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The opinions within this web page are not ours. Authors have been credited for the individual posts where they are

Symptomatic apical Periodontitis

From: Javier Pascual To: ROOTS Sent: Saturday, August 23, 2008 5:31 PM Subject: [roots] Saturday Morning Retreatment A good friend of mine phoned a couple of days ago with a little problem. Best I could do but maybe I missed a middle-mesial canal, or is it a lateral? what do you think?

excellent case presentation and i would like to know what is the material of choice in case of perforation - Dr.kishore nallapati. Javier, thanks for sharing this wonderful case! Could you please share your opinion on general prognosis for this type of perforations (i mean, that was way huge perf...)? Also, did you cover the chamber floor with MTA (on x-ray there is similar radiographic density...what's the material?)? If yes, why? - Dmitri Thanks Pavan and Dmitri. Ideally a nonsurgical technique through intracoronal placement of the material to repair the perforation should initially be done in order to preserve the periodontum and increase the probability of long term success. (Regan JD. Endod Topics 11-2005) Level, position, size and time are related with the prognosis (Ruddle Pathways of the Pulp). Material and the hability to see (Dental Microscope) the defect are also crucial too. In this case the deffect couldnīt be repaired in situ, so we recomended to place CaOH. The perforation was sealed as soon as we could (after two days). The perforation defect was repaired with MTA (Torabinejad and Chivan Clinical Applications of MTA JOE Mar 1999), then I covered the pulp chamber floor with a flow composite. Moisture from the perforation will allow to set the MTA. In my opinion prognosis for the perforation is good: short time, good material and proper placement - Javier Javier, thanks for such a comprehensive answer :-) I have one more question though: When you covered MTA at the same visit with flowable composite what was the adhesive sequence? Did you etch and prime before MTA placement? - Dmitri I confess this was first time I tried this sequence. I read it a few weeks ago in roots. I wait a few minutes for initial setting and then etch and prime over MTA. I couldnīt appreciate (visually and gentle touch with a DG16) any change (hardness) in my packed MTA after the procedure. This was a really thin layer of material and moisture from the perforation would be enough for a proper set. What do you think? - Javier

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