Huge Perforation!
16/09/2021
Ibrahim El Naggar
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Retreatment is one of the biggest challenges for the clinician due to the unexpected surprises, prognosis and diagnosis which may be tricky in many situations.
In this case, this female patient was complaining about pain during biting, related to a previously treated tooth.
Fig. 1
Pre Op , X - Ray showing a poor quality obturation and radiolucency in the middle of the tooth.
Fig. 2
In the Upper image we performed the testing before the tooth using the periodontal probe which gave normal sulcular depth.
In the lower image, while moving to the lingual furcation the probe penetrated deeper, indicating a problem in that site.
Fig. 3
Disassembling the restoration we found the presence of small Red Dot which may indicate a perforation which is covered by GIC in this situation.
Fig. 4
Using the Ultrasonic the disassembling of the Composite around the canals was made easily.
Fig. 5
The first surprise was the presence of a File underneath, moreover we had a good view of the perforation.
Fig. 6
Two canals and a huge perforation were visible
Fig. 7
The perforation site was closed with PTFE tape while starting with the retreatment of the two root canals
Fig. 8
Obturation done & PTFE in place.
Fig. 9
A resorbable collagen foam was put in the perforation
Fig. 10
A Bioceramic material was used to repair the perforation
Fig. 11
Post Operative X-ray.
After retreating the tooth and repairing the perforation, the patient was sent back to the referring dentist.
Conclusions
The Clinician must be able to assess the current situation from diagnosis, treatment till prognosis and also to be able to deal with different clinical surprises during the Retreatment.
Bibliography
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