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Treatment plan dilemma (by Ilya Mer)

All clinical cases Cases by Ilya Mer Endodontics Perforation repair RetreatmentPublished February 27, 2015 at 9:17 am Comments Off on Treatment plan dilemma (by Ilya Mer)

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One more puzzle case which treatment plan better in this case. Surgical or non surgical?

Preoperative images  Tooth  was attempted to retreat within last month. Any canal in  MB root  couldn't be negotiated. Via falsa and small perf in mid third was done. Tooth needs new prosthesis but prosthodontist doesn't want to keep this tooth without root canal done and sent me that patient for evaluation. What treatment plan would you choose?

Preoperative images
Tooth was attempted to retreat within last month. Any canal in MB root couldn’t be negotiated. Via falsa and small perf in mid third was done. Tooth needs new prosthesis but prosthodontist doesn’t want to keep this tooth without root canal done and sent me that patient for evaluation. What treatment plan would you choose?

Well, MB root looks hopeless, ledge in mid third in most cases means you can’t negotiate this canal till apex. In cases like that surgical approach can be considered as a first choice. But how about MB2? Can it be helpful to find the way to an root apex? I case you find MB2 it can work out.

And it worked out!

And it worked out! I found an orifice just next to GP at MB canal

and negotiated canal till it's apical portion

and negotiated canal till it’s apical portion

Actually ledge and perf was done because of lack of straight line access  to MB root. Only one canal was found in MB root. Perf were sealed with BC sealer (at the same moment  with obturation)

Actually ledge and perf was done because of lack of straight line access to MB root. Only one canal was found in MB root. Perf were sealed with BC sealer (at the same moment with obturation)

Final images You could see my attempt  digging for additional canal which wasn't found. Hope it was really only one canal.

Final images You could see my attempt digging for additional canal which wasn’t found. Hope it was really only one canal.

So why the choice was non surgical ReTx? The access was very easy and attempt to find MB2 was reasonable. In case of final restoration already been done – surgery would be first option in my clinic.

 

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