Retreatment of lower left first molar
The opinions within this web page are not ours.Authors have been credited for the individual posts where they are. - www.rxroots.com photographs courtesy: Dmitri Ruzanov From: Dmitri Ruzanov To: ROOTS Sent: Tuesday, June 02, 2009 8:56 PM Subject: [roots] Rapid failure This patient was referred for elective retreatment of lower left first molar (referral planned restorative). Tooth originally treated 5-7y back Asymptomatic First visit: access and asessment canals contained ZnPO4 filling debridement, shaping and desinfection (distal was huge oval system with large apex) Ca(OH)2 and temp Second visit: final desinfection and lenght confirmation obturation build-up with amalgam Fast forward to today (4 month later) referral sends to for re-eval: huge PARL on distal root Obj: asymptomatic, only percussion is slightly positive perio: wnl, except for distal uniformly 5-6mm (i guess this is due to referrals aggressive prep on distal and gingival trauma - rescently) Rtg: PARL confirmed What do you think may be etiology? Why did PARL appear that early and show that big pattern of bone loss? What would you do? - DmitriSuspect fracture of distal root? - Bill Bill, Yes, i suspected fracture at first, but: - it doesn't have "common" radiologic appearance - there are no isolated pockets... However, i somehow am afraid there is the fracture, altough can't prove it yet... Could you think of another reason for failure? It may well be that i'm seeing only trees and miss the forest :-) - Dmitri Dimitri if the patient is asymptomatic I would leave it alone for another 6 months. This lesion may well be a result of the struggle of his body to eliminate all the sealer. - Carlos Murgel CD, Dr. Carlos, I have told the patient we need wait and "watch" it for at least two months (provided the dynamics is so fast, I thought two months would be ok to see if there is any difference) :-)) Have you seen this reaction to sealer before? Do you suggest to restore the tooth for the time "on watch" and how? at present the tooth is prepped by referral, but not restored... should i request lab.fabricated provisional? - Dmitri I would reenter and place mta apically.as much as we struggle, we cannot properly obturate big oval canals with gp/resilon alone - Sergiu Dimitri, I would place a temporary restoration on it. I have see this before with my own cases, but you need to be sure that you did everything at the RCS and don't have a fracture. For sure I would wait for more months with a good temporary restoration - Carlos Murgel CD, Dr. Sergiu, Carlos, thanks for replies! As for now, i decided to fabricate lab.processed temporary crown, wait ca 2month and re-evaluate. in case i feel it's not fracture and the it's not healing i will reopen the tooth and try some more tricks (incl. MTA plug) on distal system. Will try post follow up on this case as it progresses - Dmitri
