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where they are. - www.rxroots.com photographs courtesy: Marga Ree
From: Marga Ree
Sent: Saturday, January 29, 2005 3:26 PM
Subject: [roots] Perforation
This is a previous post from January this year, to show you a similar
tissue lesion after a perforation. I think that it must have been the
NaOCl that caused this effect, but it healed uneventfully. - Marga
This 50 year old woman presented with irreversible pulpitis of tooth # 35.
The referring dentist did an attempt to start a rct, but he made a
perforation and didn't find the original canal. He told me that he had
irrigated with NaOCl, tried to dry the canal with paperpoints (and I suspect
with air from the air-water syringe) and all of a sudden the patient
reported a sharp pain. He stated that he stopped the treatment immediately,
filled the access opening with Ca(OH)2 and removed the rubber dam. Then he
noticed that there was a swelling of the left side of her face. He referred
the patient to me with the request whether I could see her the same day,
which I did. I noticed a perf to the buccal side, and after cleaning and
shaping the original canal, I closed the perf with MTA, applied Ca(OH)2 and
rescheduled the patient within 3 days. I told her that the swelling might
have been caused by an air emphysema or the NaOCl. After 3 days the swelling
had decreased, but the patient reported a numb feeling in the left side of
her face, and the whole area was very sensitive upon touching. There was a
soft tissue lesion present, which I cleaned out. I removed some necrotic
tissue and remnants of set MTA. Then I finished the rct. Today I saw her
again, 1 week after I finished the rct. She was almost free of
symptoms and reported that the normal feeling was coming back. The soft
tissue lesion was closing and showed signs of
What caused the swelling? Was it indeed an air emphysema or NaOCl?
What caused the soft tissue lesion? Ca(OH)2? NaOCl ? A combination of the
above mentioned factors?
Looking forward to your input. - Marga
I saved all the information you sent to me!
I will read carefully the articles you sent...and will pay attention to your
protocol and guidelines. I hope to see the patient tomorrow. She scheduled an
appointment at the course with us...I have a particular interest to
follow up this case...so...I SCHEDULED her to one of my best students...so it
will be possible to me to act in the case...and she will follow my guidelines
and we will follow together ROOTS guidelines...ROOTS UNIVERSITY...sharing cases,
learning with cases and experiences around the globe...Digital archive...
Articles in the folders to read and remember....WONDERFULL! NEXUS!!!
I will try to take pictures to keep you informed! Thank you very much!
- Márcia Valéria (Brasil)