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PDL on both central incisors : Funky case - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are - www.rxroots.com
From: Ilya Mer
To: ROOTS
Sent: Sunday, December 20, 2009 12:38 PM
Subject: [roots] two funky incisors

Just wanted to show you very funky case.

Patient was sent to me for the second opinion. The first opinion was 
exo and implants. #11 and 21 (8 and9) after apico which made around 
8 years ago. In spite of uncompleted obturation clear PDL has been 
seen on both central incisors. Teeth are stable without any symptoms.
Previous doctor saw strange lesion on the lateral side of the root 
of #22 (10) and started endo. In the end of visit he filled it with 
Vitapex (calcium hydroxide paste with iodoform on base of
silicon oil) and recommended to extract the tooth.

As well as I understood the situation the tooth has suffered for 
inadvertence. During apicoectomy of centrals  the surgeon  gave a 
deep notch on the lateral incisor. Having understood his mistake
he left it as it. So situation has developed like horizontal fracture. 
Obliteration has been occurred in the apical fragment and necrosis 
in the coronal one. PAL been formatted on the biggest foramen.
So, how to treat it?

The first appointment I spent to remove Vitapex from root canal 
and bone. A small amount of paste I didnít manage to reach it inside 
the bone. Calcium hydroxide as a temporary filling. In the second
visit I succeeded to spread through obliteration but didnít have 
apical patency. Obturation of apical third with gutta and sealer, 
the bone defect  MTA Angelus, and injection by Obtura.

#22 after removing cement in the coronal and middle third I found 
beautiful and healthy bone in periapex. No trace of infection or 
inflammation. It was filled with MTA without any periapical  matrix.

Best regards from Moscow - Ilya.

Great - Leandro A P Pereira

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Middle mesial

Endo misdiagnosis

MTA retrofill

Resin core

BW importance

Bicuspid tooth

Necrotic #8 treatment

Finding MB2 / MB3

Deep in a canal

Broken file retrieval

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Pushed over apex

MB2 and palatal canal

Long lower third

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CT Implant surgury

Weird Anatomy

Apical trifurcation

Canal and Ultrasonics

Cotton stuffed chamber

Pulp floor sandblasting

Silver point removal

Difficult acute curve

Marked swelling

5 canaled premolar

Sealer overextension

Complex anatomy

Secondary caries

Zygomatic arch

Confluent mesials

LL 1st molar (#19)

Shaping vs Cleaning

First bicuspid

In Vivo mesial view

Inaccesible canals

Premolar 45

Ortho and implant

Radioluscency

Lateral incisor

Obturation

Churning irrigant

Cold lateral

Tipped to lingual

Acute pulpitis images

Middle distal canal

Silver point

Crown preparation

Epiphany healing

Weird anatomy

Dual Xenon

Looking for MB2

Upper molar resorption

Acute apical abcess

Finding MB2

Gingival inflammation

Irreversible pulpitis

AG BU ortho band

TF Files

using TF files

Broken bur

Warm technique

Restorative prognosis

Tooth # 20 and #30

Apical third

3 canal premolar

Severe curvature

Interesting anatomy

Chamber floor

Zirconia crown

Dycal matrix

Cracked tooth

Tooth structure loss

Multiplanar curves