From: Marga Ree
To: ROOTS
Sent: Thursday, June 09, 2011 8:47 PM
Subject: [roots] Retreatment of a front tooth

30 year old woman, with history of previous surgery on 12. Recently the tooth became symptomatic.
I suspected a root fracture, no probing depths of any significance.

We agreed upon disassembly and inspection what it looked like. Ususally you cannot use the Metalift
to remove crowns on front teeth, because of the path of insertion, but I managed to remove this crown
with just a little chipping off of the porcelain on the palatal side. She found her current crown very
unsighty, but it had a decent fit, and we decided to use it as a temporary in between visits,
while the tooth was in CaOH.

After the tooth became asymptomatic, an apical plug of MTA was applied, and the crown was cemented
for the last time. I promised her to make a nicer temporary after insertion of the post.
Today I finished treatment, post placement and a cosmetic build-up of LuxaCore, veneered  with a
flowable composite, a bit of shaping and polishing, she was pretty satisfied with the result.
I explained that we had to follow up till signs of healing were visible, that she still might need
surgery, and that the prognosis is guarded

I am still not confident that there isn't a fracture, we'll see.  - Marga






Beautiful as usual, marga, but I’m confused.  Your photos show using the metalift to retrieve the crown,
apparently done successfully with the post still attached to the tooth.  You then show a photo of the
crown/post as one unit, as if it had been pulled as one piece.  Did you reassemble it for phototgraphic
purposes.  I doubt you were able to remove the crown and the post with the metalift unit.- gary

Hi Gary, I removed the crown with the Metalift, and the post with ultrasonics. Because the crown didn't
have much retention, I used a temporary SS post to increase its retention. I inserted the post, filled
the crown with a resin material, seated the crown, and after the material had set, removed the crown
with the temporary post embedded in the crown. Crown with post embedded were cemented with a temp. cement.
- Marga

No white stain to match the contra lateral tooth?  Marga absolutely phenomenal.  Please teach me how
to work with composites this way. - Keith

Dear Marga, excellence case and fotos as usual. - Lukasz Kwolek

Hi Marga, Looking at clinical photo I see a scar - has this tooth undergone an apical osteotomy
before your re-treatment ?

Re-treatment is perfectly done, but with such type of bone defect prognosis is really guarded :-(.- Valeri