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The opinions within this web page are not ours. Authors have been credited for the individual posts and photographs where they are. -

Left lateral upper incisor

From: RafaŽl Michiels To: ROOTS Sent: Thursday, September 22, 2011 2:31 PM Subject: [roots] Re: 4 year Recall quiz Yesterday a 37 year old man came in. I performed the initial treatment back in 2007. Diagnosis back then was AAP (asymptomatic apical periodontitis) on the left lateral upper incisor. Cleaning: 2,5% NaOCl, final rinse with 17% EDTA Shaping: WL 22mm MAF 40 Taper 6 (profile 40.06) Cold lateral condensation: GP + AH+ Temp restoration in GIC. 1 visit Central incisor tested normal to all tests Today he presented with a sinus tract and the radiolucency became much bigger. The central still tests normally to percussion, cold etc. What is your treatment plan? No financial restrictions, oral health hygiene is adequate, ASA 1, motivated to keep his teeth as long as the prognosis is reasonable. Retreatment? Surgery? Both? Ex + Impl? I have chosen one of the above, I will show you later. But what would you choose and why? If you need more info, just ask, but I think I pretty much summed up everything - Rafael Thanks for the post Rafael. How is the probing depth? Any apico-crestal defect,palatogingival groove ? If negative I would retx. - Unni Probing is normal all around the tooth. No pocket deeper than 2mm.- Rafael Hi Rafael, I would go with retreat first, with CaOH interim dressing for a few weeks. Asses response to retreat& then consider surgery. - Imran Raf, What is happening coronal with this lateral incisor ? Is the filling broke ? Can you suggest there is coronal leakage and re-infection ? If yes, than normally would be to go more towards retreatment... If there is no coronal leakage and you are confident in your treatment from 2007, what do you think you can improve today with your re-treatment ? Warm vertical instead of cold lateral or Ca(OH)2 instead of single visit ? ;-) greetings & wait your case report and see how it went ! - Roberto It seems like most rooters agree to do a retreatment. I also chose to retreat. It is never fun to retreat your own cases, but I know that I have improved a lot since 2007, so the choice for retreatment was logical. Things I can improve: -Better cleaning protocol, using PUI. -Better obturation technique, WVC. -2 visits, and when the sinus tract disappears, then we have a hunch that healing might start. If the sinus tract does not disappear 1 month after the second visit, I will perform an apex resection. MAF is enlarged to size 60 right now. I attached the picture from after the first visit 2 days ago. Calciumhydroxide is placed in the canal. - RafaŽl Palatal root of cleared molar Palatal root of cleared molar Palatal root of cleared molar Palatal root of cleared molar
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