presented the tooth with a normal masticatory function and no painful symptoms. Therefore, it can be concluded that the additional root canals may be present and the CBCT is an important tool to evaluate the internal root morphology. In cleft lip and palate patients, the root canals morphology should be carefully analyzed due to high prevalence of dental anomalies which may influence the success in endodontic treatment.
牙髓治疗失败往往与解剖变异有关。唇腭裂患者的前牙会出现一些解剖结构变化。本文旨在报告一例唇腭裂患者上颌中切牙双根双管的牙髓再治疗情况。一名11岁男性患者，自述左侧上颌中切牙（21号牙）咀嚼时疼痛，该牙在首次牙髓治疗后出现了窦道。根尖片显示21号牙根的解剖结构有改变，根尖区有透射影，且已进行了适当的牙髓治疗。在锥形束计算机断层扫描（CBCT）图像中，观察到腭侧区域存在一个未预备和充填的副根管。因此，采用逐步深入技术对未处理的副根管进行预备，并充填牙胶和根管封闭剂。随访1年后，患者该牙咀嚼功能正常，无疼痛症状。因此，可以得出结论，可能存在额外的根管，CBCT是评估牙根内部形态的重要工具。在唇腭裂患者中，由于牙齿异常的发生率较高，可能会影响牙髓治疗的成功率，因此应仔细分析根管形态。
