Desafios do retratamento endodôntico complexo

relato de caso clínico com acompanhamento de 2 anos

Abstract

Endodontic retreatment itself represents a challenge for the clinician, as all aspects of the primary treatment must be understood and mastered, in addition to the new difficulties created by the initial intervention. The aim of this study is to report a clinical case of endodontic retreatment and the different challenges associated with it. The patient presented for a general evaluation, during which radiographic examination revealed a periapical lesion associated with tooth 47, previously subjected to root canal treatment. The metallic crown and core were removed, exposing the mesial canals, followed by the removal of the fiberglass post using ultrasonic tips under magnification. Retreatment of the mesial canals was performed using the Reciproc R25 system followed by R40, while the distal canal was prepared with hand files and instrumented up to a size 80 Kerr file. An accessory M cone, calibrated to size 80 was selected, thermoplasticized only in its last millimeter, and inserted into the canal. The mesial canals were obturated using the single-cone technique with R40 cones. A two-year follow-up was conducted, during which the patient remained asymptomatic, and complete regression of the lesion was observed. It is concluded that the challenges of endodontic retreatment may be diverse; however, technological advancements and biologically-based knowledge applied in clinical practice enable clinicians to overcome them. In this case, the challenges were related to fiberglass post removal, disinfection, and apical resorption, associated with difficulties in cone anchorage during obturation. This case highlights how the integration of diagnosis, technology, and bioactive materials can lead to the preservation of the tooth, the main objective of modern evidence-based endodontics.