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Right Central Incisor hurts - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are - www.rxroots.com
From: Javier Pascual
To: ROOTS
Sent: Wednesday, March 30, 2011 12:36 AM
Subject: [roots] HELP WITH A PLANIFICATION CASE

This patient was referred to me by oral surgeon on March 2011

Chief complaint: My right central incisor hurts

Dental History (patient version): At the age of 10 dental trauma. 
Endo was done five or six years ago because tooth was yellow 
(an internal bleaching was offered to the patient to solve discoloration)

Pain History:Patient feels like a beating pain related to the 
apical part of tooth 1.1

Clinical exploration: Vertical percussion normal, Horizontal 
percussion some discomfort but not painful, Buccal probing under 
anestesia reveals a deeper point of 5 min in central position.

I took periapical radiographs and ask patient to bring me a CBCT 
that previously was taken by oral surgeon.

What do you think about this treatment plan? First of all Ill 
acces through the crown remove guttaperha, search for canal, 
cleaning and shaping procedure and Ca(OH)2 medication for 
2-4 weeks. After that Ill pack canal with guttapercha. 
Then I have to treat perforation. What do you think about 
this perforation? Is this subcretal? paracrestal? or above 
bone level? If its subcrestal Ill seal it orto via with MTA.
But Im afraid this is paracrestal and maybe Ill need to raise 
a flap and seal it surgically. What do you think after seeing 
CBCT? Ill take better periapicals and post intraoral pictures 
next visit.

Any comment will be of help!! Thank you very much  - Javier!!

That's a nice case to deal with! I think the best option will be to raise a flap after you do the orthograde endo and seal the perforation with MTA. After raising the flap you will see what is going on indeed and you can correct if needed the MTA seal and prepare perfectly the root surface. Please keep us informed! - Bojidar After obturating the canal, I would seal the perforation with glass ionomer instead of MTA. Since it seems to be paracrestal indeed and the risk is that the MTA will be washed away. Afterwards I would raise a minimal flap and finish the glass ionomer. - Rafal Thank you Rafel and Bojidar. I also think I will have to raise a flap. If deffect is paracrestal I think MTA is not a good idea because it cant be polished. What about a componer like Dyract or Geristore? For the surgery maybe just sulcular incision without vertical incisions? - Javier Javier, You need to check the presence of a periodontal pocket. In this case it is more important than the CBCT. Use your perio probe to do that. If you find a normal depth, go to ortograde seal with White MTA. During retreatment, if you find a small and rounded perforation, instead of MTA you can seal the perforation with a guta percha master cone and endodontic sealer as a "second" canal. If you find a perio pocket, go to surgical repair with resin to avoid aesthetic problems. Resin it's easy to be polished, I don't like the polish quality of GICs, specially under microscope view. Choose by papilae preservation flap design without releases. - Leandro Thanks for you advices Lendro!! Theyre of great help. Yes there is a perio deffect, 5 mm pocket and gingival retraction (central-buccal) Next visit Ill take pictures of soft tissue before starting treatment. - Javier Hi Javier, I think it's a good idea to plug the hole with resin. Would be great to make a flap intrasurcular and if the defect does not invade the periodontal bone mesiodistal bone, preserving the taste. It can help with 212 for isolating the adhesive technique, if the defect permit. - Ivan Garrido Thank you Ivn!!! Ill phone you this evening to discuss the case. Nice to read you here!! - Javier Hi Javier, im interested which CBCT was used for imaging in this case. like the quality of the image - M.J. Hi Michael. CBCT: Morita Accuitomo 80 Visualization Software: Kodak Kdis - Javier Pascual

Occlusal trauma

Premolar and RCT

Resistant lesion

Screw job

Geristore resorption

Curved MB canal

Tectraciclin in surgery

Root resorption

Endo perio lesion

Crack resorption

Mandibular molar

External resorption

Rubber dam limits

Middle mesial

3D obturation

Inflammatory resorption

Hess anatomy 3

Wierd upper 2nd molar

Implants and/or teeth

Cracked tooth syndrom

Crown root fracture

Open Sinus lift

Mandibular nerve

Missed DL canal

Apical Periodontitis

Endodontic autopsy

MM Canal

3 visit retreatment

Deep bifurcation

Dangerous curve

Lower wisdom

Coronal lateral

Hess anatomy

VC Obturation

Diagnostic trivia

Sinus tract

Extraction & Clearing

Tooth #2

Implant placement

tooth clearing "technology"