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 orthograde retreatment of a root-end filling
The opinions within this web page are not ours.Authors have been credited
for the individual posts where they are. - www.rxroots.com photographs courtesy: Marga Ree
From: Marga Ree To: roots Sent: Thursday, June 07, 2012 1:18 AM Subject: [roots] orthograde retreatment of a root-end filling This patient presented with swelling and pain. 21 was surgerized a couple of years ago and the crowns on 21 and 22 were connected. I told the patient that I would retreat first, but that a resurgery could be necessary. Luckily we could remove the retrofilling with ultrasonics, Munce burs and some pre-bended explorers. She was asymptomatic after the first session, and we filled with MTA, a post and a composite core. Today she returned for a 1 year recall, and was happy to hear that surgery was not indicated - Marga orthograde retreatment of a root-end filling

orthograde retreatment of a root-end filling

orthograde retreatment of a root-end filling Great result , Marga. How do you think about the long term mechanical prognosis of those root end surgerized teeth? Is VRF an issue about which we should inform our patients? What numbers do you tell the patient. From the biological aspect I am pretty confident, that the long term success will be quite high in such cases. But what about the mechanics? Just out of curiosity: In the 1yearCBCT there is a radioopaque particle which I can not detect in the PA. What can this be? - Jörg Thanks Jörg Are you referring to the crown-root ratio? Lateral forces and parafunctional activity? Yes, that might be an issue, but I have to say that if there is sufficient radicular and coronal tooth structure, and an adequate ferrule, these cases have in general a favorable long-term prognosis. In my opinion, the role of the crown-root ratio is a bit overestimated. Remaining tooth structure is paramount, I'll post a case to illustrate this issue. The particle is probably extruded MTA, or CaOH that hasn't resolved - Marga Super, conservative result! Not much "luck" though, more like great skill and experience + application. So many of these teeth become implant cases these days. I like and place/restore implants, but NOT when the natural tooth is restoratively viable and endodontically treatable. Just one question, what is the small radiodense area on the recall CbCT, labial to the apex?. It looks like amalgam, possibly in the soft tissue, but is not on the recall xray. Thanks for posting - Ken Heritage Thanks Ken, I think it is either extruded MTA of CaOH that hasn't resolved. I have had some other cases in which CaOH failed to resolve - Marga Hello Marga. Its a great honor for me to talk with you. Great case and very nice healing. - Ricardo Machado Very nice case Marga. Thanks to this particle I realized that the MTA and the intracanal post look more radiopaque in the CBCT than it used in the periapicals. Of your answer I guess that that it is the same for CaOH. What is the explanation? Did you cut the retrofilling in some pieces with US @ Munce burs? If the retrofilling had extruded into the periapcial are, how would you resolved? Thanks for share and warm regards. - Nuria Campo, DDS I think Marc has answered your first question. As for removing the retrofilling, yes, I loosened it with US tips. I did extrude some of it in the peri-apical tissues, but was able to retrieve it again with pre-bended explorers. A matter of patience and persistence....:-)) - Marga

Protaper flaring

6 yr old Empress

Cvek pulpotomy

Middle mesial

Endo misdiagnosis

MTA retrofill

Resin core

BW importance

Bicuspid tooth

Necrotic #8 treatment

Finding MB2 / MB3

Deep in a canal

Broken file retrieval

Molar cases

Pushed over apex

MB2 and palatal canal

Long lower third

Veneer cases

CT Implant surgury

Weird Anatomy

Apical trifurcation

Canal and Ultrasonics

Cotton stuffed chamber

Pulp floor sandblasting

Silver point removal

Difficult acute curve

Marked swelling

5 canaled premolar

Sealer overextension

Complex anatomy

Secondary caries

Zygomatic arch

Confluent mesials

LL 1st molar (#19)

Shaping vs Cleaning

First bicuspid

In Vivo mesial view

Inaccesible canals

Premolar 45

Ortho and implant

Radioluscency

Lateral incisor

Obturation

Churning irrigant

Cold lateral

Tipped to lingual

Acute pulpitis images

Middle distal canal

Silver point

Crown preparation

Epiphany healing

Weird anatomy

Dual Xenon

Looking for MB2

Upper molar resorption

Acute apical abcess

Finding MB2

Gingival inflammation

Irreversible pulpitis

AG BU ortho band

TF Files

using TF files

Broken bur

Warm technique

Restorative prognosis

Tooth # 20 and #30

Apical third

3 canal premolar

Severe curvature

Interesting anatomy

Chamber floor

Zirconia crown

Dycal matrix

Cracked tooth

Tooth structure loss

Multiplanar curves