Após os excelentes casos apresentados pelos meus amigos eu apresento um caso de um 2.1.
Um central “é fácil” seria a resposta mais esperada, eu responderia depende de caso para caso.
Mas para mim o que este caso tem de interesse é ser um caso de diagnóstico e possivelmente um caso que encontramos na nossa prática clinica diária mais vezes do que aquelas que possamos pensar…
Em retroespectiva:
Paciente sexo masculino,de 30 anos de idade,recorreu à minha consulta pois queria branquear o dente 2.1.
O Dente apresentava uma fractura do bordo incisal aquando de uma queda de skate quando o paciente tinha 10.
O que me deixou logo apreensivo…
Após observar o dente,e antes de indicar que tipo de tratamento iriamos fazer,realizei uma radiografia na qual me deparei com esta imagem…
Ao observar a radiografia reparei que poderia ter um problema maior do que aquele que eu poderia pensar, o dente 2.2 apresentava uma reabsorção apical…Visto este cenário o que tinha eu de fazer???Isto já não era apenas um tratamento de um central….
Exploração Clinica!!!Era a palavra de ordem para chegar a alguma conclusão com o que que deveria fazer
O que obtive foi:
O diagnóstico obtido foi Necrose Pulpar com Periodontite Apical Assintomática no dente 2.1 e Reabsorção Apical do dente 2.2 devido à lesão apical do dente 2.1.
Tratamento: Tratamento Endodôntico Não Cirurgico dente 2.1 e Observação do dente 2.2
E assim foi, iniciei a instrumentação do dente 2.1.
A instrumentação foi realizada com limas mecanizadas Protaper.A sequência foi S1,S2,F1,F2,F3,F4,F5, sendo o calibre alcançado com uma lima K NiTi nº50
O Protocolo de Irrigação final realizado foi, Ácido Citrico 10% 1´, NaOCl 5,25% e Alcool 96º sendo que durante a fase de instrumentação houve uma irrigação abundante cerca de 40 minutos com NaOCl 5,25% aquecido e activado com pontas ultrasónicas.
Utilizei um cone 06 auto-fit calibrado a 50
Obturei com System B e Obtura II
O recall foi realizado após um ano na cidade de BARCELONA, pelo facto do paciente neste momento viver lá.Como é previsivel não foi dificil obter uma radiografia de controlo!!!!!
Pedi a um colega da UIC (Jordi) para o receber na faculdade e foi lá que se fez o Rx…
Também pedi para serem realizados os testes de sensibilidade ao frio no dente 2.2, os quais para meu agrado revelaram que este apresentava vitalidade.
Foi um caso interessante, o que partilho convosco, demonstrando a importância dos testes de exploração clinica.
Abraço a Todos e boas endos…..
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