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  Retreat of a surgical "treated" 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: Jörg Schröder
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


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