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Fistula in first upper premolar - Courtesy ROOTS

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From: "Nikolaas Dewilde"
Sent: Friday, August 14, 2009 7:47 PM
Subject: [roots] 2 cases

My name is Nikolaas Dewilde and I am currently finishing the third and
final year of my postgraduate studies in endodontics, at Ghent University.
These are my first two cases on Roots.

Patient number one presented herself with little but constant pain of
the first upper molar. A root canal treatment was done several years
ago, but the patient could not remember when exactly. There was
amalgam in the pulp chamber. I opened it up, removed the amalgam, part
of the pulp chamber roof that was still present, and found the MB2.
Prepared the canals with ProTaper, passive ultrasonic irrigation of
NaOCl and EDTA. Obturated using Gutta Condensors.

Patient number two was a referral. A fistula was present at the first
upper premolar, and her dentist had first sent her to a maxillofacial
surgeon, who performed apical surgery. (Without prior root canal
treatment.) Problems continued, the fistula would not disappear, so
the dentist decided to refer the patient to me. As you can see on the
radiographs, i suspect the palatal root was not resected. The surgeon
"obturated" the buccal root canal during surgery (orthograde; no
retrofill, though). And the fistula actually traces to the second
premolar, which is necrotic and painful. I started by doing root canal
treatment on the second premolar, as you can tell from the
radiographs. (ProTaper, hybrid obturation.) Next time, I will open the
first premolar orthograde, and I plan on putting an MTA-plug at the
apex of the buccal root canal. Any thoughts on this treatment?

Any remarks are welcome - Nikolaas

The fact that you are a MAC user means I LOVE YOU ! I have to say this because if not.....well...... GRADUATING STUDENTS........the seminal force to correct the damage done by the previous generation including myself. ROOTS SUMMIT IX - are you promoting the bejeebers out of it......??????? GET WITH THE PROGRAM - Kendo Hi Nikolaas, Especially love the second case! Looks exactly like a mirror image of one of the endos of Cliff Ruddle in the following article :) - Amir Excellent cases! Nikolaas Grtz, - RafaŽl

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