From: Marga Ree
To: ROOTS
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 it´s an orthodontic retention, and you needn´t retrieve and it´s an soft indirect ferulization (perhaps this is not the right word), isn´t 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