Check Page Ranking

Home
Dental tourism
Conferences
Dental books
Bad breath
Kids caries
Smoking effects
Patient info
Dental Videos
Wisdom tooth
Diabetes
Drugs of choice

Endo tips    Better Endo    Endo abstracts    Endo discussions


 Perforation


The opinions within this web page are not ours.Authors have been credited
for the individual posts where they are. - www.rxroots.com photographs courtesy: Marga Ree
From: Marga Ree
To: ROOTS
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
healing.

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

Hi 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)

Protaper flaring

6 yr old Empress

Cvek pulpotomy

Middle mesial

Endo misdiagnosis

MTA retrofill

Resin core

BW importance

Bicuspid tooth

Necrotic #8 treatment

Finding MB2 / MB3

Deep in a canal

Broken file retrieval

Molar cases

Pushed over apex

MB2 and palatal canal

Long lower third

Veneer cases

CT Implant surgury

Weird Anatomy

Apical trifurcation

Canal and Ultrasonics

Cotton stuffed chamber

Pulp floor sandblasting

Silver point removal

Difficult acute curve

Marked swelling

5 canaled premolar

Sealer overextension

Complex anatomy

Secondary caries

Zygomatic arch

Confluent mesials

LL 1st molar (#19)

Shaping vs Cleaning

First bicuspid

In Vivo mesial view

Inaccesible canals

Premolar 45

Ortho and implant

Radioluscency

Lateral incisor

Obturation

Churning irrigant

Cold lateral

Tipped to lingual

Acute pulpitis images

Middle distal canal

Silver point

Crown preparation

Epiphany healing

Weird anatomy

Dual Xenon

Looking for MB2

Upper molar resorption

Acute apical abcess

Finding MB2

Gingival inflammation

Irreversible pulpitis

AG BU ortho band

TF Files

using TF files

Broken bur

Warm technique

Restorative prognosis

Tooth # 20 and #30

Apical third

3 canal premolar

Severe curvature

Interesting anatomy

Chamber floor

Zirconia crown

Dycal matrix

Cracked tooth

Tooth structure loss

Multiplanar curves