Case report: Duizend bommen en granaten


Picture 1 and 2:
Six month follow-up of healing big lesion
Pulp necrosis and acute apical abscess with huge palatal swelling
First visit: large collection of pus and application of CaOH2
Second visit: despite persisting drainage, even after thorough aspiration through the apex, apical plug of MTA
The challenge was to adapt the MTA to the funnel shaped apical area. I’ve used gel foam pellets with which in the end I’ve probably filled up the whole lesion since every time I went up with one of these pellets, with the pressure required to pass the pellet across the narrowest part of the canal, once the pellet became loose in the wider apical part, the plugger all of a sudden went through since there wasn’t any tissue resistance at the end of the root.
Quite immediate resolution of the symptoms
Provisional restoration had not been replaced yet when I saw patient back for the follow-up, so I’ve replaced it with a resin restoration and fibre post.
It looks like there would be some hard tissue/root formation around the MTA?

Picture 3:
Patient came for recall one year after treatment and everything seems to be OK see last picture. But patient is in doubt. Because in the mean time she’s changed dentist and the new one advises extraction and implant because of ‘risk of fracture’.

Jan Berghmans

Jan Berghmans

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