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Good Prognosis is in the eye of the beholder

September 23, 2011 By Dr Pierre Pizem 2 Comments

Dental Operative Microscope and Retreatment, Orthograde MTA plugs and root repairs, Root Canal Treatment Pre-Therapy 430646-1 Dental Operative Microscope and Retreatment, Orthograde MTA plugs and root repairs, Root Canal Treatment Per-Therapy 430646-1Dental Operative Microscope and Retreatment, Orthograde MTA plugs and root repairs, Root Canal Treatment Per-Therapy 430646-2  Dental Operative Microscope and Retreatment, Orthograde MTA plugs and root repairs, Root Canal Treatment Per-Therapy 430646-3Dental Operative Microscope and Retreatment, Orthograde MTA plugs and root repairs, Root Canal Treatment Post-Therapy 430646-1Dental Operative Microscope and Retreatment, Orthograde MTA plugs and root repairs, Root Canal Treatment Post-Therapy 430646-2

 

Root canal procedure and periradicular tissu healing 2016-02-21Root canal procedure and periradicular tissue healing 2016-02-21

Case Study Number 430646

External root resorption associated with chronic apical periodontitis altered the shape and position of the foramen through osteoclastic activity, in the x ray images (2008), the modified foramen in distal root is positioned farther from the radiographic apex and gutta percha appears in overextension. A large and circumbscribed radiolucency involves both roots as well as the furcation. This indicates an important periradicular tissues destruction. Tooth mobility level 2 goes along with this tissue loss.

Based both on this 2008 pre operative X ray dental image and clinical findings, should an extraction plus an implant have been an appropriate decision? most certainly  not in my book, time has proven otherwise. Still, up until nowadays, this case is definitely a controversial one, meaning that it is possible for different practitioners to prognosticate endodontic success (very few among practioners) or failure with a great amount of disparity.

Endododontic retreatment and MTA root-end fillings have been performed with a Zeiss Pro Ergo Microscope in september 2008. Last displayed X ray film on this post shows an 8 years post operative clinical outcome. Radiographic examination shows a complete regeneration of periradicular tissues and a resorptive defect healing. An implant would not have been indicated in this case.

As stated by John I. Ingles: “The practicing dentist should not be cited for faulty judgment when even the so-called experts tends to disagree on prognosis… All in all, one must ultimately develop confidence in one’s own abilities. Being able to practice using a great variety of techniques and not being “married” to a single approach in every case will greatly enhance one’s capabilities. And on this is based good prognosis, the result of skill, knowledge, and self confidence.”

Read more about MTA Precision placement with the microscope (.pdf)

Filed Under: Dental operating microscope (D.O.M.) assisted R.C.T., Dental operative microscope and retreatment, Extreme endo clinical cases, NEW CASES, Orthograde MTA plugs and root repairs, Post endodontic treatment outcomes, Regeneration of the periradicular tissues, Resorptive defects healings, Dealing with casted and machined posts removal Tagged With: endodontic file, endodontic revision, external root resorption, microendodontics, Mta, mta apical obturation, Opmi Proergo microscope, orthograde mta placement, posterior mta plug, prognosis, regeneration of periradicular tissues, Retreatment, root canal procedure, root end filling material

Reader Interactions

Comments

  1. Daniel Flynn says

    February 21, 2016 at 6:48 pm

    Beautiful healing Pierre. Congratulations on a fantastic result

    Reply
    • Dr Pierre Pizem says

      February 21, 2016 at 6:52 pm

      Thanks Daniel

      Reply

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