A thing of beauty is a joy forever – unless you’re an anti-endodontite!

This 16 year old girl was recommended to have 36 extracted. Her dentist separated an instrument, and caused a perforation during an attempt to remove it. She was referred to an endodontist who recommended extraction. I have to say that I can understand his decision, because there was a huge lesion in the furcation, she was on antibiotics, and the tooth was pretty painful on touch. The reason why we decided to give it a go was the motivation of the patient to preserve her tooth, and the fact that there was only a wide occlusal cavity, so restorative prognosis was good.  

In the first session, I was able to bypass the fragment and seal the perforation with MTA. In the second session, I could remove the instrument, and placed CaOH again, due to draining distal canals. 

We waited for 2 months, and she returned symptom free. Because it was impossible to obtain dry canals in the distal root,I decided to use a MTA based sealer (BioTech Endo sealer,an Italian product by Isasan) in combination with resilon cones. MTA is a great product, but pretty difficult to get it in small, narrow spaces like the apical portion of a root canal instrumented up to a file size 35/40. This type of sealer is not sensitive to moisture, it needs moisture to set, so that is an advantage in case of a weeping canal. Disadvantages of this sealer: you need to mix it yourself, it’s not easy to  get it down into the canal due to its consistency, and the radiopacity is mediocre, see the apical portions of the distal canals, it’s hard to identify the sealer. 

After 2 months of CaOH, the lesion had already decreased in size. One year follow-up shows a beautiful healing.

Marga Ree