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From: "Kostas Tsaltas"
Newsgroups: roots
To: "ROOTS"
Sent: Friday, October 14, 2005 2:56 PM
I need your valuable suggestions for the management of this case.
Tooth #21 with apicoectomy without ortho or retrograde obturation,
active fistula, presence of an istrument (reamer?) in the root canal,
and periodontal problem.
The options are too many and i am a little bit confused.
How do you suggest me this case should be managed? - Kostas
I would go for the conservative management first....retrieve the
instrument from inside teh canal, establish an apical stop, debride,
irrigate, place an intracanal medicament(CaOH)....when the fistula
closes and teh signs subside....Fill - Hend
Retreatment with out of doubt. Access, remove the instrument,
CaOH, if the apex is too open MTA apical plug - Carlos Murgel
Kostas, I think I would try to remove the instrument, which, in this
film seems to go all the way into the pulp chamber and hopefully this
makes it relatively easy to remove.
If you can do that, then I'd place Ca(OH)2 for a few days, have the
pt back, and then, in my opinion you could choose between three
different options: 1/ conventional endod, with probably a wide open
apex (due to apicoectomy), but you might still be able to get a stop
by tapering the prep; 2/ MTA apical plug and back fill, 3/ attempt
revascularization (see paper) (if yoht not need to place Ca(OH)2,
and place the triple paste instead after removing the instrument).
what do you think, Kostas? - Marcos Arenal
Kostas , Just this week I have removed a broken file similar to your
case, but it was a big Hedstroem file.
It took almost 10 min with the ultrasonic unit around the coronal tip and
hand files to find a way between the instrument and the canal walls
BTW I would think first in conventional endodontics with caoh for 2 weeks
good luck - Carlos Heilborn
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