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ECIR after ortho, internal approach with TCA
From: Marga Ree
Sent: Tuesday, April 03, 2012 8:46 PM
Subject: [roots] ECIR after ortho, internal approach with TCA
Here is a case that I showed in New Jersey, I completed it last week.
The resorption was visible a few years after ortho was finished.
The ECIR did not extend into the root, so we decided to treat it.
After working the scan, it was confirmed that the lesion was limited
to the clinical crown, and the port of entry was distopalatal.
First session: Typical picture after opening up, channels with bleeding
points, predentin layer intact. After gross debridement with a bur,
TCA was used to create a coagulation necrosis of the resorptive tissue
in the channels. C& S was done as usual, then CaOH.
After I was done with TCA, you can see that the bleeding points were
black. CaOH is very helpful, because you can distinguish the resorptive
tissue better at the next session. Same applies to CaOH.
Second session, procedure was repeated, debridement with bur, and then
alternated with TCA. At the beginning, you can still see some isolated
bleeding points. After chasing them with a bur and TCA, they disappeared.
Third session: There were still 2 bleeding points, and I chased them till
I almost perforated: I inserted a size 06 hand file in them, and attached
the EAL. I was just a few tenth of a mm away from the PDL and stopped
just in time...:-)
Obturation and refreshing of dentin with a bur, because TCA is a strong
acid, and after using it, dentin is demineralized to a too great depth,
leading to a weak bond - Finally a composite core was placed. - Marga