orthograde retreatment of a root-end filling
From: Marga Ree
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
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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
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
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