Moreira Mário A, Silveira Virgínia R, Alcantara Veronica O, Sousa Frederico B, Sousa Bruno C
Dentistry, Ceará Federal University, Sobral, BRA.
Morphology, Paraíba Federal University, João Pessoa, BRA.
Cureus. 2023 Apr 4;15(4):e37106. doi: 10.7759/cureus.37106. eCollection 2023 Apr.
Tooth loss due to fracture and the failure of endodontic treatment (ET) are common situations in teeth with extensive tissue destruction. This is due to the fragility of the remaining dental structure and the difficulty in sealing cavities, which is sometimes associated with the violation of the supracrestal insertion tissue. The previous restoration of marginal ridges or cusps with composite resin (CR) restores their fracture resistance, due to the adhesive characteristics of the restorative material, while also protecting the quality of endodontic treatment through better sealing. However, the protocol adopted in teeth requiring endodontic treatment involves performing the restorative procedure only after the endodontic procedures. The objective of this study was to report a case in which restoration of marginal ridges and/or cusps was performed prior to endodontic treatment, focusing on maintaining the tooth in function without dental fracture. The restoration was performed with an inverted operative sequence before the endodontic treatment. There was a violation of the supracrestal insertion tissue, requiring crown lengthening surgery (CLS) prior to the restorative procedure. Clinical and radiographic evaluations were performed postoperatively at seven days, three, six, and nine months, and five years. Tooth function was maintained without dental fractures or restoration loss. Periradicular space healing occurred with the disappearance of the lesion. Performing the restorative procedure prior to endodontic treatment in teeth with extensive coronal destruction is an alternative technique that facilitates clinical procedures, reduces the likelihood of dental loss due to fracture, and promotes endodontic treatment success.
因折断和牙髓治疗失败导致的牙齿缺失在组织广泛破坏的牙齿中很常见。这是由于剩余牙体结构的脆弱性以及密封窝洞的困难，有时还与龈上附着组织的破坏有关。用复合树脂修复边缘嵴或牙尖可恢复其抗折性，这得益于修复材料的粘结特性，同时通过更好的密封保护牙髓治疗的质量。然而，需要牙髓治疗的牙齿所采用的方案是仅在牙髓治疗程序之后进行修复程序。本研究的目的是报告一例在牙髓治疗之前进行边缘嵴和/或牙尖修复的病例，重点是保持牙齿功能且不发生牙折。在牙髓治疗之前以倒置的手术顺序进行修复。存在龈上附着组织破坏，在修复程序之前需要进行冠延长术。术后分别在7天、3个月、6个月、9个月和5年进行临床和影像学评估。牙齿功能得以维持，未发生牙折或修复体脱落。根尖周间隙愈合，病变消失。对于冠部广泛破坏的牙齿，在牙髓治疗之前进行修复程序是一种替代技术，可简化临床操作，降低因折断导致牙齿缺失的可能性，并提高牙髓治疗的成功率。
