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

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