Claudia Hoffman
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 TWENTY-FIVE-YEAR-OLD
female presented to our office with a history of root canal therapy,
installation of a post and core, and a temporary crown three months
prior to her visit. The patient had unremarkable medical and
dental history. Her chief complaint was, “I had a root canal and
ever since my tooth has hurt. First it swelled up and now it just
aches all the time. I was told I need a root amputation.”
The initial radiograph revealed that # 30 had
undergone root canal therapy that appeared good, but there was bone
loss in the furcation. (See Figure 1.) The intra-oral exam
revealed pain in response to percussion, palpation, and chewing.
The patient was advised that # 30 was losing
bone in the furcation and was possibly cracked or perforated. The
treatment options were presented to the patient: extraction and an
implant or bridge or exploration and possible repair if at all possible.
The patient chose to have me try to find the
etiology of the problem and try to repair the problem if
possible. She was advised that the prognosis for any treatment to
try to save the tooth at this time was very guarded.
The tooth was isolated under a rubber dam and the
core filling was removed. A large round perforation was apparent on the
mesial-buccal area, and there was tremendous bleeding and destruction
of the bone. The perforation was cleaned and irrigated with
sodium hypochlorite, EDTA, and chlorohexidine. Then the repair
was sealed with MTA. This material was chosen because it exhibits
excellent tissue compatibility and creates a non-resorbable
barrier. Also, it was very difficult to obtain homeostasis and
visibility, MTA is the material of choice in areas with potential
moisture and difficult visibility. (See Figure 2.)
The procedure was performed six weeks ago; the patient was sore for two
days and then felt fine.
This perforation has a very guarded
prognosis. Perforations in the furcation threaten sulcular
attachment, and in this case has been compromised. The more
apical the perforation the more favorable the prognosis. Also,
the perforation had three weeks from perforation to repair and was
large in size; these factors make the prognosis in this case very
guarded. It was a heroic case that I thought I would share.
I will keep you posted on long-term results.
September - October 2007
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FIGURE 1: Showing root canal therapy on # 30 with bone loss in the furcation.
FIGURE 2: Showing the repair sealed with MTA.
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