From: Jörg Schröder
To: ROOTS
Sent: Wednesday, October 10, 2007 1:35 PM
Subject: [roots] Endo after Trauma

16 year old pt, hx of trauma (avulsion about 6 years ago)

Somebody did the (I don't like to call this a RCT!!) .....on #12. Pain on percussion and swelling on #21. The same
person tried to enter the pulpchamber and made a subgingival perforation about 2mm in diameter due to a lack of vision
and orientation.

1. visit closure of the perforation with composite( perforation has been above bone level) then I started to dig my way
down, following the light colour of the former canal. At 18 mm I felt something might go wrong and I took a x-ray.
About 1 mm to far to the distal. CaOH2 and adhesive temporary filling. Due to holidays (pt. travelled through europe)
we met again yesterday. No signs, no symptoms and a marvelous gingiva.

As I knew where to go I made it to get patent by using Endosonore Files # 20 in 31 mm. So I could see what I did. 2.
wire -film at 20 mm showed a little deviation to the distal so I went for the last 0,5 mm and got patent. MTA Angelus
grey and adhesive build-up. I have bben a little upset about the small gap between MTA and buildup. Seems to be too
much bonding :((

I will keep you informed about the follow-up.

Best regrads from Berlin, Germany - Jörg Schröder





Nice job  - Joseph Dovgan

Great case as always. Fantastic documentation and
approach. Congratulations from Brazil, sergio Martins.

Challenging case Jörg. Nice management and documention. Some questions:

The perforation is supracrestal and subgingival, how did you manage the wet of gingiva for made adhesive repair? and
did you use flowable resin or an hybrid or microfill one?

Did you put  MTA and Adhesive buildup in the same visit?
I don´t know Endosonore files, can you explain something more about them... material, diameter, sección, do you use
manually or rotating with a motor, perhaps Ultrasounds... sorry if it has no sense but sonore suggest US.

Nuria Campo, Barcelona, Spain -

Dear Nuria,

after irrigation with warm NaOCl and using anesthesia with 1:100000 adrenaline, and some electro surgery there has been
a quite dry surface there. Maybe it is not visible on the picture. It is important to reduce the gingiova a little more
then necessary to prevent a cappilary effect from the margins. When I was sure that the field was dry for some time I
acid etched the margins of the perforation, then applikation of dentine bonding agent. The difficult thing has been not
to touch the tissue too much. then I used a flowable composite, which does not flow very well (Estelite Low Flow) Yes
MTA and Buld-up in the same visit. The Angelus MTA sets very fast compared to the DentSply-type.

Endosonre files are SS files without a handle. They are used in a special mount  called endo-chuck, so you can use them
in a US device. You can prebend the files, so you can even work around curved structures.They are available in
different diameters. My favorite is ISO 20 or 25. - Jörg

Hi Jörg! Great job!

I don't see any problem concerning the "Heliobond-Gap"
It's a less filled floawble that is not as radioopaque
(or not at all) as a regular composite-that's it. Keep diggin'  ;-) - da' Chris

Jorg, Excellent work. How did you find the original canal after going too much distaly ?
This is no easy work! - Thomas

Great job Jörg,
any esthetic disadvantages regarding the use of grey MTA ?

Regards abd heard you'll be in Stuttgart - hoping to meet you - Peter

Thank you Peter,

I liked your resorption case very much.
As the MTA ends subcrestal, I am not reallyafraid of staining. Tooth will be bleached in a third visit.- Jörg

Dear Thomas, thank you. To be honest I have been very upset about my digging direction. I always saw a thin white spot
surrounded by darker dentine, which I followed. From time to time the microopener had "grip" . Then I tried to imagine
which way the canal would have taken after the trauma.< To the buccal side seems not very realistic. As I knew from the
x-ray I had to go more to the mesial. I first tried mesial an ended upwith wire-film no.2. Then I tried a little more
distopalatal and there it was. Next time I will do one more x-ray to be informed about the axis of my preparation
earlier. - Jörg