MTA after poor surgery

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MTA after poor surgery - Courtesy ROOTS

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From: Javier Pascual
To: ROOTS
Sent: Thursday, February 11, 2010 11:22 PM
Subject: [roots] ORTO MTA AFTER POOR SURGERY

This patient was referred to my office a month ago with an asymptomatic apical abscess on 2.1 Previous RCT and
periapical surgery on it (nasty scar) Metal-Ceramic crowns with coronal leakage.

I decided to retreat prior surgery in order to achive a proper obturation all along the root canal.
After four weeks WITH Ca(OH)2 fistula has disappeared. Today I packed a collagen sponge and 5 mm of MTA.
(probably It´s a bit short) Maybe patient can avoid a new surgery. What do you think? - Javier.

WHY YOU WORK THRUE CROWN? CROWN FIT VERY POOR (OPEN MARGIN) - J.ROSS

Yes Julius that is a problem. I managed to work in a "clean field" during all my procedures.
I advised referral dentist and patient about that issue and the influence in the prognosis but they don´t want
to move that crowns before some evidence of healing. I would have remove that crowns and prepare a good provisional
first. -  Javier.

Excellent treatment!!  I would restore the canal with a fiber post and resin build-up.
Hopefully you will get a recall PA.
Can I use this as a teaching case with full attribution to you?? - Fred

THANK YOU VERY MUCH FRED, OF COURSE YOU CAN. I´LL SEND YOU PPT ARCHIVE TOMORROW IN THE MORNING.
NOW I´M IN ANOTHER COMPUTER AND DON´T HAVE THE PRESENTATION WITH ME - Javier

Javier,

In my humble opinion the apical third is filled by collagen sponge only ( compare to CaOH filling PA ) and that may
become a reason for need of second apical surgery to have the orrifice filled & sealed with MTA only. There is a
chance this case to heal as it is, but I would personally go for second apical surgery after ortho MTA placement.
In such large canal one may use just fiber reinforced posterior composite Nulite F for filling the canal and build up.
That of course just in case you have access to this composite. (see attached files - 3M presentation about
Filtek Silorane vs Nulite F - page 14 Chapter 2. Shrinkage and Stress and Nulite F brochure )
Other option is to go the way Fred suggested - fiber post and Luxacore.

That is an excellent case where canal may be filled with MTA by using Dr.Kossev's capillary condensation technique.
Then you will not need a collagen sponge. My 0.2 cents. - Valeri Stefanov

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