Medicação intracanal sem trocas periódicas como tratamento de dente avulsionado: relato de caso
DOI:
https://doi.org/10.21270/archi.v7i5.2996Resumo
Posteriormente ao reimplante de dentes avulsionados existe a necessidade da realização do tratamento endodôntico o mais breve possível em casos diagnosticados com necrose pulpar. O protocolo de tratamento de dentes avulsionados envolve o uso de medicação intracanal a base de hidróxido de cálcio, entre sessões, como um fator complementar à redução de micro-organismos, prevenção e estabilização da reabsorção radicular, indução de formação dentinária e reparo dos tecidos periapicais. O objetivo deste trabalho é apresentar e discutir um protocolo de tratamento frente à reabsorção radicular externa causado posteriormente ao reimplante de um dente avulsionado, por meio do uso de uma medicação intracanal sem a necessidade de trocas periódicas. Paciente do gênero masculino, 16 anos de idade, sofreu uma queda seguida de avulsão do dente 21. Relatou que o dente foi mantido em água e reimplantado após 10 minutos, sendo instalada uma contenção flexível, a qual foi removida apenas quando se iniciou o tratamento endodôntico, 9 meses após o trauma. Ao exame radiográfico, observou-se reabsorção radicular externa a nível médio e apical, portanto, foi definido o protocolo terapêutico com o uso de medicação intracanal à base de hidróxido de cálcio, associado ao propilenoglicol e óxido de zinco, a qual foi capaz de permanecer intracanal por um período superior a dois anos e estabilizar a reabsorção radicular externa. Conclui-se que o reimplante dentário associado ao protocolo de tratamento utilizando esta medicação intracanal sem trocas periódicas, possibilitou a manutenção do dente em funcionalidade e estética, e evitou possíveis sequelas psicológicas.Descritores: Avulsão Dentária; Reimplante Dentário; Reabsorção da Raiz; Hidróxido de Cálcio; Óxido de Zinco.
Downloads
Referências
Andreasen JO, Andreasen F, Andersson L. Textbook and color atlas of traumatic injuries to the teeth, 4.ed. Oxford: Blackwell Munksgaard; 2007.
Panzarini SR, Gulinelli JL, Poi WR, Sonoda CK, Pedrini D, Brandini DA. Treatment of root surface in delayed tooth replantation: a review of literature. Dent Traumatol. 2008; 24(3):277-82.
Gopikrishna V, Baweja PS, Venkateshbabu N, Thomas T, Kandaswamy D. Comparison of coconut water, propolis, HBSS, and milk on PDL cell survival. J Endod. 2008; 34(5):587-9.
Gopikrishna V, Thomas T, Kandaswamy D. A quantitative analysis of coconut water: a new storage media for avulsed teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 105(2):61-5.
Grossman LI, Ship II. Survival rate for replanted teeth. Oral Surg Oral Med Oral Pathol. 1970; 29(6):899-906.
Andreasen JO, Andreasen FM. Examination and diagnosis of dental injuries. In: Andreasen JO, Andreasen FM (ed). Textbook and color atlas of traumatic injuries to the teeth. Copenhagen: Mosby; 1994. p.195–217.
Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F et al. Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth. Dent Traumatol. 2007; 23(3):130-6.
Pohl Y, Fillippi A, Kirschner H. Results after replantation of avulsed permanent teeth. II. Periodontal healing and the role of physiologic storage and antiresorptive-regenerative therapy. Dent Traumatol. 2005; 21(2):93-101.
Cardoso Lde C, Poi WR, Panzarini SR, Sonoda CK, Rodrigues Tda S, Manfrin TM. Knowledge of firefighters with special paramedic training of the emergency management of avulsed teeth. Dent Traumatol. 2009; 25(1):58-63.
Andreasen JO, Kristerson L. The effect of extra-alveolar root filling with calcium hydroxide on periodontal healing after replantation of permanent incisors in monkeys. J Endod. 1981;7(8):349-54.
Andreasen JO, Kristerson L. The effect of limited drying or removal of the periodontal ligament. Periodontal healing after replantation of mature permanent incisors in monkeys. Acta Odontol Scand. 1981; 39(1):1-13.
Ashkenazi M, Sarnat H, Keila S. In vitro viability, mitogenicity and clonogenic capacity of periodontal ligament cells after storage in six different media. Endod Dent Traumatol. 1999; 15(4):149-56.
Andersson L, Andreasen JO, Day P, Heithersay G, Trope M, Diangelis AJ et al. International Association of Dental Traumatology. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol. 2012; 28(2):88-96.
Yamashita FC, Previdelli ITS, Pavan NNO, Endo MS. Retrospective study on sequelae in traumatized permanent teeth. Eur J Dent. 2017; 11(3):275-80.
Kling M, Cvek M, Mejare I. Rate and predictability of pulp revascularization in therapeutically reimplanted permanent incisors. Endod Dent Traumatol. 1986; 2(3):83-9.
Flores MT, Andreasen JO, Bakland LK, Feiglin B, Gutmann JL, Oikarinen K et al. International Association of Dental Traumatology. Guidelines for the evaluation and management of traumatic dental injuries. Dent Traumatol. 2001;17(5):193-8.
Trope M. Clinical management of the avulsed tooth: present strategies and future directions. Dent Traumatol. 2002; 18(1):1-11.
Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F. International Association of Dental Traumatology. Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth. Dent Traumatol. 2007 ;23(3):130-6.
American Association of Endodontics. Recommended Guidelines of the American Association of Endodontists for the Treatment of Traumatic Dental Injuries. Chicago; 2013.
Barnett F. The role of endodontics in the treatment of luxated permanent teeth. Dent Traumatol. 2002; 18(2):47-56.
Mohammadi Z, Dummer PM. Properties and applications of calcium hydroxide in endodontics and dental traumatology. Int Endod J. 2011; 44(8):697-730.
Trope M. Clinical management of the avulsed tooth. Dent Clin N Am. 1995; 39(1):93-112.
Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 traumatically avulsed permanent incisors. 2. Factors related to pulpal healing. Endod Dent Traumatol. 1995; 112):59-68.
Negri MR, Panzarini SR, Poi WR, Sonoda CK, Gulinelli JR, Saito CT. Analysis of the healing process in delayed tooth replantation after root canal filling with calcium hydroxide, Sealapex and Endofill: a microscopic study in rats. Dent Traumatol. 2008; 24(6):645-50.
Soares AJ, Nagata JY, Casarin RCV, Almeida JFA, Gomes BPFA, Zaia AA et al. Apexification with a new intra-canal medicament: a multidisciplinary case report. Iran Endod J. 2012; 7(3):165-70.
Soares AJ, Lima TFR, Nagata JY, Gomes BP, Zaia AA, de Souza-Filho FJ. Intracanal dressing paste by calcium hydroxide, chlorhexidine and zinc oxide for the treatment of immature and mature traumatized teeth. Braz J Oral Sci. 2014; 13(1):6-11.
Buck CLBP, Soares AJ, Buck A, Nagata JY, Zaia AA, Souza-Filho FJ. Avaliação de dentes reimplantados submetidos a um novo protocolo terapêutico. Rev Assoc Paul Cir Dent. 2012; 66(3):200-5.
Soares AJ, Souza-Filho FJ. Traumatized teeth submitted to a new intracanal medication protocol. Braz J Dent Traumatol. 2011; 2(2):1-5.
Soares AJ, Prado M, Lima TFR, Zaia AA, Souza-Filho FJ. The multidisciplinary management of avulsed teeth: a case report. Iran Endod J. 2012; 7(4):203-6.
Soares AJ, Lima TFR, Lins FF, Herrera DR, Gomes BPFA, de Souza- Filho FJ. Un nuevo protocolo de medicación intraconducto para dientes com necrosis pulpar y rizogénesis incompleta. Rev Estomatol Herediana. 2011; 21(3):145-9.
Poi WR, Sonoda CK, Martins CM, Melo ME, Pellizzer EP, de Mendonça MR, Panzarini SR. Storage media for avulsed teeth: A literature review. Brazilian Dental Journal. 2013;24(5):437-45.
Goswami M, Chaitra TR, Chaudhary S, Manuja N, Sinha A. Strategies for periodontal ligament cell viability: an overview. J Conserv Dent. 2011;14(3):215-20.
Malhotra N. Current developments in interim transport (storage) media in dentistry: an update. Br Dent J. 2011; 211(1):29-33.
Thomas T, Gopikrishna V, Kandaswamy D. Comparative evaluation of maintenance of cell viability of an experimental transport media “coconut water” with Hank’s balanced salt solution and milk, for transportation of an avulsed tooth: an in vitro cell culture study. J Conserv Dent. 2008; 11(1):22-9.
Souza BDM, Bortoluzzi EA, Teixeira CS, Felippe WT, Simões CMO, Felippe MCS. Effect of HBSS storage time on human periodontal ligament fibroblast viability. Dent Traumatol. 2010; 26(6):481-3.
Souza BDM, Luckemeyer DD, Felippe WT, Simões CMO, Felippe MCS. Effect of temperature and storage media on human periodontal ligament fibroblast viability. Dent Traumatol. 2010; 26(3):271-5.
Hwang JY, Choi SC, Park JH, Kang SW. The use of green tea extract as a storage medium for the avulsed tooth. J Endod. 201; 37(7):962-7.
Estrela C, Holland R. Calcium hydroxide: study based on scientific evidences. J Appl Oral Sci. 2003; 11(4):269-82.
Lopes HP, Estrela C, Siqueira JF Jr. Treatment of teeth with incomplete rhizogenesis. In: Berger CA, editor. Endodontia. São Paulo: Pancast; 1998.
Grover C, Shetty N. Evaluation of calcium ion release and change in pH on combining calcium hydroxide with different vehicles. Contemp Clin Dent. 2014; 5(4):434-9.
Soares AJ, Prado M, Brazão MA, Gomes BPFA, Zaia AA. The biocompatibility of a new endodontic paste used in dental trauma. Rev Odontol UNESP. 2015; 44(4):232-8.
Souza-Filho FJ, Soares AJ, Vianna ME, Zaia AA, Ferraz CC, Gomes BP. Antimicrobial effect and pH of chlorhexidine gel and calcium hydroxide alone and associated with other materials. Braz Dent J. 2008; 19(1):28-33.
