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From: Marga Ree
Sent: Sunday, September 24, 2006 5:27 PM
Subject: [roots] A miracle :-)?
This patient was referred for tooth 21. She sustained a trauma
12 years ago, at the age of 9, tooth 21 was avulsed and
replanted within 1,5- 2 hours. In the meantime, her mother
stored the tooth in her mouth. Root canal treatment was performed
a couple of weeks after the trauma.
Two years ago, the patient noticed a sinus tract. After a while
she decided to seek treatment, and was referred to me.
There was a large radiolucency and a lateral perforation with
extrusion of filling material. I told her that the prognosis was
guarded to poor, and after discussing the treatment options,
we decided to retreat. Removal of filling material,
and long term Ca(OH)2.
After 3 months, the sinus tract was still present, and to the
touch, there was drainage of exsudate out of the sinus tract.
We decided to take out the knife: Significant bone loss, huge
perforation, crack on the buccal side of the root. My first
intention was to close the flap and recommend extraction. But,
since we had nothing to loose, I decided to retrofill the
whole root with composite. I also covered the buccal aspect
of the root with composite. I told her that the prognosis
was very poor
Ten days postop, she came to my office with a swelling and
drainage of pus from the sulcus. There was pocket of + 10 mm
on the buccal, till the resection surface. I prescribed AB,
and felt very bad. I thought by myself, I never should have
started this treatment, this was ridiculous.
Last week, she came in for a 6 month recall. Wow, I couldn't
believe my eyes. There was no probing depth whatsoever,
the patient was completely symptomfree, and look at the
radiograph: beautiful healing.........:-))
A miracle? Of course this is after 6 months, and I am still
reserved to tell the patient that the long term prognosis is good,
but I found this pretty encouraging - Marga
Amazing, Marga! Everytime I open your emails&attachments
I know I will see the best. I save most of them in a folder - Marcela
Marga, What bonding technique did you use and what type of
composite? What a wonderful result! - Charles
Charles, I used clearfil SA primer in conjunction with dual
cure clearfil photobond, both from Kuraray, and a dual cure core
material Build-it from Pentron - Marga
Hi Marga, the miracle is you! Best regards - Jörg
Hi Marga, Wonderful doc like usual. Some question, despite of
the unusual of the case:
When you say that you retrofill with composite the canal,
are you saying that fill ortograde path or retrograde?
And why composite vs White MTA?
BTW, the tooth 21 is joined to their neighbours, I suposse that
itīs an orthodontic retention, and you neednīt retrieve and
itīs an soft indirect ferulization (perhaps this is not the
right word), isnīt it? - Nuria from Spain
Thanks Nuria, I filled the root retrogradely. I used
composite to reinforce the root as much as possible, because
of thin walls and the fracture line. Yes, it is an orthodontic
retention wire, and I managed to leave it in place during the
course of the treatment. - Marga