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Endo tips    Better Endo    Endo abstracts    Endo discussions

Apex Locators in the diagnosis of perforations

Difficult trauma case - Courtesy ROOTS
The opinions within this web page are not ours. Authors have been credited for the individual posts
and images where they are.

From: Márcia Valéria Vieira (Brasil)
To: ROOTS
Sent: Monday, June 13, 2005 8:17 AM
Subject: [roots] Dificult trauma case need help

Need some help with this case. Suggestions and comments welcome!

The dental trauma occurred 17 years ago, when she was 6 yo.

I did a PPT presentation...and tried to resize the pictures...
I hope I did the correct procedure. Sorry...no microscopes...
no digital radiography...only my digital camera and X Rays...
and light box to take the X Rays' pictures...hand instruments 
...NaOCl!!! Do you think is it possible to work with the 
pictures to improve them...if we plan to write a ROOTS's
article (Kendo? Fred? Trope? Fabrício Teixeira? Carmem? 
Liviu? who else...english would be easy to you!!!!!) about 
the dental trauma impact in the lives of our patients without 
proper follow-up, orientation...and poor prognosis!!!

I will wait your comments and suggestions!
- Márcia Valéria Vieira (Brasil)

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trauma case Marcia , The films look foreshortened so it might be better to take another with the RD clamps off in order get a true idea of how long the root actually is. Having said that, it would be a real shame if we lost those clinical crowns. I think the case could be treated with MTA a la Marga-Style. I believe Marga Ree has some experience with these cases, I seem to remember doing a spectacular job in a similar case she posted in December. Ah, I found it !! I enclose the image she sent at that time. (I hope you don’t mind Marga) And, of course Marcia, You will need to get a scope as soon as you can!!! Robert M. Kaufmann DMD MS(Endo) trauma case
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trauma case Hi Marcia, I think you took the right decision to start treatment and you did everything you could during the first session. With regard to the fenestrations thayt appeared, I had once a similar experience with a perforation, I noticed a soft tissue defect after the patient returned for the second session after three days. It healed without any problems. I will post this case again. What I would recommend is summarized in the attached slides, which are from one of my presentations on the placement of MTA I would also recommend to read these papers, because they provided new information concerning the difference between grey and white MTA, the use of US and the backfill with composite. If you don't have the full articles, I will be happy to post them. - Marga trauma case
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trauma case J Endod. 2004 Mar;30(3):167-72. Related Articles, Links Evaluation of ultrasonically placed MTA and fracture resistance with intracanal composite resin in a model of apexification. Lawley GR, Schindler WG, Walker WA 3rd, Kolodrubetz D. Department of Endodontics, Wilford Hall Medical Center, Lackland AFB, Texas, USA. The purpose of this study was to evaluate whether intracoronal delivery of an apical barrier of mineral trioxide aggregate (MTA) placed ultrasonically, non-ultrasonically, or ultrasonically with the addition of an intracanal composite resin provided a better seal against bacterial leakage. A second purpose was to determine whether intracanal composite resin or gutta-percha and sealer placed against an apical barrier of MTA provided greater resistance to root fracture. In a standardized in vitro open apex model, MTA was placed as an apical barrier at a thickness of 4 mm, with and without ultrasonic vibration. The barriers were challenged with bacteria exposure within a leakage model, and fracture resistance was assessed with increasing forces applied via an Instron machine. After 45 days, the addition of ultrasonics significantly improved the MTA seal, compared with the non-ultrasonics treatment (Kruskal Wallis nonparametric ANOVA with Dunn multiple comparison test p < 0.05). Bacterial leakage occurred in 6 (33%) of 18 in the non-ultrasonic MTA group, 2 (11%) of 18 in the ultrasonic MTA group, and 1 (6%) of 18 in the ultrasonic MTA-composite group. There were no significant differences at 90 days. A 4-mm thickness of MTA followed with an intracanal composite resin demonstrated a significantly greater resistance to root fracture than MTA followed with gutta-percha and sealer (one-way ANOVA with Newman-Keuls multiple comparison test, p < 0.01). The MTA-gutta-percha group was not significantly different than the MTA unrestored positive control. Comparative Study of White and Gray Mineral Trioxide Aggregate (MTA) Simulating a One- or Two-Step Apical Barrier Technique. Journal of Endodontics. 30(12):876-879, December 2004. Matt, Gary D. DDS, MS; Thorpe, Jeffery R. DDS; Strother, James M. DDS, MS; McClanahan, Scott B. DDS, MS Abstract: This study investigated the use of Mineral Trioxide Aggregate (MTA) as an apical barrier by comparing the sealing ability and set hardness of white and gray MTA. Forty-four root segments were prepared to simulate an open apex. Apical barriers of white and gray MTA were placed to a thickness of 2 mm or 5 mm. The samples were obturated immediately (one-step) or after the MTA set for 24 h (two-steps). After placement in methylene blue dye for 48 h, the samples were sectioned for leakage analysis and microhardness testing of the barrier. Gray MTA demonstrated significantly less leakage than white MTA (p < 0.001), and the two-step technique showed significantly less leakage than one-step (p < 0.006). The 5-mm thick barrier was significantly harder than the 2 mm barrier, regardless of the type of MTA or number of steps (p < 0.01). Results suggested that a 5 mm apical barrier of gray MTA, using two-steps, provided the best apical barrier.
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