From: Terry Pannkuk
To: ROOTS
Sent: Thursday, February 04, 2010 8:03 AM
Subject: [roots] CBCT guided perf repair

This patient is my dental assistant that i started retreating today.  I presented the CBCT when I first got my Kodak
last Fall.  We discovered that the DB root had been strip perfed.  The endo had been performed by her former employer
about 25 years ago.  She said she's always been aware of the tooth and that she's always been told to wait awhile and
it should get better.  She knows better now, I've retrained her. :)

The CBCT was very helpful because we knew right were the DB canal had been strip perfed so I could "sneak" up on it.
I cleaned and shaped the MB1, missed MB2, and P before removing the gp from the DB because I wanted everything else
disinfected and cleared before spilling any crap out the perf site. I then picked away at the gp with a Martin Explorer
clearing the perf without drilling or using chloroform.  After I had cleared it away down to a deeper apical level well
below the perf I picked the rest away with 25-35 K-files, never really using a drill or solvent. After gaining patency,
I irrigated with a bit of chloroform and blotted it out with some paper points but found all the gp was gone.  I then
cleaned and shaped the DB to completion (as were the other canals), copiously irrigating, then placed a dry mix of
CH and closed.

It will be interesting to see if her awareness of the tooth goes away.  Her perio is fine and there is no communication
with the furcation.   I expect a good prognosis after finishing in a month and repairing internally with MTA - Terry





Excellent treatment.  It will be great to get a cbct follow-up - Fred

Thanks, since she's my dental assistant, I can use her and get post treatment CBCT's and sequential recall CBCT 's :):):)
-  Terry