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Symptomatic apical Periodontitis
From: Javier Pascual
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
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