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Pulpo periodontitis:bridge:lateral incisor - 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: Valeri Stefanov
To: ROOTS
Sent: Friday, June 25, 2010 12:01 AM
Subject: [roots] Never do that - either "at home" or at your practice J

68 yrs old lady came to my practice yesterday.
A colleague of mine have made this bridge app. 2 years ago. 
Now all is shuttering and there is a subperiosteal
abcess of lateral incisor with pulpoperiodontitis.

You see lateral incisor after instrumentation with hand 
K files #06.02 up to #20.02, then HERO Shaper Difficult
Sequence set of machine files and apical third final
shaping with hand K files again to # 40.02. Canal currently
is filled with paste which is a mixture of  Oleandomycin, 
Dexamethasone and Indometacine for one week. I will
place CaOH for another week and will afterwards finally  
fill with bioceramic iRootSP. I have also prescribed her
Clindamycin per os due to allergy to several medicines 
including penicillin.

A perfect example what one has NOT to do :

1. Only two implants placed,  with the one supposed to 
   replace a missing second premolar been lost two months
   after implantation
2. Instead of attempting to place at least 4 implants 
   ( first molar, second premolar,canine on the right and
   central incisor on the left ) and leaving natural 
   teeth alone, the colleague proceeded with the bridge you see on RX.

The treatment plan that was destined to fail from the very start.

I am now trying to save the incisors and to convert the case 
to a partial prosthesis, due to lack of bone and lack
of funds on patient's side for something else.

It is NOT so much about the type of implants to be used, 
be it even Ankylos :-).

It is about correct treatment planning and execution of 
the treatment. - Valeri Stefanov


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