Tooth #8 : chronic periapical abscess with sinus tract - Courtesy ROOTS
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From: Fred Barnett
Sent: Sunday, November 08, 2009 7:12 AM
Subject: [roots] [EinsteinResidents] #8 retreat and revasc
from a 2nd yr resident....cool case.....fingers crossed!! - Fred
Pt presented with a history of trauma 4 years ago
The 2 pink sticks and a golden screw were stuck in by a dentist
soon after. He presented with a chronic periapical abscess w/
sinus tract. Easy retreat with braided hedstrom technique...or
a variant of it. Apex was severely resorbed and using light speed
files was gauged to be >#120. A quick glance over to Dr B, and next
thing I know I was being handed over bimix paste by Lorie!
Pt returned 4 weeks later with the sinus tract resolved.
Getting a heme scaffold all the way up the canal was real easy.
MTA cervical seal+Triage and a Luxacore build-up were used to
restore the tooth. Lets see if this works. Herodontics, anyone? - Bilal
can you explain me what is revascularization? as far as i understood
you allow fresh blood to clot in the canal and initiate new blood
vessels to grow in the tooth and completing the apexogenesis
process naturally. but in this case since its a periapical abscess
don't you expect some bacteria inside the canal? how do you manage it?
kindly explain me - Dr.kishore nallapati.
Hi Pavan, Revascularization is where you create a blood clot in the
canal.The clot then acts as a scaffold or fibrin matrix on which cells
get trapped and can lead to regeneration. Well wht type of
cells are there, nobody knows...some authors/researchers feel that the
cells are from the periodontoum.. .so that is a big question.
Prior to attempting the revasc procedure, you need to disinfect the
canal space. This is done with the use of copious amounts of Hypo and
the Triple Antibiotic paste (Ciprofloxacin+Metranidazole+Minocycline).
But during the entire prep, you do not mechnically instrument the canal.
Hope this a a little helpful
For more papers on revascularization check out Dr. Robert Kaufmann's
site...there is a gold mine of literature on revascularization &
regenerative endodontics - Trishul
how does this compare/contrast to apexigenesis....can CaOH or MTA be
used instead - Joseph A Belsito
Giving it my best shot, but correct me if i am wrong .......Apexogenesis
is the physiologic process of root formation where apexification is when
root formation has been induced. Well when you use CaOH or MTA its just
apexification. Its where a hard tissue barrier is formed which offers you
an apical stop/barrier against which you can backfill with guttapercha.
Some of the disadvantages seen when this is done is
1) Time factor - With CaOH u need to wait atleast 4 to 6 months for the
apical barrier to form
2) Long term use of CaOH results in the weaking of the dentin
(Andreasen Study,2002), and hence suceptibilty to root fractures
increases even after filling with guttapercha
3) MTA does not result in apxification, it just provides u with an apical
barrier against which you can backfill.This still leaves you with the
basic problem, where you are left with thin dentinal walls,
which are again suceptible to fracture.
In revascularization you just create a disinfected space using a triple
paste,which is then filled with a blood clot. This provides a matrix which
allows cellular growth and results in normal/healthy root development.
MTA IS used when revascularization is carried out, it is used as a coronal
seal upon which a suitable access restoration can be placed. Well it can
be seen in the photo's posted Dr.Barnett in the previous mail.
Hi , Similar to apexogenesis,But use 3mix paste intead of CaOH2 as dressing.
1st visit -irrigation with hypochlorite,3mix paste.3 weeks later initiate
bleeding and MTA plug at CEJ level.Calcium hydroxide use is avoided because
of possible damage to Hertzwig's epithelial root sheath,irregular barrier
formation and seal is inferior to MTA. a good seal coronally is important
to prevent reinfection of the canal space. (what i've understood so far
from the literature in a nutshell) - Impran
hi trishul, thank you for your explanation. where do you get this tripple
antibiotic paste? can you send me an article regarding this procedure.i will
get back to you incase of any doubts - Dr.kishore nallapati.