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Jan 2006

I have posted this case earlier and wanted to show the 2 month follow-up.

This 13 year old boy has sustained a trauma on tooth 11. The horizontal root fracture has unfortunately been treated by his dentist by performing an endo in the 2 segments. After a while the coronal segment has been retreated by a resident of the endo program, with gutta-percha and sealer.

His symptoms never went away, tooth was sensitive to percussion and had a grayish discoloration.

Conventional retreatment till the fracture level, coronal segment filled with MTA, flap raised and removal of the apical fragment in 2 parts, all done in 1 treatment session. After removing the sutures, sodiumperborate for a few days, and the access opening filled with composite.

Healing is amazing, after 2 months tooth is rock solid and patient is completely symptomfree, for the first time since the trauma took place. And then to think that he had been adviced to have the tooth extracted..........Marga

Marga,I have a sodium perborate question. Is this correct---mix to a consistency of wet sand and seal in chamber with IRM. No cotton pellet necessary? Is a few days typically adequate? or is a weekly check sufficient?- Kendel

Hi Kendel,That is correct. I always use a barrier of Glass ionomer cement, on top of the root canal filling, and make sure that I am 2-3 mm below the CEJ. No cotton pellet. In this case the discoloration was not very sginificant, so I brought him back in a few days. Usually I do a weekly or even a 2 weekly check, depending on the degree of discoloration. - Marga

Marga, totally awesome. seeing this case a few weeks ago was a great experience, but the follow-up takes all my breath. Do you mind to post a pic of the sutures, please. just if you took any - Bijan

Hi Bijan,Thanks for the compliments! I used Tevdek 6-0 sutures, which I removed after 5 days. Here are some pics from 5 days postop. If possible, I try to remove the sutures after 3 days, but I am not every day in the office, so in this case it took a bit longer.- Marga

Marga, what an awesome case.I sent it to my local endodontist (Dr. Mark Olesen) who is a very good guy and also a very good endodontist (reminds me of you!!). He sent me some really great information back that I thought I would post below because it really was valuable. He trained at USC but Torbinajed obviously helped him along the way.- Glenn

Hi Glenn: Yes, it really helps plugging the canal with MTA 1st rather than at the time of surgery since the fracture always seems to be diagonal in bucco-lingual dimension, with the remaining good root being much longer facially. And since we want to try to preserve as much root length as possible, best to do minimal beveling if possible when doing surgery (MUCH beveling would be needed if placed MTA retrofill surgically rather than orthograde). the literature reports that the apical segment of horizontal root fractures stays vital ~80% of the time. but since ~1998 i've had about 4-5 (no intention of bragging here) where have had to do this type of surgery. i haven't seen any published articles on this yet, but it just seemed like the obvious thing to do when we learned from Torby that MTA was the way to treat open apices.

Hi Glenn,Thanks for your input, I completely agree with the comments of Mark Olesen.- Marga
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