Terapia fotodinâmica antimicrobiana no tratamento de periodontite apical assintomática em pré-molares com variação anatômica – relato de caso clínico

Abstract

INTRODUCTION: Periradicular lesions can be symptomatic or asymptomatic, causing extensive bone resorption when extensive. Endodontic treatment consists of treating or preventing the development of periradicular lesions. To achieve a positive result, it is extremely important to know the internal root anatomy, not eliminating the chances of anatomical variations. Associated with this procedure is the use of antimicrobial photodynamic therapy (aPDT), in which the photosensitizer is activated by laser light, damaging the cellular components of the microorganisms, promoting a good optimization of disinfection. OBJECTIVES: To report a clinical case of endodontic treatment resulting from an extensive periapical lesion, using intracanal medication, antimicrobial photodynamic therapy and other adjuvant therapies to the treatment. METHODOLOGY: This is a patient who underwent endodontic treatment in the lower premolars on the left side (teeth 34 and 35), with a diagnosis of asymptomatic apical periodontitis. This diagnosis was confirmed after performing a three-dimensional imaging exam, Cone Beam Computed Tomography (CBCT). The treatment was carried out in multiple sessions, using additional means of disinfection with intracanal medication, agitation of the irrigating solution and application of aPDT. RESULTS: Two months after the first consultation, the beginning of regression of the extensive periapical lesion was observed, associated with the success of circumventing the unexpected condition of root anatomical variation that influenced the course of endodontic treatment. 12 months after starting treatment and 7 months after obturation, a significant reduction of 45,2% of the lesion was observed by cross-sectional CBCT. Finally, 17 months after the start of treatment and 12 months after filling, the last CBCT was performed, proving the reduction of the lesion by 49,7% in a cross-sectional view. CONCLUSION: Additional sanitization techniques associated with intracanal medication changes are very efficient in cases of extensive periradicular injury. Thus, endodontic treatment, when performed respecting the prognosis and anatomical variations, has a high success rate after proper follow-up.