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Failed case of mine - Courtesy ROOTS

From: Mark Dreyer 
Sent: Wednesday, March 09, 2005 9:23 AM
Subject: [roots] Failing case of mine

First x-ray is pre-op.  Second x-ray is MTA repair of strip perf with file in canal 
to maintain patency while MTA was setting.  Did a month of caoh, all symptoms resolved.  
Lower left is post-op x-ray taken the day we completed, and lower right x-ray is 
today on recall showing large lesion on distal.

No isolated deep probing defects and no major symptoms other than some mild tenderness 
with chewing (thankfully referring doc picked up on this complaint and sent patient
back to me prior to doing crown)

Advised patient that I hope the problem is that I missed a distal canal as that would 
explain the failure to heal on the distal.  I will go back in and look again.  Iím 
going to irrigate with the Sterilox fluid also.  Advised worse case scenario is we 
canít get healing with non-surgical means and then root end surgery will be indicated - Mark

If you don't find another canal why not just retreat that root.  I've done that a 
couple of times and had success.  Don't know why but it worked. Guy

Check for a crack and vitality on #31.  I doubt you missed a canal, but of course 
you should look.  I love doing lower molar surgeries - DanS

Dear Mark: I also think the problem could be from 31. Is there decay on the mesial? - Jorg

The tooth responded vital last October.  I didnít retest this time.  Iíll be sure to do 
that when he comes back for the re-tx  - Mark

Mark, Looks like strip perf repair is going well--although incomplete healing, at least 
from the view shown. What was the recall period?

I'm not quite sure why the root filling looks 'fragmented' in the apical few mm's of 
the distal. However, I agree taht you may have missed a second distal canal 
(judging by the eccentric position of the obturation and root anatomy). I'm a little 
concerned about the coronal restoration at recall. What material is it, who placed it, 
and how long has it been there...looks like either GIC to me--coronal leakage???

Also, I presume the second molar is vital?? And...what was the final apical size of the
distal. I'd go to at least a size 45/04 or even 60/04, depending on the 'feel' of the 
canal, of course- Peter

Hi Peter, The recall period is 5 months.  The MAF on the distal was 50.  I usually do
a bit of a stepback to get at least a .10 taper.  Not sure on the restoration.  
I always do bonded resin seal of the chamber floor so hopefully no leakage.

Iíll post followup including re-testing of 2nd molar which was vital last October - Mark
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