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The opinions within this web page are not ours. Authors have been credited
for the individual posts where they are. Photos courtesy Marga Ree - ROOTS

Difficult retreatment:GP cone:lentulo spiral

From: Marga Ree
To: ROOTS
Sent: Wednesday, April 02, 2008 7:05 PM
Subject: [roots] Difficult retreatment

This was a difficult one, the dentist couldn't find the palatal canal.  
The root canal filling of the buccal was and extruded significantly, 
and the patient presented with a sinus tract.

I suspected 3 canals, and indeed there was a deep split in the buccal. 
I could remove the main part of the extruded gp cone, but some remnants 
stayed behind in the peri-apical tissues. I had to extend the buccal 
canal orifice in a mesio-distal direction, in order to get access to 
both canals.

Ca(OH)2 for 6 weeks, and today I finished treatment. Fiber post and BU 
of composite  as usual. - Marga

Marga, and i thougth that i am having the most complex cases in my practice. stunning as usual. extremely well done, as usual.- Sergiu Nicola Very,very nice Marga, as usual .How did you remove the GP cone ? - Paul Thanks Paul. Before using any solvents, I always try to engage the gutta-percha filling by screwing in a Hedstrom file, and remove it in one piece. Because the filing had been extruded in the peri-apical tissues, I didn't manage to remove it completely. - Marga Marga, I love the treatment, the presentation and of course the result. Can you please tell me how you place your Ca(OH)2 ? - Thomas Thanks Thomas. I bring a lentulo spiral to WL for application of the white stuff. - Marga Dear Marga, How thick is the white stuff ? Is it watery or solid or in between ? I am asking because lately I found out that sometimes it doesn't flow well inside the canal especially close to the apex. - Thomas Nice case Marga, Micholis hi marga , as others have already said, excellent treatment and documentation, we all look forward to your cases! In page 2 lower left is that CaOH extruded from the sinus tract? - Abdul Abdul, Thank you for the kind words. Yes, that's Ca(OH)2 extruded into the sinus tract. This happens once in a while when bringing CaOH to length after instrumentation. Some clinicians try to achieve this on purpose. When it happens, there is ususally a quick resolution of the sinus tract. Just my clinical experience, no scientific background - Marga Hi marga. Just as a footnote to that. Traditionally when treating ailing implant fixtures we have tried to detoxify the exposed surfaces with things like acetic acid , or tetracycline, another acidic medium. Recently, there have been reported some very positive results attained by flapping, thorough debridement, and the placement of caoh2 circumferentially around the ailing implant, and suturing closed. In essence an external version of what we do internally in endo. Are you and paul going to be home Tuesday aug 5. Connie and I are taking chrissy on a northern Europe cruise to celebrate her graduation and I believe the carnival splendor will be in port in Amsterdam that day for about 7 hours or so - Gary
Protaper flaring

6 yr old Empress

Cvek pulpotomy

Middle mesial

Endo misdiagnosis

MTA retrofill

Resin core

BW importance

Bicuspid tooth

Necrotic #8 treatment

Finding MB2 / MB3

Deep in a canal

Broken file retrieval

Molar cases

Pushed over apex

MB2 and palatal canal

Long lower third

Veneer cases

CT Implant surgury

Weird Anatomy

Apical trifurcation

Canal and Ultrasonics

Cotton stuffed chamber

Pulp floor sandblasting

Silver point removal

Difficult acute curve

Marked swelling

5 canaled premolar

Sealer overextension

Complex anatomy

Secondary caries

Zygomatic arch

Confluent mesials

LL 1st molar (#19)

Shaping vs Cleaning

First bicuspid

In Vivo mesial view

Inaccesible canals

Premolar 45

Ortho and implant

Radioluscency

Lateral incisor

Obturation

Churning irrigant

Cold lateral

Tipped to lingual

Acute pulpitis images

Middle distal canal

Silver point

Crown preparation

Epiphany healing

Weird anatomy

Dual Xenon

Looking for MB2

Upper molar resorption

Acute apical abcess

Finding MB2

Gingival inflammation

Irreversible pulpitis

AG BU ortho band

TF Files

using TF files

Broken bur

Warm technique

Restorative prognosis

Tooth # 20 and #30

Apical third

3 canal premolar

Severe curvature

Interesting anatomy

Chamber floor

Zirconia crown

Dycal matrix

Cracked tooth

Tooth structure loss

Multiplanar curves