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Retreatment through the crown - Courtesy ROOTS

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credited for the individual posts where they are - www.rxroots.com
From: Ilya Mer
Sent: Thursday, June 17, 2010 9:49 PM
Subject: [roots] retreatment through the crown

#16(#3) sent to my office to consult and retreatment. Buccal swelling and sinus tract is appeared. The huge round
house was done from 16 (3) to 25 (13) by sister of the patient just several months ago. They asked me to perform
the endo through the crown and save the bridge ( and tooth as well). Unfortunately almost all abutments were compromised.
I believe this molar exacerbation was only the first bird. I did the access through the crown and found MB2 canal with
separate apex that caused the AP and sinus tract. I had to work 2 visits in order to complete the cleaning and shaping
of 4 canals. Screw post from palatal was removed as well. After 4 weeks with calcium hydroxide all symptoms gone and
fistula was closed. Obturation with squirt from Obtura unit and of access cavity sealing with silver amalgam at the
same appointment. I believe the prognosis of this tooth will be good but   not for all bridge abutments.  Sealing the
edge af access with block out resin prevents from closure of electrical network and allows EAL measure.

Ilya.....HOW FANTASTIC was that tip saabout the sealing of the edge for apex locator. Its such a huge problem for me. You are using the ROOT ZX from morita? Excellent stuff That is why I belong to ROOTS Great tip. - Glenn Glenn! You are welcome! But i'm surprised that you dont know this trick. I've learnt it from somebody from internet forum as well. Yes, I use ROOT ZX for last 12 years :-) - Ilya Truly a beautiful job, Ilya. I had a patient referred to me Monday who had been promised she would not need a new crown. 95% of the time I can go through the crown but on some cases removing it and placing a bonded temp is preferableÖand some do crack in spite of our best efforts. The young dentist got a phone call with a request to never make that kind of promise again. He had placed the crown a few weeks ago with an obvious lesion present. Iíve done that a couple of times and paid for a new crown. I think all of these are going to leak and a new crown is always preferable. Some will disagree but I have to deal with my failures every day.- Guy Guy, Thank you fro response. I quite agree with you. In most cases the old crown must be off especialy if the quality is no so good like in this case. - Ilya some difficult case to resolve!!! you did real nice job there though! now what I canīt help to ask is did you medicated for 4 months with CaOH? only with CaOH or did you used another medication with it? - Marilinda Marilinda! I use aqueous solution of calcium hydroxide and usually place it for 2 weeks. In this case after two weeks with medication some symptoms still remained, and I made a decision to wait additional two weeks. Thanks for response, Ilya Ilya, beautifully done, perfect example of the endo-implant algorithm, these teeth do not have to be extracted, congratulations, keep posting - Jose Nice job - Jorge Vera Jose! Thank you so much. I would like to receive this case before the crown and not to struggle after. The referral IMO did nothing to save the tooth L = Ilya Jorge! Thanks for response. I was at your lecture in Moscow last year. It didnít make me buy TF :-) but Iíve learnt a lot. Thank you. Iíd like to ask you what kind of radiopaque solution did you use to irrigation in order to receive the radiograph picture? I tried to use Hypaque or something like this but one being mixed with sodium hypochloride it had a rapid reaction with creation a lot of free Chlorine. Thank you. Ilya Hi Ilya: Thanks, that was a quick trip in and out of Moscu last year. The radioopaque solution we used was Claristat mixed with NaOCl prepared by a Chemist, but you just raised my eyebrows concerning free Chlorine, I will check into that. Thanks again, and use those Twisted files and you will love them - Jorge Vera Jorge! Thank you for your reply! Are you sure about "Claristat" spelling? Google doesnt show something similar to radioopaque solution. I would very grateful for if you will tell me exact name of this solution.- Ilya Hi again Ilya: sorry, my mistake. Name is Claritrast 300 Link to the product Another one is Optiray. It can be mixed with NaOCl so that the density of the irrigant used is quite similar to 5.25% NaOCl but I don't know if that combination would also release a lot of chlorine, would you let me know if you find out?. I will also check with my Chemist. On coming back to Russia I was invited to St Petersburgh in May but couldn't go but certainly next time will contact you so we can have a drink together, it is always fun there. - Jorge Vera
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