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Severely bevelled root tip - Courtesy ROOTS

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credited for the individual posts where they are - www.rxroots.com
From: RafaŽl Michiels
Sent: Sunday, July 25, 2010 8:50 PM
Subject: [roots] Severely bevelled root tip

Here is a case that came in last week.
The patiŽnt has got a new dentist, since her previous one retired. The patiŽnt was sent for a
treatment of tooth 16 and for an advise on tooth 21 (tender to percussion).
It is the 21 that was somewhat shocking to me.
21 was treated by the dentist, but she could not find the canal, since it was obliterated.
So, she sent the patiŽnt to the hospital to the oral surgeons. But there is also an "endodontist"
there. He could not get in the canal either, so they decided to do an apex resection.
Now, that happened in january.
The first radiograph is taken this week and I can see this:
- apex resection with a severly beveled root tip
- no retroprep nor retrofill
- the hole through which the "endodontist" searched for the canal, is just as big as a cylindrical
bur (the rest was non-opaque composit, which was placed by the original dentist.
- After opening, my suspections were confirmed, that there was still a cotton pellet in the canal.

I saw only 2 options: Trying to negotiate the canal and then do a RCT, possible with MTA apical plug,
or if I could not do a RCT, I would redo the surgery.

I treated tooth 16 and put in some calcium hydroxide. This took me 90 minutes, so after this, I asked
the patiŽnt if she could stay for an extra 30 minutes just to see if I was able to negotiate the canal.
I took the microscope, and then saw they searched too much to the B side. So I just searched some more
to the palatal and found the canal. I simply flushed it a few times, put in some calcium hydroxide
and will finish it in a second visit.

So, normally this tooth was almost lost, due to 'second-line "dentistry" failing completely'.
Grrr, just so frustrating sometimes. - RafaŽl Michiels

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