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 didn’t manage to reach it inside the bone. Calcium hydroxide as a temporary filling. In the second
visit I succeeded to spread through obliteration but didn’t 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