Demonstração do acesso sem a utilização de ampliação, no qual podemos observar quão difícil é visualizar a câmara pulpar e o cálculo pulpar que ali se encontra.
Câmaras calcificadas: problemas e principais desafios
Em endodontia, as câmaras calcificadas podem revelar-se um desafio durante o tratamento.1,2
A visualização das câmaras calcificadas pode revelar-se um desafio, devido à sua natureza estreita e intrincada. Com a visibilidade limitada, é mais difícil localizar com precisão e percorrer os canais no interior da câmara, aumentando o risco de não tratar alguns canais e de fazer um tratamento incompleto.2
Este tipo de câmara pode ter canais constritos ou sinuosos, fazendo com que seja difícil aceder e percorrer o sistema dos canais radiculares. Os espaços estreitos e as obstruções calcificadas constituem um desafio para a limpeza, a modelação e a desinfeção eficaz dos canais.1,3
Lidar com câmaras calcificadas pode prolongar a duração do tratamento e aumentar a complexidade da intervenção. Os dentistas podem ter de utilizar várias técnicas e instrumentos para superar os desafios criados pelas calcificações, o que exige mais competências e conhecimentos.2
Para lidar com estes desafios, os dentistas utilizam ferramentas e técnicas avançadas como microscópios, instrumentos com ultrassons, limas rotativas e auxiliares de ampliação para melhorar a visualização e o acesso e aumentar a precisão. Adicionalmente, a formação contínua e estar a par dos mais recentes avanços em endodontia podem ajudar os dentistas a tratar eficazmente as câmaras calcificadas e a obter um resultado favorável no tratamento.1,2,4
A utilização do microscópio na minha vida profissional tem sido uma excelente ajuda, pois consegui resolver casos complexos que, em várias ocasiões e sem a sua ajuda, poderiam ter levado mais de três consultas. Para além disto, a ampliação também me permitiu levar a cabo o meu trabalho na minha clínica de endodontia sem desenvolver problemas musculoesqueléticos. Optei por começar a utilizar a ampliação na minha clínica de endodontia em 2009 e tem sido um enorme apoio no meu trabalho rotineiro desde então.
Ao lidar com câmaras calcificadas, os microscópios de endodontia proporcionam diversas soluções clínicas
Localização da câmara melhorada: A alta ampliação e iluminação do microscópio permitem localizar a câmara calcificada com precisão. A visualização melhorada ajuda a identificar detalhes anatómicos discretos, sendo mais simples apontar a localização exata da câmara no interior do dente.5,7 Abordagem precisa do canal: A ampliação do microscópio possibilita uma visualização melhorada dos canais estreitos e sinuosos no interior da câmara calcificada. Isto permite que o endodontista aborde os canais com mais precisão, reduzindo o risco de não tratar alguns canais ou de cometer erros na intervenção.6,7 Instrumentação melhorada: O foco preciso e os pequenos do microscópio permitem que os endodontistas realizem uma instrumentação intrincada na câmara calcificada. Isto inclui o acesso e a modelação dos canais, a remoção de calcificações e a preparação do sistema de canais radiculares para desinfeção e obturação.5,7,8 Limpeza e desinfeção completas: A ampliação proporcionada pelo microscópio permite uma vista detalhada das paredes do canal radicular e das complexidades anatómicas intrincadas no interior da câmara calcificada. Isto assegura uma limpeza e desinfeção completas, pois o endodontista pode consegue remover com eficácia resíduos, tecido infetado e bactérias de todo o sistema de canais.7,8 Risco de perfuração reduzido: A elevada ampliação do microscópio ajuda o endodontista a avaliar com precisão a espessura das paredes dentinárias no interior da câmara calcificada. Isto reduz o risco de perfuração durante a instrumentação, pois o operador pode percorrer com precisão os canais sem danificar a estrutura dentária envolvente.6,7,8 Obturação precisa: O microscópio permite uma avaliação e o posicionamento precisos do material de obturação no interior da câmara calcificada. Isto assegura uma selagem ideal do sistema de canais radiculares, o que reduz as probabilidades de complicações pós-tratamento e promove o sucesso a longo prazo.7,8
Com a ajuda das pontas ultrassónicas, começamos por eliminar o cálculo pulpar desde a entrada dos canais identificados previamente, usando 12% de ácido etilenodiaminotetracético (EDTA) para remover o tecido inorgânico e para observar adequadamente as variações na cor do cálculo pulpar e na dentina da câmara pulpar.
Dra. Cynthia Mercado Velazquez, Cidade do México
Abertura de acesso para identificar a câmara calcificada.
Dra. Cynthia Mercado Velazquez, Cidade do México
Identificar a entrada dos canais usando pontas ultrassónicas.
A entrada dos ductos mesiobucal (MB) e distobucal (DB) é observada nas diferentes ampliações 0,4x e 1,0x.
Dra. Cynthia Mercado Velazquez, Cidade do México
Campo de visão com menos ampliação (0,4x).
Dra. Cynthia Mercado Velazquez, Cidade do México
Campo de visão com mais ampliação (1,0x).
Os cálculos pulpares têm uma cor acinzentada em comparação com as paredes amareladas da câmara pulpar. Desta forma, ao distinguir as mudanças na cor na câmara, podemos aprender a eliminar em segurança os cálculos pulpares que aderem à câmara. Sem a ajuda da ampliação, seria muito difícil discernir estas alterações e o EDTA teria de ser utilizado.
Dra. Cynthia Mercado Velazquez, Cidade do México
Identificar os canais MB e DB através da câmara calcificada com uma ampliação de 1,6x.
Subsequentemente, após a eliminação de parte do cálculo pulpar na entrada do canal MB, com a ajuda da ponta ultrassónica podemos observar o pavimento da câmara pulpar com a presença do tecido pulpar. Com o ampliação de 0,4x e 1,0x, podemos ver que as diferentes estruturas localizadas nesta área são adequadamente discerníveis a uma ampliação de 1,0x.
Dra. Cynthia Mercado Velazquez, Cidade do México
Identificar os canais MB e DB através da câmara calcificada com uma ampliação 0,4x.
Dra. Cynthia Mercado Velazquez, Cidade do México
Identificar os canais MB e DB através da câmara calcificada com uma ampliação de 1,0x.
Comparação de duas ampliações de 1,6x e 1,0x, respetivamente, sendo possível observar mais detalhes do pavimento com uma ampliação de 1,6x do que com a ampliação de 1,0x.
Dra. Cynthia Mercado Velazquez, Cidade do México
Identificar o MB 1 com uma ampliação de 1,6x.
Dra. Cynthia Mercado Velazquez, Cidade do México
Identificar o MB 1 com uma ampliação de 1,0x.
Seguindo o caminho onde o pavimento da câmara pulpar já tiver sido localizado, a eliminação do cálculo pulpar prossegue pouco a pouco até que os todos canais molares sejam localizados.
Dra. Cynthia Mercado Velazquez, Cidade do México
Identificar os 4 canais MB completamente após a remoção da calcificação com uma ampliação de 0,6x.
Goga R., et al, Pulp stones: a review, IEJ 41, 457-468, 2008
2
Chaini Kallirroi and Georgopoulou Maria, General pulp calcification: Revisão de bibliografia e relatório de caso ENDO, Lond. Engl. 2016; 10 (2) : 69-75
3
Nupura, Vibhute, Daule, Bansal and Mahalle, J Pat Care 2016, 2:1
4
Moss – Salentijin Letty, Calcified Structures in Human Dental Pulps, JOE , Vol. 14 No. 4 Abril de 1998
5
Wu Daming, et al, The clinical treatment of complicated root canal therapy with the aid of a dental operting microscope, IDJ 2011 ; 61:261-266
6
Iandolo A. Et al, Calcification detection and management in the obliterated endodontic space, JO March 2023 ; 15(1)
7
Carr Gary B., The use of the operating microscope in endodontics, Dent Clin N Am 54 (2010) 191–214
8
Del Fabbro Massimo, Endodontic therapy using magnification devices: A systematic review, Journal of dentistry 38(2010)269 – 275
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![Identificar os canais MB e DB através da câmara calcificada com uma ampliação 0,4x.]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_6.jpg/_jcr_content/renditions/original.image_file.100.75.139,155,1235,979.file/root_canal_treatment_picture_6.jpg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_6.jpg/_jcr_content/renditions/original.image_file.360.270.139,155,1235,979.file/root_canal_treatment_picture_6.jpg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_6.jpg/_jcr_content/renditions/original.image_file.768.576.139,155,1235,979.file/root_canal_treatment_picture_6.jpg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_6.jpg/_jcr_content/renditions/original.image_file.1024.768.139,155,1235,979.file/root_canal_treatment_picture_6.jpg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_6.jpg/_jcr_content/renditions/original.image_file.1096.822.139,155,1235,979.file/root_canal_treatment_picture_6.jpg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_6.jpg/_jcr_content/renditions/original.image_file.1096.822.139,155,1235,979.file/root_canal_treatment_picture_6.jpg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_6.jpg/_jcr_content/renditions/original.image_file.1096.822.139,155,1235,979.file/root_canal_treatment_picture_6.jpg"} "Identificar os canais MB e DB através da câmara calcificada com uma ampliação 0,4x.")
![Identificar os canais MB e DB através da câmara calcificada com uma ampliação de 1,0x]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_7.jpg/_jcr_content/renditions/original.image_file.100.75.161,83,1474,1071.file/root_canal_treatment_picture_7.jpg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_7.jpg/_jcr_content/renditions/original.image_file.360.270.161,83,1474,1071.file/root_canal_treatment_picture_7.jpg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_7.jpg/_jcr_content/renditions/original.image_file.768.576.161,83,1474,1071.file/root_canal_treatment_picture_7.jpg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_7.jpg/_jcr_content/renditions/original.image_file.1024.768.161,83,1474,1071.file/root_canal_treatment_picture_7.jpg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_7.jpg/_jcr_content/renditions/original.image_file.1280.960.161,83,1474,1071.file/root_canal_treatment_picture_7.jpg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_7.jpg/_jcr_content/renditions/original.image_file.1313.985.161,83,1474,1071.file/root_canal_treatment_picture_7.jpg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_7.jpg/_jcr_content/renditions/original.image_file.1313.985.161,83,1474,1071.file/root_canal_treatment_picture_7.jpg"} "Identificar os canais MB e DB através da câmara calcificada com uma ampliação de 1,0x")
![Identificar o MB 1 com uma ampliação de 1,6x.]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_8.jpg/_jcr_content/renditions/original.image_file.100.75.188,36,1388,938.file/root_canal_treatment_picture_8.jpg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_8.jpg/_jcr_content/renditions/original.image_file.360.270.188,36,1388,938.file/root_canal_treatment_picture_8.jpg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_8.jpg/_jcr_content/renditions/original.image_file.768.576.188,36,1388,938.file/root_canal_treatment_picture_8.jpg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_8.jpg/_jcr_content/renditions/original.image_file.1024.768.188,36,1388,938.file/root_canal_treatment_picture_8.jpg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_8.jpg/_jcr_content/renditions/original.image_file.1200.900.188,36,1388,938.file/root_canal_treatment_picture_8.jpg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_8.jpg/_jcr_content/renditions/original.image_file.1200.900.188,36,1388,938.file/root_canal_treatment_picture_8.jpg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_8.jpg/_jcr_content/renditions/original.image_file.1200.900.188,36,1388,938.file/root_canal_treatment_picture_8.jpg"} "Identificar o MB 1 com uma ampliação de 1,6x.")
![Identificar o MB 1 com uma ampliação de 1,0x.]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_9.jpg/_jcr_content/renditions/original.image_file.100.75.343,0,2181,1380.file/root_canal_treatment_picture_9.jpg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_9.jpg/_jcr_content/renditions/original.image_file.360.270.343,0,2181,1380.file/root_canal_treatment_picture_9.jpg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_9.jpg/_jcr_content/renditions/original.image_file.768.576.343,0,2181,1380.file/root_canal_treatment_picture_9.jpg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_9.jpg/_jcr_content/renditions/original.image_file.1024.768.343,0,2181,1380.file/root_canal_treatment_picture_9.jpg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_9.jpg/_jcr_content/renditions/original.image_file.1280.960.343,0,2181,1380.file/root_canal_treatment_picture_9.jpg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_9.jpg/_jcr_content/renditions/original.image_file.1440.1080.343,0,2181,1380.file/root_canal_treatment_picture_9.jpg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_9.jpg/_jcr_content/renditions/original.image_file.1838.1379.343,0,2181,1380.file/root_canal_treatment_picture_9.jpg"} "Identificar o MB 1 com uma ampliação de 1,0x.")
![Identificar os 4 canais MB completamente após a remoção da calcificação com uma ampliação de 0,6x.]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_10.jpg/_jcr_content/renditions/original.image_file.100.75.73,0,1830,1318.file/root_canal_treatment_picture_10.jpg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_10.jpg/_jcr_content/renditions/original.image_file.360.270.73,0,1830,1318.file/root_canal_treatment_picture_10.jpg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_10.jpg/_jcr_content/renditions/original.image_file.768.576.73,0,1830,1318.file/root_canal_treatment_picture_10.jpg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_10.jpg/_jcr_content/renditions/original.image_file.1024.768.73,0,1830,1318.file/root_canal_treatment_picture_10.jpg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_10.jpg/_jcr_content/renditions/original.image_file.1280.960.73,0,1830,1318.file/root_canal_treatment_picture_10.jpg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_10.jpg/_jcr_content/renditions/original.image_file.1440.1080.73,0,1830,1318.file/root_canal_treatment_picture_10.jpg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/root-canal-treatment/root_canal_treatment_picture_10.jpg/_jcr_content/renditions/original.image_file.1757.1318.73,0,1830,1318.file/root_canal_treatment_picture_10.jpg"} "Identificar os 4 canais MB completamente após a remoção da calcificação com uma ampliação de 0,6x.")
![]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/extaro-300-dental/images/extaro-300-related-product.jpg/_jcr_content/renditions/original.image_file.100.100.file/extaro-300-related-product.jpg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/extaro-300-dental/images/extaro-300-related-product.jpg/_jcr_content/renditions/original.image_file.360.360.file/extaro-300-related-product.jpg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/extaro-300-dental/images/extaro-300-related-product.jpg/_jcr_content/renditions/original./extaro-300-related-product.jpg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/extaro-300-dental/images/extaro-300-related-product.jpg/_jcr_content/renditions/original./extaro-300-related-product.jpg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/extaro-300-dental/images/extaro-300-related-product.jpg/_jcr_content/renditions/original./extaro-300-related-product.jpg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/extaro-300-dental/images/extaro-300-related-product.jpg/_jcr_content/renditions/original./extaro-300-related-product.jpg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/extaro-300-dental/images/extaro-300-related-product.jpg/_jcr_content/renditions/original./extaro-300-related-product.jpg"})
![]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/opmi-proergo/images/zeiss-opmi-proergo-dental.jpg/_jcr_content/renditions/original.image_file.100.100.file/zeiss-opmi-proergo-dental.jpg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/opmi-proergo/images/zeiss-opmi-proergo-dental.jpg/_jcr_content/renditions/original.image_file.360.360.file/zeiss-opmi-proergo-dental.jpg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/opmi-proergo/images/zeiss-opmi-proergo-dental.jpg/_jcr_content/renditions/original.image_file.768.768.file/zeiss-opmi-proergo-dental.jpg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/opmi-proergo/images/zeiss-opmi-proergo-dental.jpg/_jcr_content/renditions/original./zeiss-opmi-proergo-dental.jpg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/opmi-proergo/images/zeiss-opmi-proergo-dental.jpg/_jcr_content/renditions/original./zeiss-opmi-proergo-dental.jpg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/opmi-proergo/images/zeiss-opmi-proergo-dental.jpg/_jcr_content/renditions/original./zeiss-opmi-proergo-dental.jpg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/opmi-proergo/images/zeiss-opmi-proergo-dental.jpg/_jcr_content/renditions/original./zeiss-opmi-proergo-dental.jpg"})
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