Friday, November 30, 2012

Root Canal Surgery to Repair Post Perforation


#6 Post perforation on a long span (7 unit) bridge. Pt is insistant that she does not want to lose this tooth or bridge at this time.  Lateral radiolucent lesion is present adjacent to the perforation.
CBCT taken to evaluate the position and extent of perforation, bone loss and possible surgical intervention. Given the treatment options, the patient wishes to try and maintain the tooth with surgical repair of post perforation. Pt understands that post repair will not improve coronal margins, but does not wish to replace bridge at this time.
Surgical flap reflected, post perforation located, 2-3mm post resected, lateral root preparation created.
Geristore used to repair root.
Lateral root restoration contoured to adjacent root.
Post Op radiograph showing perforation repair.
6 month recall showing initial healing. Pt is asymptomatic and fully functional.
At 18 month recall, bone has healed completely, tooth #6 is asymptomatic and fully functional.  Tooth #4 is now testing necrotic w/ asymptomatic apical periodontitis. RCT has been recommended.

 This case demonstrates how a skilled endodontist's surgical abilities can save what would seem like non-restorable, iatrogenic damage.




6 comments:

Anonymous said...

Why reflect the flap all the way from the gingival margin instead of making a semilunar style design?

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

You could do a semi-lunar flap, but this particular case, we are addressing the lateral root surface, so I think a full thickness flap gave me better access to the defect.

Jay Denton said...

I thought MTA would be used for this type of repair. Is that another option?

Justin M. Parente, DMD said...

Nice case Jason!

Harold Craig said...

Is this the more recommended method of conducting a post-perforation surgery? It seems like this particular procedure took up a pretty large chunk off the root.

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

Harold,

Actually, I thought that was a pretty conservative amount of root removed. I had to take enough of the post off to have some retention for the repair material.

Jason