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Case Presentation Roots

Therapy for 21. New patient, male. Age: 37 Pocket Depth 2-3, Movement 0, good oral hygiene, BOP+. Crown at 21 insufficient, inc. too long. Dehiscence at 11 Since a few years recurrence of pain and swelling in this area with positive percussion at 21 axial and sagittal.

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Case Presentation Roots

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  1. Therapy for 21. New patient, male. Age: 37 Pocket Depth 2-3, Movement 0, good oral hygiene, BOP+. Crown at 21 insufficient, inc. too long. Dehiscence at 11 Since a few years recurrence of pain and swelling in this area with positive percussion at 21 axial and sagittal. Some times with light quincke edema as an allergic reaktion  Treatment at general hospital. Involvement of 21 is supposed by physician Case Presentation Roots

  2. History. Trauma with crownfracture and open pulp 20 years ago. Therapy: Root canal treatment, stift cast building and crown. One year later massive swelling outgoing 21. Pain, high fever. >> Root cut with intubation anaesthesia . From this time on, recurrence of loosing the crown, leakages and so on. Since the last time ( 3 years ago ) the crown is too long. Dehiscence at 11 because of scars. Case Presentation Roots

  3. Occlusal correction of some unknown practitioners. Correction of occlusion. Now nonocclusion. Damage at ceramics palatal. Chronic irritation of the gum. Case Presentation Roots

  4. X-Ray Apicale periodontitis. Retrograde filling. Silver amalgam? Massive cast. Space between cast an root filling. Crestal bone o.k. Case Presentation Roots

  5. What shall we do. My plan. Removal of the cast and the root filling with orthograde access and desinfection. Perhaps surgery to remove the retrograde filling at the same time. Retrograde seal with MTA. New root filling und adhesiv fiber cast. Filling and finally new crown. Case Presentation Roots

  6. Case Presentation Roots Visit 1: • I removed the crown, the cast and the guttapercha. • Retrograde I found silveramalgam . • Rinsing with NaOCl, Alc. und EDTA. • Removing of the amalgamfilling with piezo instruments ProUltra (Maillefer/Dentsply) from orthograde. • Frequently rinsig with Chlorhexidine. • Removing of Am particles with micro suc. • After removal of Amalgam -->> Pus (+++). • Rinsing with CHX until there came no pus anymore. • Ca(OH)2, Cavit, crown fixed with Harvard cement.

  7. Case Presentation Roots Visits 2 - 8 • Two days later --> massive Pain. • Crown ex. / Cavit and Ca(OH)2 ex. / Pus (+++) -> Pain stopped immediately. • I perforated the crown pal. and fixed it with adhesiv cement and let the tooth open. • Daily rinsing with CHX. Antibiosis for seven days with isocillin. • Three days later Ca(OH)2 again and tight closure. • Changing of Ca(OH)2 weekly. Ca(OH)2

  8. Case Presentation Roots Visit 9 • After 4 weeks -->> • Apical closure with MTA. Waiting for 20 minutes until MTA is solid. • After that > rinsing with NaOCl ,Alc.. • Activation of NaOCl with piezo technique. • Root filling with Guttapercha / vertically condensation (Sybron Elements). • MTA has been pushed forward a little bit, although I carefully filled the guttapercha in. Ca(OH)2

  9. Case Presentation Roots Visit 9 • Some clinical pictures

  10. Case Presentation Roots Visit 9 • Adhesive fixing of fiber cast with Syntac Classic + Variolink II. • On X-ray it seems that there were some unfilled areas. • But I think it is either the cast or the less radiopak resin. • I‘m sure I filled it up totally. Ca(OH)2 MTA Guttapercha Fiber cast

  11. Case Presentation Roots Visit 9 • Build up with 3M/Espe Filtek Z250 A2 • Preparation • Temporary crown • Since 9 Month without any problems. • Perc. (-) axial as saggital. • Definite Crown is scheduled. • Thanks for your attention and criticism.

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