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MTA after poor surgery - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are - www.rxroots.com
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 Itīs 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 donīt 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. IīLL SEND YOU PPT ARCHIVE TOMORROW IN THE MORNING. NOW IīM IN ANOTHER COMPUTER AND DONīT 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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