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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
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
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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
case presentation roots3
Occlusal correction of some unknown practitioners.

Correction of occlusion. Now nonocclusion.

Damage at ceramics palatal.

Chronic irritation of the gum.

Case Presentation Roots
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X-Ray

Apicale periodontitis.

Retrograde filling. Silver amalgam?

Massive cast.

Space between cast an root filling.

Crestal bone o.k.

Case Presentation Roots
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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
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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.
slide7

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

slide8

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

slide9

Case Presentation Roots

Visit 9

  • Some clinical pictures
slide10

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

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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.