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Endo tips    Better Endo    Endo abstracts    Endo discussions

Hidden internal resorption

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for the individual posts where they are.
From: Terry Pannkuk
To: ROOTS
Sent: Friday, May 21, 2010 6:10 AM
Subject: [roots] Hidden Internal Resorption

I just packed this case a few moments ago.  GP in the buccal systems 
and MTA packed completely through the palatal with an esthetic bonded 
resin surface/core placed afterwards.   The CT was helpful in showing
the internal resorption defect clearly ahead of time.  The dentin walls 
are amazingly thin at the level of the defect seen on transverse sections.

Interesting history on this one but since it has some dark elements, 
I'íll refrain from discussing them, no educational value.

Take home point on this case. You need adequate coronal flaring on the
palatal to get good access to the apex past the resorption defect, clean, 
shape, and fill with MTA densely.  I usually like to make sure
the smallest plugger fits to length before packing MTA. If it doesnít fit 
to length you are likely to fill short and get voids -  Terry

what made/lead you to do a CT on this case as a pre-op? - Craig Barrington I could BS you and say I saw the shadow on the PA (which is subtly visible) but I didnít. Itís a long story which will bore people, especially those who are already sick of me. J Letís just say the patient didnít believe she needed endo and travelled around town for a few second/third opinions before she finally circled back to me and I took a CT to show her why she needed endo. The internal resorption defect was a surprise finding that validated the need for endo. I wouldnítí have normally ordered a CT on a case like this unless I had been perceptive enough to see the defect. The CT didnít provide a COD, it was a validating CT for the patient. If I hadnít seen the internal resorption defect preoperatively it would have been obvious after access and the result/treatment would have been the same. Itís just that knowing it ahead of time provided easier communication and planning up front without confusing the patient - Terry Terry, Why have you decided to fill buccal canals with gutta, if you filled the problematic canal with internal resorbtion entirely with MTA ? What was your logic behind such approach ? Why not all of them with MTA ? - Valeri Good question especially since George Bogenís article in the JOE showed that routine obturation of MTA is practiced by some. What would be the point of obturating with MTA unless it is a special case with gross irregular anatomy with an irregular terminus that cannot be sealed adequately with gp/sealer? It took me quite a few compaction cycles to get the MTA adequately to the apex past the defect. It simply has poor flow is isnít going fill in secondary and tertiary anatomy as well as gp/sealer. The buccal systems were narrower and had routine form, filling with MTA wasn'ít a consideration. Sometimes Iíll fill with MTA if I know Iím going to have to perform endo surgery. That didnít seem to be an issue with this case, and even if surgery was necessary on the palatal root, it would have to be approached from the palatal. It would be next to impossible to bevel the palatal root down and eliminate the resorption defect without completely obliterating the buccal roots to access it from the buccal approach. The buccal roots seemed best obturated conventionally. I know where this argument might be heading; if you are presuming that obturation is not important and that a coronoapical seal would be better achieved by packing MTA in the buccal systems even though you donít fill apical anatomy; I canít argue with you; I simply view obturation as important, especially on necrotic cases. - Terry thanks...i was hoping you would say that the preop film was such an odd and "not very diagnostic" angle that you knew you would get the "angle" you needed with the cbct..... not every patient is built to fit the one size fits all XCP rinns or other instruments........ sometimes you can help but get a high angle shot on a flat palatal vault type patient. i have actually learned that a pedo film in the rinn instrument will give a pretty good look in most of these patients but it would certainly take away a lot of diagnostic delimma guess work by simply recogonizing the existing patient anatomical limations for the one size fits all factor and simply go to a cbct....rambling....summed up: thanks - Craig barrington

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