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Endo Questions for the RWE Faculty:

In this area, users are encouraged to ask questions from the RWE Faculty regarding Endodontics in General and the EndoSequence Technique.

Endo Questions for the RWE Faculty:: Case ??

Missing

Joined: July 2018

Rank: Officer

Posts: 33

#1
Hello, I did this case in late 2013 , I did indirect pulp caping in lower 6 using caoh2 and filled wz composite filling, cl.ll as shown in the first x-ray( taken 8 months ago), but we didn't follow up the case since then, until 8 months ago the patient complained again but this time there is a sign of recurrent caries, leakage occurred !!? ( Think that caoh2 dissolved leaving a gap).., huge lesion is present related to the mesial root..so we did a Rct and Now there is a sign of healing in this j shaped lesion, I did this Rct under isolation following the correct protocol , irrigated wz 250 cc of naocl, 50 cc wz chlorohexidine in 5 appointments activated by PUI , MDA...,edta cream used all over the procedure wz each file, intracanal medication was used for a period of time ..., The problem here is that there is intermittent pain esp. in occlusion, when chewing food ....what should I do now?? Should I do Rettt ??? Thanks

Attachments: Fb_img_1539779789751 Fb_img_1539779793461

Allen_ali_nasseh

Joined: August 2013

Rank: Faculty General

Posts: 297

#2
In reply to Mina Moheb Post OP radiographic quality is not diagnostic. You have over prepared both roots. There's a chance that there may be strip perforation. There's certainly an apical perforation. A CBCT and axial view will help triage the case. Do not retreat as they tooth will be further weakened. If there is no strip perforation (based on CBCT) an exploratory surgery by a microscope trained endodontist can possibly still save the tooth. Otherwise, extraction may be required. Please make sure not to prepare the canal to such large sizes. You have to look a the preoperative radiograph and your working length file shots to determine what size would be adequate. Every tooth is different. This is too large for this tooth. 
Missing

Joined: July 2018

Rank: Officer

Posts: 33

#3
Thank you sir, if there is a perforation of any kind will healing occurs like in this case? Mesials are prepared to F2 hand protaper ,distal F3 hand protaper....what is your taper& size for such molar ??

Attachments: Screenshot_20181019-155501

Allen_ali_nasseh

Joined: August 2013

Rank: Faculty General

Posts: 297

#4
In reply to Mina Moheb Depends if it was disinfected enough before obturation, what kind of material was used for obturation (biocompatibility/seal/antimicrobial qualities) and other factors. If it's a strip perforation and is symptomatic it's not a good sign. Observe to see if it heals. If it breaks down you may need to extract. 
Missing

Joined: July 2018

Rank: Officer

Posts: 33

#5
Understood sir, what is your taper& size for such molar ?