PDL on both central incisors : Funky case - Courtesy ROOTS
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From: Ilya Mer
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