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for the individual posts and photographs where they are. - www.rxroots.com

ECIR after ortho, internal approach with TCA


From: Marga Ree
To: roots
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

ECIR after ortho, internal approach with TCA

ECIR after ortho, internal approach with TCA

ECIR after ortho, internal approach with TCA

ECIR after ortho, internal approach with TCA

ECIR after ortho, internal approach with TCA

ECIR after ortho, internal approach with TCA

Revascularization

Anastomosing Laterals

Calcified canals

Pulp chamber

Calcified molar

Ominous Lesion

Instrumenting MB2

Infection

Bleaching

Buccal caries

Recent recall

Bleeding

Cast post cores

Severe pain

Perio pocket

Not much calcified

Hess anatomy

3 palatal POE

Crap endo

Implant algorithm

Recapitulations

Long term recall

Cluster

Nerve proximity

Tooth #15

Psicologic condition

Fractured central

Radicular root

Wave lower molar

ECIR type III

ECIR recall

Stainless steel band

Intraradicular

Microscope dentistry

Complex root canal

Upper premolar

Scope bracket

Thermafilth abuse

Retreatment failure

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