Retreat of a surgical "treated" molar
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From: Jörg Schröder Sent: Wed 7/11/2007 17:57 To: ROOTS Subject: [roots] Retreat of a surgical " treated" molar Retreatment 2 years after "apectomy". Due to persistent pain on this upper first molar patient had a apectomy on this molar 2 years ago. Since then he had the same complaints from time to time. (pain on chewing, tender to percussion, no swelling). The preop rx presented a radiolucency on the palatal root tip. The only root, which has been treated surgically has been the mesial. After access it was quite clear what had happened: Missing of MB2, RCT through big parts of the roof of the pulpchamber with big amounts of necrotic tissue underneath. Guttapercha in the DB had been extruded beyond the foramen, so it took some time to remove it with a microopener and copious of NaOCl. MB2 merged with MB1 in a severe curvature. The GP in the palatal canal had been "loose" inside the canal. After removal fluid started to come out spontaniously. I then used CHX as irrigation , because I was not sure wether the lesion has been within the sinus. After some ccm of CHX I could see the bone. I asked the Pt. to breeze through his nose and closed the nose at the same time with two of my fingers to have a look if the Schneiderian membran will move. as it did not, I was quite confident not o shape the sinus;)). 2 visits, MTA in MB1, DB and P. Kollagen barrier in the P to avoid massive extrusion of MTA (ISO 70) MB2 has been obturated with GP. Because I could visualize the retrofill from the access, MB2 merged in the middle part of the canal, there seemed to be no lesion on the MB and most of all I was scared to push retrofill material into the sinus during a possible attempt to remove it with US I left retrofill in MB1 in place. Adhesive Buildup at the end a my hope, that it will heal. Best regards from Berlin, Germany - Jörg Schröder --------------------------------------------------------------------------------
That "Merging MB2 & MB1" picture in your Folie2 is great! For a minute I wondered "how on Earth did Jörg manage to send such bright white light FROM the apical end of the canal TO the chamber....?" Until (I think) I realized what it was... Or did you illuminte the root through the gum and bone at the time of taking this picture?? - JL
