Desafios e perspectivas no tratamento endodôntico em idosos: uma revisão narrativa da literatura

Abstract

This study aimed to discuss the main challenges of endodontic treatment in older adult patients, as well as to analyze clinical and technological strategies that may contribute to safer and more predictable management. This is a narrative literature review, with searches conducted in the PubMed, SciELO, and Google Scholar databases using terms in Portuguese and English related to aging, endodontic treatment, pulp canal obliteration and calcification, comorbidities, polypharmacy, operative microscopy, and cone-beam computed tomography (CBCT). Publications considered relevant to understanding the biological, clinical, and technological aspects involved in endodontic treatment in older adults were selected. The literature indicates that age-related changes in the dentin–pulp complex, combined with a higher prevalence of systemic diseases and the concomitant use of multiple medications, influence treatment planning, procedural safety, and prognosis, requiring comprehensive clinical assessment and, when necessary, a multidisciplinary approach. From an operative perspective, canal calcification and narrowing increase the difficulty of canal location and instrumentation, raising the risk of deviations and perforations. Technologies such as CBCT, magnification, and ultrasonic tips enhance diagnosis and access, while digital approaches, including static guided endodontics and dynamic navigation, tend to improve efficiency and preservation of tooth structure, although they depend on adequate infrastructure, professional training, and control of potential sources of error. It is concluded that endodontic treatment in older adults is feasible and can be conservative when individualized, and that more standardized clinical studies are needed to guide specific protocols for this population.