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Abordagem endodôntica em dentes com anatomia complexa: revisão integrativa
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A anatomia complexa do sistema de canais radiculares constitui um dos principais desafios da endodontia contemporânea, uma vez que a presença de canais curvos, acessórios, calcificados ou com ramificações atípicas dificulta significativamente o diagnóstico, a instrumentação, a irrigação e a obturação, aumentando o risco de insucessos clínicos. Esta revisão integrativa teve como objetivo analisar criticamente as evidências científicas publicadas entre 2015 e 2025 sobre a abordagem endodôntica de dentes com anatomia radicular complexa. A pesquisa foi conduzida na base PubMed, com a utilização de descritores combinados por operadores booleanos, e incluiu estudos primários, clínicos e laboratoriais, que abordassem diretamente as implicações anatómicas no tratamento endodôntico. As evidências foram organizadas em seis categorias temáticas: diagnóstico por imagem, instrumentação, irrigação, estratégias antimicrobianas, tecnologias inovadoras e o papel dos biofilmes. No diagnóstico, destacou-se o papel fundamental da tomografia computorizada de feixe cónico (CBCT) e da microtomografia computadorizada (micro-CT) no mapeamento tridimensional da morfologia radicular, permitindo a identificação precisa de canais acessórios, fusões e curvaturas. No que diz respeito à instrumentação, sistemas mecanizados de níquel-titânio (NiTi), especialmente os com tratamento térmico e memória controlada, mostraram-se eficazes na conformação de canais curvos com menor risco de transporte ou fratura. A irrigação, por sua vez, revelou melhores resultados com a irrigação ultrassónica passiva (PUI), que melhora a penetração dos irrigantes em regiões de difícil acesso, como canais laterais e ismos, sendo ainda mais eficaz quando associada a agentes quelantes ou ativação fotoacústica. Quanto às estratégias antimicrobianas, verificou-se o crescente interesse na incorporação de nanopartículas metálicas (como prata, cobre e óxido de zinco) a materiais obturadores e medicações intracanais, com resultados promissores no combate a microrganismos resistentes como o Enterococcus faecalis. No campo das tecnologias inovadoras, destacou-se a endodontia guiada, que permite o acesso preciso a canais calcificados através de guias baseadas em imagens CBCT e modelos impressos em 3D, além do surgimento de métodos como a navegação dinâmica e a utilização de laser no preparo biomecânico. A persistência de infecções devido à presença de biofilmes radiculares reforça a necessidade de abordagens terapêuticas combinadas, visto que os biofilmes oferecem alta resistência à irrigação convencional e requerem estratégias de desorganização mecânica e química complementares. Assim, conclui-se que o êxito no tratamento de dentes com anatomia radicular complexa depende da integração entre diagnóstico avançado por imagem, instrumentação mecanizada adaptada, irrigação ativada, controle eficaz do biofilme e a incorporação de inovações tecnológicas e materiais bioativos, constituindo uma abordagem multidimensional e fundamentada em evidência científica atualizada.
The complex anatomy of the root canal system represents one of the main challenges in contemporary endodontics, as the presence of curved, accessory, calcified canals or those with atypical ramifications significantly complicates diagnosis, instrumentation, irrigation, and obturation, increasing the risk of clinical failure. This integrative review aimed to critically analyze the scientific evidence published between 2015 and 2025 regarding the endodontic management of teeth with complex root canal anatomy. The research was conducted using the PubMed database, employing descriptors combined with Boolean operators, and included primary studies—both clinical and laboratorybased—that directly addressed the anatomical implications for endodontic treatment. The evidence was organized into six thematic categories: imaging diagnosis, instrumentation, irrigation, antimicrobial strategies, innovative technologies, and the role of biofilms. In terms of diagnosis, cone-beam computed tomography (CBCT) and micro-computed tomography (micro-CT) stood out as essential tools for three-dimensional mapping of root morphology, enabling precise identification of accessory canals, fusions, and curvatures. Regarding instrumentation, nickel-titanium (NiTi) mechanized systems— especially those with heat treatment and controlled memory—proved effective in shaping curved canals with reduced risk of transportation or instrument fracture. Irrigation showed better results with passive ultrasonic irrigation (PUI), which enhances the penetration of irrigants into hard-to-reach areas such as lateral canals and isthmuses, and was even more effective when combined with chelating agents or photoacoustic activation. As for antimicrobial strategies, there has been growing interest in incorporating metallic nanoparticles (such as silver, copper, and zinc oxide) into obturation materials and intracanal medications, with promising results in combating resistant microorganisms like Enterococcus faecalis. In the field of innovative technologies, guided endodontics emerged as a key advancement, allowing precise access to calcified canals through guides based on CBCT images and 3D-printed models, alongside the development of techniques such as dynamic navigation and the use of lasers in biomechanical preparation. The persistence of infections due to the presence of root canal biofilms reinforces the need for combined therapeutic approaches, as biofilms are highly resistant to conventional irrigation and require complementary mechanical and chemical disorganization strategies. Therefore, it is concluded that the success of treating teeth with complex root canal anatomy depends on the integration of advanced imaging diagnosis, adapted mechanized instrumentation, activated irrigation, effective biofilm control, and the incorporation of technological innovations and bioactive materials— constituting a multidimensional approach grounded in up-to-date scientific evidence.
The complex anatomy of the root canal system represents one of the main challenges in contemporary endodontics, as the presence of curved, accessory, calcified canals or those with atypical ramifications significantly complicates diagnosis, instrumentation, irrigation, and obturation, increasing the risk of clinical failure. This integrative review aimed to critically analyze the scientific evidence published between 2015 and 2025 regarding the endodontic management of teeth with complex root canal anatomy. The research was conducted using the PubMed database, employing descriptors combined with Boolean operators, and included primary studies—both clinical and laboratorybased—that directly addressed the anatomical implications for endodontic treatment. The evidence was organized into six thematic categories: imaging diagnosis, instrumentation, irrigation, antimicrobial strategies, innovative technologies, and the role of biofilms. In terms of diagnosis, cone-beam computed tomography (CBCT) and micro-computed tomography (micro-CT) stood out as essential tools for three-dimensional mapping of root morphology, enabling precise identification of accessory canals, fusions, and curvatures. Regarding instrumentation, nickel-titanium (NiTi) mechanized systems— especially those with heat treatment and controlled memory—proved effective in shaping curved canals with reduced risk of transportation or instrument fracture. Irrigation showed better results with passive ultrasonic irrigation (PUI), which enhances the penetration of irrigants into hard-to-reach areas such as lateral canals and isthmuses, and was even more effective when combined with chelating agents or photoacoustic activation. As for antimicrobial strategies, there has been growing interest in incorporating metallic nanoparticles (such as silver, copper, and zinc oxide) into obturation materials and intracanal medications, with promising results in combating resistant microorganisms like Enterococcus faecalis. In the field of innovative technologies, guided endodontics emerged as a key advancement, allowing precise access to calcified canals through guides based on CBCT images and 3D-printed models, alongside the development of techniques such as dynamic navigation and the use of lasers in biomechanical preparation. The persistence of infections due to the presence of root canal biofilms reinforces the need for combined therapeutic approaches, as biofilms are highly resistant to conventional irrigation and require complementary mechanical and chemical disorganization strategies. Therefore, it is concluded that the success of treating teeth with complex root canal anatomy depends on the integration of advanced imaging diagnosis, adapted mechanized instrumentation, activated irrigation, effective biofilm control, and the incorporation of technological innovations and bioactive materials— constituting a multidimensional approach grounded in up-to-date scientific evidence.
Descrição
Palavras-chave
Anatomia dos canais radiculares CBCT Biofilme Irrigação Tratamento endodôntico Endodontia guiada Root canal anatomy Biofilm Irrigation Endodontic treatment Guided endodontics