When Retreatment Fails…
30/11/2023
Fellow
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The role of endodontics is to save as many teeth as possibile. Today thanks to technology (Microscope, CBCT, New instruments) we are able to manage very difficult cases. It’s very important manage different situation because sometimes first endodontics treatments and also retreatments fails.
Today thanks micro-endodontic surgery we are able to give a “new life”to our teeth.MB1, MB2 and their isthmus Suture
Fig. 1
X-ray show my retreatment of first left upper molar.
Despite microscope and ultrasonic tips I have not been able to find and treat the MB2 (Second Mesio-Buccal canal).
Fig. 2
The importance of CBCT today to show us in a very simple way the problem.
In this case show a very large lesion not visibile in a 2D X-Ray affecting the mesio-vestibular root.
So i decided to do micro-endodontc surgery to solve the problem.
Fig. 3
After the flap we can appreciate the dimension of the lesion.
Fig. 4
Mesio-vestibular root.
Fig. 5
MB1, MB2 and their isthmus
Fig. 6
Methylene blue for see better the limits of the root and make evident the presence of extra canals, voids, cracks and other characteristics of the root.
Fig. 7
Ultrasonic tips for the creation of the retrograde cavity.
Fig. 8
Bioceramic Putty as material for the obturation.
Fig. 9
Suture
Fig. 10
X-Ray Post-Op
Fig. 11
X-Ray Control at 1 year
Fig. 12
2015: Graduated in dentistry from the University of Valencia.
2017: Master in Endodontics from the University of Bologna.
Federico Michelini has been a speaker in national and international congresses regarding endodontics.
Tutor of the Master of Endodontics and of the Degree Course of Dentistry and Dental Prosthesis for the University of Bologna.
He won the Closed Meeting of Italian Society of Endodontics in 2019.
He attended the advanced course of retreatments and endodontics surgery of Italian Academy of Endodontics.
He attended the course of microscopy by Dott. Fabio Gorni.
Member of the Italian Society of Endodontics
Member Fellow of Style italiano Endodontics.
Opinion Leader and Speaker for Morita, Coltene and Labomed.
He works in Parma and Piacenza dedicating to microscopic endodontics.
Conclusions
Endodontic surgery its a great option to solve treatment that in orthograde way fails.
Important not to forget that its very important know the anatomy and its variables and for sure works with correct instruments to work in a simpler and best way. I think that in case of Endodontic surgery a CBCT as a pre-operative X-ray is mandatory because give us a lot of information that 2D X-ray does not give us.
We have to believe in Endodontic Surgery because help us to solve a lot of problem and to save teeth.
Bibliography
1)Syngcuk Kim, Samuel Kratchman. Modern endodontic surgery concepts and practice: a review. J Endod. 2006 Jul;32(7)
2) Frank C Setzer, Samuel I Kratchman. Present status and future directions: Surgical endodontics. Int Endod J. 2022 Oct;55
3) S Patel, J Brown, T Pimentel, R D Kelly, F Abella, C Durack. Cone beam computed tomography in Endodontics - a review of the literature. Int Endod J. 2019 Aug;52(8).
