December 2, 2011
If this were your tooth, what would you do….feel free to comment below
Here is a really herodontic case!
Reasons not to save it:
1. Radiological findings indicating severe bone loss
2. Lack of ferrule
3. Huge perforation in the distal canal
4. Three fractured instruments – lentulo, Haedstrom and K-file
Reasons to save it:
1. The patient wants to keep her natural tooth
2. Can’t afford grafting+implant+prostho
3. No periodontal involvment, normal probing
4. Vital adjacent teeth, she didn’t want to do a bridge.
5. The referring dentist wanted me to save the tooth.
And I decided to perform the RCT with the informed consent signed and the patient informed that this tooth may not last long. The patient came to me with pain on percussion and palpation. After opening the tooth I saw that pus was draining through the large perforation. After removing the three instruments, Ca(OH)2 was placed for a two week, followed by another Ca(OH)2 placement for 2-3 weeks. All symptoms were gone and the perforation was moist and not wet (Leandro’s thing) I decided to obturate. The mesials are obturated with squirting technique and the distal is filled with MTA, using a collagen barrier (BioGide resorbable membrane). The post endodontic build up was done with two fiber post in the mesials and Gradia resin composite.
I want to hear your thoughts o this case – will you treat this case before knowing the reasons to save it or not? Will you treat it after knowing them? All critics are welcome!
Bojidar Kafelov, DDS
Svedent Dental Clinic
Sofia,Bulgaria,9 Solunska Str.