Wednesday, May 28, 2008

Surgical Repair of Post Perforation

This patient presented without pain but presence of draining sinus tract in the buccal attached tissue over #7. The position of the draining sinus tract directly at the level of the post, normal periodontal probings and evaluation of the radiograph made me suspicious of a post perforation. (note the widened ligament to the level of the post, and completely normal appearance at the periapex)
Options discussed included retreatment or apical surgery. Since the crown is all porcelain, we decided to treat surgically.

Ochsenbein-Luebke surgical flap was selected to prevent recession of marginal gingival, and minimal loss of crestal bone. The periodontal attachment was still in tact following flap reflection despite the loss of buccal bone adjacent to the perforation.


Metal tip of the post was visible without any removal of any buccal bone.

The post was counter-sunk using a high speed handpiece.

Preparation of the root. Note that this was not the apex of the root. This repair was being done on the mid-root surface.


Geristore was selected as the restorative material. Since Geristore is a bonded material, moisture control is important. Astringedent was used for hemostasis and the root was acid etched, primed and bonded.

Geristore placed in the preparation and cured.

Geristore was contoured to the root surface.


Final film. This will be an interesting case to follow. Expect a good result and repair of boney defect. We'll continue to monitor this tooth over time. Endodontic surgery has provided a valuable service to this patient prolonging the life of this tooth, the crown and hopefully regenerating the boney defect. Stay tuned for updates!

12 comments:

Javier Pascual Irigoyen said...

Great!! That is a really interesting case. Please could you tell me why did you choose and Hybrid Ionomer instead of MTA? Another question, do you always use MTA as retrofilling material? maybe sometimes SuperEba or Geristore? If not, which are the reasons to decide for one especific material? Again CLAP CLAP CLAP. Most of the endodontists from Spain have one problem, we aren´t well form in endo surgery.

Jason J. Hales D.D.S., M.S. said...

I chose to use the Geristore instead of MTA because of the boney defect and the nature of the preparation. As you can see, I was not using an ultrasonic to do a typical retropreparation. I simply countersunk the end of the post and sealed over it. I did not have the mechanical retention that a normal retropreparation would have to retain the MTA. My concern with using MTA for this repair was that it might wash out.

McLupu said...

you do not think that glass ionomer will permit leakage (even is adhesive cement) ?

Jason J. Hales D.D.S., M.S. said...

I chose Geristore because of the need for bonded retention and its biocompatibility. Here are a few quick articles showing some of the beneficial aspects of Geristore as a root repair material.

A 2001 study by Greer, West, Liewehr, Pashley, (JOE, July 2001 Volume 27, Number 7)suggests that the new compomers Dyract and Geristore are equal or superior to IRM and equivalent to Super-EBA in their ability to reduce apical leakage when used as retrofilling materials.

A study by Camp, Jeansonne, Lallier, (JOE September 2003, Volume 29, Number 9)
showed that gingival fibroblasts attach to Geristore better than MTA or SuperEBA.

An invitro study by Pichardo, George, Bergeron, Jeansonne, Rutledge (JOE, April 2006, Volume 32, Number 4) showed Geristore having better sealing ability than MTA and SuperEBA.

Josh said...

Jason...
First time reader of your blog. This is great information. I plan on making this a regular visit during my non-productive times!

With the root perf from the post, do you feel like bacteria was able to leak into the root canal system through the perf? If so, would you have retreated the endo as well?

Jason J. Hales D.D.S., M.S. said...

Josh,
Great question. In this case, I made sure that there was no coronal commumination in the area of the defect. (You can see my perio probe did not communicate) So my assumption was that retreatment was not needed. Also there is no sign of apical radiolucency. If this were my tooth, I wouldn't have retreated it. We'll watch closely for healing and be more aggressive if needed.

Essma said...

Really interesting case! Btw, extra blog! Congradulations, and regards from Bosnia!

The Bondi Beach Dentist said...

Wow, interesting case.
Aren't you concerned with moisture control?
Haddon (dentist in Sydney, australia)
http://www.bondibeachdental.com.au

Jason J. Hales D.D.S., M.S. said...

Moisture is controlled in the surgical enviroment with continous suction in the area, hemostatic agents, and speed of treatment. It really dries up quite nicely. Remember the treatment is done under the microscope which allows us to monitor moisture during the procedure as well.

Jason J. Hales D.D.S., M.S. said...

Moisture is controlled in the surgical enviroment with continous suction in the area, hemostatic agents, and speed of treatment. It really dries up quite nicely. Remember the treatment is done under the microscope which allows us to monitor moisture during the procedure as well.

H and L Office furniture said...

I am a dentist in Sydney from www.dentistbondisydney.com.au named Dr Andrew Sih. We do many dental implant cases and just wanted to tell you how interesting this case is.

Patricia Surgical Dentist said...

I just love reading your article. The one you handled is probably an unusual case. Anyway, this is good for students who are studying further in the field of dentistry. Thanks for this information.

I must say you deserve a thumbs up!