Hidayat Opik Taofik, Sitam Suhardjo, Irmaleny Irmaleny, Harnowo Setyo, Suridwan Wawan
Doctoral Candidate, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia.
Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia.
Clin Cosmet Investig Dent. 2025 May 14;17:217-223. doi: 10.2147/CCIDE.S516207. eCollection 2025.
Endodontic treatment outcomes may change over time. Factors such as compromised coronal seal and inadequate obturation can lead to canal reinfection and often periapical infection, thus developing into periapical lesions. Biofilm occupying the surface of the root tip can cause failure of conventional endodontic treatment or retreatment. Healing is achievable depending on the success of efforts to eradicate the biofilm layer from the site. Tooth discoloration after a root canal treatment can also be concerning, with several causes and treatment options. One of the minimally invasive aesthetic treatment options for discolored anterior teeth is dental bleaching or direct composite veneers.
A 22-year-old patient experienced pain in the right maxillary lateral and central incisors with a history of trauma at the age of six. Both teeth have undergone root canal treatment at the age of ten years. Clinically, the teeth were discolored with visible old composite restorations. Radiological finding shows radiolucency in the periapical and compromised apical structure. Endodontic retreatment and periapical microsurgery were performed to remove the periapical lesion, followed by internal-external bleaching and direct composite veneer to restore the aesthetics.
The procedure was successful, and a one-year follow-up recall revealed bone regeneration around their apices and esthetic outcomes that satisfied the patient.
The technique described is an excellent approach in conserving the tooth with periapical lesions and compromised apical structure due to root resorption and internally stained teeth.
牙髓治疗的结果可能会随时间而变化。诸如冠部封闭不全和充填不充分等因素可导致根管再感染，且常引发根尖周感染，进而发展为根尖周病变。占据根尖表面的生物膜可导致传统牙髓治疗或再治疗失败。能否愈合取决于从该部位清除生物膜层的努力是否成功。根管治疗后牙齿变色也可能令人担忧，其有多种原因及治疗选择。对于变色前牙，微创美学治疗选择之一是牙齿漂白或直接复合树脂贴面。
一名22岁患者右上颌侧切牙和中切牙疼痛，6岁时有外伤史。两颗牙齿均在10岁时接受了根管治疗。临床上，牙齿变色，可见陈旧的复合树脂修复体。影像学检查显示根尖周有透射区且根尖结构受损。进行了牙髓再治疗和根尖周显微手术以去除根尖周病变，随后进行内外漂白和直接复合树脂贴面以恢复美观。
该手术成功，一年的随访复查显示根尖周围有骨再生，美观效果令患者满意。
所描述的技术是一种保存因根吸收和内部染色而患有根尖周病变且根尖结构受损牙齿的极佳方法。
