Home page
Bone regeneration
Root fracture
Filing buccals
Apical periodontitis
Off angle xray
Bicuspid
MB3
Lower Bi
5 canals
Sinus tract #13
Perio endo lesion
Inflammation
Calculus formation
Antibiotics in periodontitis
POE for MB2
Balloon sinus elevation
Confluent MB system
Lasers in endo
Endo cases
Antimicrobials
Molar case # 17
Dark color dentin
Gum pain
Ortho reabsorption
Strange anatomy
Tooth abscess
Dens case Tx options
Deep bifurcation
Buildups in RCT
Smoking /dental health
Immediate implant
Fractured US tip
Silver cone removal
Dental trauma
Post and core
Apico # 19
Irreversible pulpitis
MB, DB and P
Extra anatomy

Peri apical cyst - Courtesy ROOTS

Endo tips    Better Endo    New additions    Endo abstracts    Back to home page    Endo discussions

The opinions within this web page are not ours. Authors have been credited for the individual posts where they are. Photos courtesy Carlos Heilborn, Reggio Emilia - ROOTS

From: Carlos Heilborn
To: ROOTS
Sent: Saturday, January 05, 2008 12:15 AM
Subject: [roots] Opinions and suggestions welcome

First very difficult situation of the year
I have received this case last week, for me it is a peri apical cyst, but considering the size and that is very productive
( I have drained it through root canal twice in a week) I would like to know how do you think this case should be
approached.
Conventional RTC and monitoring
Surgical Approach
Marsupialization
Any other dx tools prior deciding? - Carlos Heilborn

I would use 2 ca(oh)2 appointments, from 3 to 3 months, rx reevaluation, and apical plug of mta, most cases heal just fine. - Sergiu Nicola Hi Carlos, Difficult case indeed. Dens invaginatus type II, associated with a very large lesion. I would try to remove the whole dens tract, which can be difficult, due to the enamel lining. When the canal keeps weeping, you could consider to do a marsupialization or decompression, because the lesion is huge. When it has decreased in size, you can fill the canal with MTA, whether or not in conjunction with surgery. Good luck! - Marga Hi Marga, Thank you very much for your suggestions, I will try to do my best!! - Carlos In my opinion this is a case of "dens invaginatus". I treated three or four cases with conventional RTC. I removed the anomalous structure in the coronal part and in the coronal third of the root then I performed the treatment in one visit only. In your case I suggest the use of MTA to seal the wide apex. You'lI find here enclosed a similar case that I treated with thermoplastic guttapercha and cement only. Prof. Emanuele Ambu - University of Modena - Reggio Emilia (Italy)

Dear Prof. Ambu Thank you very much for your answer and suggestions. Thank you for the case you posted, is quiet similar to the one I have to treat. Best regards from Asunción, Paraguay - Carlos Heilborn Hi Carlos, I always prefer the conventional RTC and follow-up before surgical approach. I believe that sometimes we can have an agreeable surprise. In this specifically case, I would do a MTA apical plug because of the wide-open apex. Please attached find a case report of mine in which I have used Portland cement for research purposes. Of course, that your case is more complex considering the cyst size. However, using a MTA apical plug you still have a promise of healing; see the attached case of the competent group of Florence University. I hope that this can help you a little. - Gustavo
Searching for MB2
Implants #18, #19
Nice retrofil
Molars with lesions
Tooth #4
Apex locators
Large Apex
Access pictures
Lower incisor retreatment
Horror case
porcelain onlay
Conservative access
Peri radicular healing
Beautiful cases
Resilon cases
Unusual Apex
Noemi cases
2 upper molars
2 Anterior teeth
Tooth #35
Anecrotic molar
Direct capping
Molar cracks
Obstructed buccals
File broken in tooth
Separated instrument
Delta
Dental Products
Dental videos
2 year trauma
Squirt on mesials
dens update
Palatal root exits
Color map 3
Middle mesial
Continuous pain
Anterior MTA
Previous trauma
Ideal case
Dens Evaginitis
Check Page Ranking