From: Suzette van der Waal
To: ROOTS
Sent: Friday, April 04, 2008 02:34 PM
Subject: [roots] Difficult retreatment
I am a 2-nd year post-graduate endodontology student in Amsterdam.
Before this, I was a general practioner for 15 years.
This is one of my recent cases.
The dentist referred for rtx 46: a crown is planned.
No symptoms or signs of inflammation. Prognosis of the 47 is poor
due to extensive cervical root resorption.
The decision was made to remove the post and rtx 46
for technical reasons.
I started with removal of the amalgam and caries and assessment
of the restorability. I made a new composite restoration with
cuspal coverage. The post was more difficult to remove than
initially thought. After removal of the composite cement with US
as far as I could see in the DOM and application of US on the post
for several minutes, I tried to unscrew the post. Unfortunately
only a piece of the coronal part twisted off. The mesial canals
were badly calcified. So during the second session we decided to
leave the post, redo the mesials and make a composite build-up.
This was easy because I already made the new restoration. There
is enough dentine left for a ferrule. I wish there was less bonding
near the mesials to obtain more undercut.
I think the prognosis 46 is good.
Is it always this difficult to remove a Flex-post
(at least that is what I think it is)?
Obviously when there were signs of infection/inflammation I would
have had no choice but to remove the post - Suzette van der Waal
Regd. your case the 46 how long do you think the tooth can stay
asymptomatic with the mesials and the distals filled short of WL?
I think you will get many responses here on techniques to remove
the post and m/b you can try a re-entry into the canal system
sometimes later - Sachin
With the quality of the old restoration and the caries it seems
hardly possible, but I think the 46 was not infected. There were
no symptoms nor signs of infection or inflammation; there was no
debris in the root canal space and no stench.
I am pretty sure I did not contaminate the root canal system and
I made a tight seal with the new composite plastic build-up.
So if indeed this is a non-infected case the odds are good.
But I agree: I've seen better shapes.
I must learn about the boundaries of retreatment, about making
the right treatment plan. Could I have known in advance that
this would be the result? - Suzette
Hi Suzette: I think your case is a beautiful example supporting
that pre-op bite-wing radiographs should be part of routine endo
exams (not just a periapical view).
As to your professional journey, do not be caught off-guard if
once back in practice (and if limited to endo this time) you find
yourself missing the control you once had in the decision-making
of your patients' treatment plans... If that were to happen it
will never be too late (not shameful) for a second 180-degree turn
- Marcos Arenal
When I mentioned treatment plan, I meant treatment plan for this
specific tooth 46.
Have you ever removed a Flex-post? How did you do it? Or can't it
be done without extensive loss of dentine?
The 46 will soon be the last in the row, so one of my worries was
not to weaken the distal root (unnecessarily?) - Suzette
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