{"id":11944,"date":"2024-07-01T10:15:39","date_gmt":"2024-07-01T08:15:39","guid":{"rendered":"https:\/\/zarc4endo.com\/?p=11944"},"modified":"2024-07-01T10:15:39","modified_gmt":"2024-07-01T08:15:39","slug":"caso-clinico-retratamiento-noe-hernandez-excalibur","status":"publish","type":"post","link":"https:\/\/zarc.jevnet.es\/es\/caso-clinico-retratamiento-noe-hernandez-excalibur\/","title":{"rendered":"Caso cl\u00ednico: retratamiento por el Dr. Noe Hern\u00e1ndez instrumentado con Excalibur\u00ae"},"content":{"rendered":"

Retratamiento de un primer molar superior con conducto omitido instrumentado con Excalibur\u00ae y obturado con NeoSealer Flo\u00ae<\/h1>\n

El\u202f doctor No\u00e9 Hern\u00e1ndez \u202f<\/strong>recibe en su cl\u00ednica a un paciente aquejado de dolor agudo en la zona del primer cuadrante. Tras realizar las pruebas diagn\u00f3sticas oportunas, se observa que el diente 16 ha sido tratado previamente y hoy en d\u00eda presenta una\u202fperiodontitis apical aguda, para la cual se debe reintervenir.<\/p>\n

Tras la desobturaci\u00f3n de los conductos, se procede a instrumentar el diente con Excalibur\u00ae<\/strong><\/a> y a encontrar el conducto omitido no tratado en un primer momento para, a continuaci\u00f3n, irrigar profusamente y obturarlo con el nuevo cemento NeoSealer Flo\u00ae<\/strong><\/a> de Zarc con la t\u00e9cnica de cono \u00fanico.<\/p>\n

Diagn\u00f3stico <\/strong><\/h2>\n

A la cl\u00ednica del doctor No\u00e9 Hern\u00e1ndez acude un paciente que presenta dolor agudo en zona del primer cuadrante. Se realizan diferentes pruebas para establecer un diagn\u00f3stico preciso:<\/span>\u00a0<\/span><\/p>\n

    \n
  1. Diente previamente tratado<\/span><\/span><\/li>\n
  2. Prueba de percusi\u00f3n positiva<\/span><\/span><\/span><\/li>\n
  3. Prueba de palpaci\u00f3n positiva<\/span><\/span><\/li>\n
  4. Sondaje fisiol\u00f3gico<\/span>\u00a0<\/span><\/li>\n<\/ol>\n

    El diagn\u00f3stico final es el de una periodontitis apical aguda en diente 16 en un diente que ha sido tratado previamente.<\/span><\/p>\n

     <\/p>\n

    \"noe
    Radiograf\u00eda inicial diagnostica<\/span><\/strong><\/figcaption><\/figure>\n


    \nRetratamiento no quir\u00fargico <\/strong><\/h2>\n

    En casos como este, donde la endodoncia inicial es deficiente, siempre optamos por el retratamiento de conductos o reendodoncia como primera elecci\u00f3n, ya que nos permite ser m\u00e1s conservadores y alargar la vida del diente.\u00a0<\/span>\u00a0<\/span><\/p>\n

    La secuencia endod\u00f3ntica se realiza de la siguiente forma:<\/span>\u00a0<\/span><\/p>\n

      \n
    1. Desobturaci\u00f3n del tercio coronal utilizando una fresa Gates Gliden #2, cuyo calibre en punta es de 70.<\/span><\/span><\/span><\/li>\n
    2. Desobturaci\u00f3n y conformaci\u00f3n del conducto con la\u202f<\/span>lima reciprocante Excalibur\u00ae <\/span><\/a>35.05 de Zarc hasta obtener permeabilidad apical y medici\u00f3n con el LEA.<\/span><\/span><\/span><\/li>\n
    3. B\u00fasqueda del conducto mesiopalatino o MB2, que estaba omitido<\/span>.<\/span><\/span><\/span><\/li>\n
    4. Calibrado apical con Excalibur\u00ae 45.05 de Zarc.<\/span><\/li>\n<\/ol>\n
      \"noe
      Instrumentaci\u00f3n con el sistema Excalibur\u00ae de Zarc<\/span><\/strong><\/figcaption><\/figure>\n


      \nUna vez hemos desobturado e instrumentado los conductos principales correctamente, procedemos a buscar el conducto omitido, que en este caso era el conducto mesiopalatino. Para ello nos servimos de puntas de ultrasonidos, desgastando de forma controlada la dentina hasta encontrarlo.<\/span>\u00a0<\/span><\/p>\n

      En un art\u00edculo publicado por Song y cols. en 2011 en el Journal of endodontics, la omisi\u00f3n de conductos era una de las causas principales de fracaso en endodoncia (20%).<\/span><\/p>\n

       <\/p>\n

      \"conductos
      Conductos localizados e instrumentados<\/span><\/strong><\/figcaption><\/figure>\n


      \nUna vez hemos localizado e instrumentado todos los conductos, pasamos a la fase clave en los retratamientos, la limpieza intraconducto. La irrigaci\u00f3n debe ser profusa, al tratarse de diente previamente tratado con imagen apical. Por ello, se utiliza hipoclorito de sodio al 4\u201925% en tres ciclos de 30 segundos de\u202f<\/span>       activaci\u00f3n ultras\u00f3nica con\u202f Z-Activator\u00ae<\/span><\/b><\/a>. Tambi\u00e9n se utiliza EDTA al 17% durante 30 segundos activado ultras\u00f3nicamente.<\/span>\u00a0<\/span><\/p>\n

      Posteriormente, se realiza una radiograf\u00eda de conometr\u00eda para comprobar el ajuste apical y se procede a obturar.<\/span><\/p>\n

       <\/p>\n

      \"conductos
      Conductos obturados<\/span><\/strong><\/figcaption><\/figure>\n

      \u00a0<\/span><\/p>\n

      Obturaci\u00f3n con biocer\u00e1mico NeoSealer Flo\u00ae de Zarc <\/strong><\/h2>\n

      Para la obturaci\u00f3n se utiliza el nuevo\u202f<\/span>cemento biocer\u00e1mico Neosealer Flo\u00ae de Zarc<\/strong><\/span><\/a>\u202fcon la t\u00e9cnica de cono \u00fanico.<\/span>\u00a0<\/span><\/p>\n

      La <\/span>ventaja principal<\/span><\/b> de estos nuevos cementos es su capacidad de fraguar incluso en condiciones de humedad en el conducto, lo cual ayuda en casos de retratamientos y necrosis pulpar.<\/span>\u00a0<\/span><\/p>\n

      Por \u00faltimo, se realiza la reconstrucci\u00f3n definitiva del caso y la radiograf\u00eda final postoperatoria. Se har\u00e1 revisi\u00f3n del caso en 6 meses para ver evoluci\u00f3n de la lesi\u00f3n apical.<\/span><\/p>\n

       <\/p>\n

      \"radiografias<\/strong><\/h2>\n
      \"radiografias
      Radiograf\u00edas finales del caso<\/strong><\/span><\/figcaption><\/figure>\n

       <\/p>\n","protected":false},"excerpt":{"rendered":"

      El doctor No\u00e9 Hern\u00e1ndez retrata un primer molar con limas Excalibur\u00ae y lo obtura con el cemento NeoSealer Flo\u00ae de Zarc.<\/p>\n","protected":false},"author":1,"featured_media":11945,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[238],"tags":[197,198,199,200,201,190],"class_list":["post-11944","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casos-clinicos","tag-caso-clinico","tag-excalibur-2","tag-neosealer-flo","tag-noe-hernandez","tag-retratamiento","tag-z-activator"],"yoast_head":"\nCaso cl\u00ednico: retratamiento por el Dr. Noe Hern\u00e1ndez instrumentado con Excalibur\u00ae - Zarc<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Caso cl\u00ednico: retratamiento por el Dr. Noe Hern\u00e1ndez instrumentado con Excalibur\u00ae - 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