Ortodontik Mini Vida Tedavisi Sebebiyle Gelişen Periapikal Lezyon: Vaka Sunumu

Öz

Ortodontik mini vidalar, stabil ankraj sağlayabilmeleri nedeniyle ortodontik tedavilerde yaygın olarak kullanılan materyallerdir. Bununla birlikte, kök apeksine yakın yerleştirildiklerinde pulpal hasar, perforasyon, kök rezorpsiyonu ve periapikal irritasyon gibi komplikasyonlara neden olabilirler. Bu olgu sunumu, ortodontik tedavi sırasında mandibular sağ kanin dişin kök apeksine yakın yerleştirilen mini vida sonucu gelişen periapikal lezyonun cerrahi olmayan endodontik tedavisini sunmaktadır. Ayrıntılı anamnez, klinik ve radyolojik muayenede periapikal bölgede bir sinüs traktı ve radyolusent bir alan saptanmıştır. Tüm tedavi seçenekleri hastaya açıklandıktan sonra rutin bir kök kanal tedavisi planlanmıştır. Takip sürecinde sinüs traktı iyileşmiş ve lezyonun radyografik iyileşmesi 48. ayda tamamen belirgin hale gelmiştir. Bu olgu sunumu, ortodontik tedavi sırasında kök apeksine yakın yerleştirilen mini vidaların komplikasyonlara yol açabileceğini, ancak bu problemlerin konservatif endodontik tekniklerle etkili bir şekilde çözülebileceğini göstermektedir.

Anahtar Kelimeler

• ortodontik ankraj teknikleri
• ortodontik diş hareketi
• kök kanal tedavisi
• periapikal hastalık

Endodontic Management of a Periapical Lesion Induced by an Orthodontic Mini-Screw: A Case Report

Öz

Orthodontic mini-screws are commonly used materials in orthodontic treatment because they can provide stable anchorage. Nevertheless, if placed close to the root apex, they can cause complications including pulpal injury, perforation, root resorption, and periapical irritation. This case study presents the non-surgical endodontic treatment of a periapical lesion that developed as a result of mini-screw placement near the root apex of a mandibular right canine during orthodontic therapy. Thorough anamnesis, clinical, and radiological examinations revealed a sinus tract and a radiolucent area in the periapical region. A routine root canal treatment was planned after all treatment modalities were explained to the patient. The sinus tract healed during follow-up, and complete radiographic healing of the lesion was apparent at 48 months. This case report demonstrates that mini-screws placed near the root apex during orthodontic treatment can cause complications, but these issues can be resolved effectively with conservative endodontic techniques.

Anahtar Kelimeler

• Orthodontic anchorage procedure
• orthodontic tooth movement
• periapical disease
• root canal therapy

Kaynakça

1. Lam R, Goonewardene MS, Allan BP, Sugawara J. Success rates of a skeletal anchorage system in orthodontics: a retrospective analysis. Angle Orthod. 2018;88(1):27-34.
2. Inchingolo AM, Malcangi G, Costa S, et al. Tooth complications after orthodontic miniscrews insertion. Int J Environ Res Public Health. 2023;20(2):1562.
3. Andreasen JO, Andreasen FM. Resorption and ankylosis of teeth after replantation. In: Andreasen JO, Andreasen FM, Andersson L, eds. Textbook and Color Atlas of Traumatic Injuries to the Teeth. 4th ed. Oxford: Blackwell Munksgaard; 2007: p: 444-80.
4. Love Rm, Firth N. Histopathological profile of surgically removed persistent periapical radiolucent lesions. Int Endod J. 2009;42(3):198-202.
5. Brudvik P, Rygh P. Root resorption beneath the main hyalinized zone. Eur J Orthod. 1994;16(4):249-263.
6. Chang PE, Kim E, Jang W, Cho HY, Choi YJ. Spontaneous repair of iatrogenic root perforation by an orthodontic miniscrew. J Am Dent Assoc. 2021;152(3):234-39.
7. Park HS, Lee SK, Kwon OW. Group distal movement of teeth using microscrew implant anchorage. Angle Orthod.2005;75(4):602-9.
8. Patel S, Dawood A, Ford TP, Whaites E. The potential applications of cone beam computed tomography in the management of endodontic problems. Int Endod J. 2007;40(10):818-30.

9. Siqueira JF Jr. Aetiology of root canal treatment failure: why well-treated teeth can fail. Int Endod J. 2001;34(1):1-10.
10. Haapasalo M, Shen Y, Qian W, Gao Y. Irrigation in endodontics. Dent Clin North Am. 2010;54(2):291-312.
11. Mohammadi Z, Dummer PMH. Properties and applications of calcium hydroxide in endodontics and dental traumatology. Int Endod J. 2011;44(8):697-730.
12. Estrela C, Holland R, Estrela CR, Alencar AH, Sousa-Neto MD, Pécora JD. Characterization of successful root canal treatment. Braz Dent J. 2014;25(1):3-11.
13. Siqueira JF Jr, Rôças IN. Clinical implications and microbiology of bacterial persistence after treatment procedures. J Endod. 2008;34(11):1291-1301.e3.
14. Gomes BPFA, Ferraz CCR, Vianna ME, et al. In vitro antimicrobial activity of calcium hydroxide pastes and their vehicles against selected microorganisms. Braz Dent J. 2002;13 (3):155-61.
15. Boukpessi T, Cottreel L, Galler KM. External Inflammatory Root Resorption in Traumatized Immature Incisors: MTA Plug or Revitalization? A Case Series. Children (Basel). 2023;10(7):1236.
16. Eskandari F, Sahebi S, Ghorbani Jahandizi N, Mofidi H. Endodontic management of internal replacement resorption of two maxillary central incisors with the aid of cone-beam computed tomography as the diagnostic tool: a case report and review of literature. J Med Case Rep. 2025;19(1):200.
17. Chen Y, Liu D. Morphologic evaluation of root resorption after miniscrew assisted en mass retraction in adult bialveolar protrusion patients. Head Face Med. 2020;16(1):16.
18. Heboyan A, Avetisyan A, Karobari MI, et al. Tooth root resorption: a review. Sci Prog. 2022;105:368504221109217.
19. Peters OA. Current challenges and concepts in the preparation of root canal systems: a review. J Endod. 2004;30(8):559-567.
20. Torabinejad M, Handysides R, Khademi AA, Bakland LK. Clinical implications of the smear layer in endodontics: a review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94(6):658-666.
21. Zehnder M. Root canal irrigants. J Endod. 2006;32(5):389-398.
22. Siqueira JF Jr, Lopes HP. Mechanisms of antimicrobial activity of calcium hydroxide: a critical review. Int Endod J. 1999;32(5):361-9.
23. Alghamdi F, Alkhattab O. Effectiveness of intracanal calcium hydroxide medicament in treating periapical lesions: a systematic review. J Stomal. 2022;75(1):44-54.
24. Dinger E, Bodrumlu E. Endodontic treatment of teeth with periapical lesions: Case series. TEJ. 2024;9(1):64-70.
25. Schäfer E, Zandbiglari T. Solubility of root-canal sealers in water and artificial saliva. Int Endod J. 2003;36(10):660-669.
26. McMichen FR, Pearson G, Rahbaran S, Gulabivala K. A comparative study of selected physical properties of five root-canal sealers. Int Endod J. 2003;36(9):629-635.
27. Vinola SM, Mahalaxmi S. Characterisation and evaluation of physical properties of AH-Plus sealer with and without the incorporation of petasin, pachymic acid, curcumin and shilajit-an invitro study. BMC Oral Health. 2024;24(1):352.
28. Souza LC, Neves GST, Kirkpatrick T, Letra A, Silva R. Physicochemical and Biological Properties of AH Plus Bioceramic. J Endod. 2023;49(1):69-76.
29. Wahbi E, Achour H, Alsayed Tolibah Y. Comparison between AH plus sealer and total fill bioceramic sealer performance in previously untreated and retreatment cases of maxillary incisors with large-sized periapical lesion: a randomized controlled trial. BDJ Open. 2024;10(1):73.
30. Inada RNH, Silva ECA, Lopes CS, et al. Biocompatibility, bioactivity, porosity, and sealer/dentin interface of bioceramic ready-touse sealers using a dentin-tube model. Sci Rep. 2024;14(1):16768.
31. Komabayashi T, Colmenar D, Cvach N, Bhat A, Primus C, Imai Y. Comprehensive review of current endodontic sealers. Dent Mater J. 2020;39(5):703-720.
32. Kamacı Esen A, Kalabalık F. Clinical outcome of root canal obturation using different based sealers: a retrospective cohort study. BMC Oral Health. 2024;24(1):1561.
33. Alharbi F, Almuzian M, Bearn D. Miniscrews failure rate in orthodontics: systematic review and meta-analysis. Eur J Orthod. 2018;40(5):519- 530.
34. Jang M, Yu SK, Lim SH, Jih MK, Jeong S. Radiologic study of the distance between the maxillary central incisor root and the incisive canal according to skeletal malocclusion classification. Sci Rep. 2024;14(1):16875.
35. Lo Giudice A, Rustico L, Longo M, Oteri G, Papadopoulos MA, Nucera R. Complications reported with the use of orthodontic miniscrews: a systematic review. Korean J Orthod. 2021;51(3):199-216.
36. Lim G, Kim KD, Park W, Jung BY, Pang NS. Endodontic and surgical treatment of root damage caused by orthodontic miniscrew placement. J Endod. 2013;39(8):1073-7.