From: Ahmad Tehrani
To: ROOTS
Sent: Tuesday, September 26, 2006 8:40 AM
Subject: [roots] Failing MTA case

Before I go on further, let me say that it was MY treatment that failed and I am not blaming MTA for my own
lack of skills...((

I retreated the case in 2004 and was staring at a size 70 apex after I removed the TF obturator.
3 months of CH dressing with 2 separate changes closed the ST before obturating it with MTA and GP back fill.
Placed an orifice barrier and closed the access with composite.

He left town on work assignment to anther state...Saw another dentist for routine cleanings who also
recommended to get the tooth crowned. It is a nice looking functioning crown with intact margins.
So I can't blame it on the crown either...)) His assignment ended and moved back to Texas.
So much for geographic success...))

He has mild symptoms to percussion, a recurring ST, >3mm perio pockets around the tooth with no mobility.
In retrospect I should have enlarged the apex more and tried to place the MTA at the root tip, but I trusted
the EFL and pp length and obturated to that point.

Since I don't do any surgery, I referred him to an endodontist who wants to retreat it first
( can you even get past MTA???) and then do apical surgery.

What do you recommend at this point? He is not implant phobic, but naturally wants to explore other options
before extraction.- ahmad









Ahmad I would do a surgery first before the implant.  You did all your best I am sure.- Carlos Murgel

If he knew how thorough you are, he would go right to apico.- Fred

I was about to say exactly the same, look how pretty this root canal filling looks, I would never retreat this,
but do the apico straight away. BTW, yes you can remove MTA with US, I have done it several times.- Marga

Dear Carlos, Marga and Fred:
I appreciate all of your help and thank you for responding.
The crux of the problem is exactly what we see.
It was my case, so I sent him for surgery and surgery alone!
The other practitioner, sees this as a failure of the periapical tissue to tolerate the septic crap inside the
root canal system. Would this case be handled better if it was retreated before any surgery? ABSOLUTELY!
I thought MTA was hard as concrete and not re-treatable.

May be MTA wasn't the best material for this tooth, since at least one of the POE is on the lateral side of
the apex feeding the lesion??? may be I should have used rubber or even polyester to allow the hydraulics to
seal additional POE's?

I am getting a headache , with all these mental gymnastics. But I do want to retreat this case and learn
from my mistakes.....I will run this by the patient to see if he allows me to retreat it at no charge.

If I do this again, I will keep changing CH and TGP (tetracycline Gutta percha) solid points until I see
evidence of bone healing radiographically. wishful thinking??? - ahmad

Dear Ahmad, I don't do surgery either. If I got your case I wouldn't retreat it. Just sent of to a surgent
with a scope. If you do retreat it, show us how the GP looks under that post&core - Thomas

Hi Thomas: The apical is all MTA. There is GP is on top of the MTA layer. I don't think there is a post in
the canal. None of the oral surgeons in my area utilize a SOM, only endodontists do use it.
Some only for treatment not for surgery. - ahmad


Dear Carlos, Marga and Fred:

I appreciate all of your help and thank you for responding.
The crux of the problem is exactly what we see.
It was my case, so I sent him for surgery and surgery alone!

The other practitioner, sees this as a failure of the periapical tissue to tolerate the septic crap inside
the root canal system.

Would this case be handled better if it was retreated before any surgery? ABSOLUTELY!
I thought MTA was hard as concrete and not re-treatable.

May be MTA wasn't the best material for this tooth, since at least one of the POE is on the lateral side of
the apex feeding the lesion???

may be I should have used rubber or even polyester to allow the hydraulics to seal additional POE's?

I am getting a headache , with all these mental gymnastics. But I do want to retreat this case and learn
from my mistakes.....I will run this by the patient to see if he allows me to retreat it at no charge.

If I do this again, I will keep changing CH and TGP (tetracycline Gutta percha) solid points until I see
evidence of bone healing radiographically. wishful thinking??? - ahmad

Dear Ahmad, I don't do surgery either. If I got your case I wouldn't retreat it. Just sent of to a surgent
with a scope. If you do retreat it, show us how the GP looks under that post&core. - Thomas

Hi Thomas: The apical is all MTA. There is GP is on top of the MTA layer. I don't think there is a post
in the canal.None of the oral surgeons in my area utilize a SOM, only endodontists do use it.
Some only for treatment not for surgery. - ahmad