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The opinions within this web page are not ours.Authors have been credited
for the individual posts where they are. - 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

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 SCHEDULED her to one of my best 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)

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