In this case 79 year old lady reported with a symptom of internal radicular resorption.
CASE TREATED BY DR. JAVIER PASCUAL
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From: Javier Pascual
To: ROOTS
Sent: Friday, June 11, 2010 12:16 AM
Subject: [roots] after Marga´s lecture I want more and more and more…
79 years old lady referred to my practice for RCT on tooth 1.2 with an internal radicular resorption
Vital pulp tissue inside the root canal system. Working lenght determination with Root ZX to 19,5 mm and confirmation with radiographs. Instrumentation with Protaper/Profile. Apical gauge bigger than #60.
Irrigation with 4% NaOCl and PUI with Satelec Irrisafe. Intracanal dressing with Calcium Hydroxide
Ultracal XS because uncontrolled bleeding
NEXT VISIT in 7 days. What do you think about this treatment option?
TENTATIVE PROCEDURE >>> Apical plug with MTA. Do you think this is a good option here Grey angelus 15 minutes setting and thena fiber post in the same visit? Or should I wait with a wet cotton pellet and give the patient a third visit?
Fiber Post:
a) Long and narrow, deeper than the resorption deffect to have better stability
b) Short and wider in order to fit it to the resorption deffect as much as possible
Can you give me some clinical tips…??
use scope, use centrix system to deliver core material inside the canal…
which core material? which adhesive system? how to apply properly my adhesive system? what kind of matrix
should i use here? single or multiple isolation? … ..Javier
Dear Javier,
I agree with your approach here, and would opt for B, a post that fit into the resorption process passively.
I would not remove additional dentin to accomodate the post. That means that the resorption process will be mainly filled with composite.
I usually reschedule a patient after placing an apical MTA plug. Looking at your case, my rational for this:
1. Apical foramen is not very wide, MTA needs moisture to set. I would insert a moist pellet to add some
extra moisture
2. There are some papers that showed that acid-etching on fresh MTA may affect the compression strength and surface hardness of MTA. Therefore. it is recommended to postpone acid-etching of MTA for at least 96 hours
after its application… MARGA
JAVIER >>>
THANKS ALL FOR YOUR MAILS, THEY ARE TRULY APPRECIATED. FINALLY REFERRING DENTIST DIDN´T ALLOWED ME TO RESTORE THE TOOTH. THIS IS TYPICAL IN SPAIN IF YOU HAVE A PRACTICE LIMITED TO ENDODONTICS. I HAVE JUST FINISHED ENDO RIGHT NOW. FINALLY A GUTTAPERCHA/AHPLUS OBTURATION FOR THE APICAL THIRD, I MANAGED TO FIT A GUTTA CONE (GAUGE #60) MODIFIED SECTIONAL OBTURATION WITH SYSTEM B IN ORDER TO AVOID GUTTAPERCHA OR CEMENT IN THE RESORPTION DEFECT AND THEN CAREFULL BACKFILL WITH EXTRUDER JUST APICAL TO THE RESORPTION DEFFECT. GP WANTS OPTION B FOR THE FIBER POST (POST JUST AS BIG AS -POSSIBLE- RESORBTION DEFECT) – Javier
Post Op Photos >>>
