Endo Tribune United Kingdom Edition

20 Endo Tribune United Kingdom Edition | 9/2016 TRENDS & APPLICATIONS A 47-year-old female patient pre- sented to our clinic with a radio- graph that showed an extensive iatrogenic perforation of the furca- tion area at tooth #36 (Figs. 1 & 2) that was associated with radio- graphic bone loss, a vestibular ﬁstula and pain on palpation. The patient had previously received urgent intervention concerning this tooth by another clinician owing to acute pain from pulpitis. The case was subsequently recom- mended for endodontic therapy. After an initial discussion with the patient, anaesthetic was administered and the tooth was isolated. After creating a coronary access, we clinically ver- iﬁed the presence of pulp necro- sis and perforation. The root canal was disinfected (crown-down) with an irrigation agent (5 % NaOCl) and ultrasonic activation using straight tips (Irrisonic, Helse). The working length was then determined with the help of a foramen locator. The ﬁnal preparation of the canal was per- formed with the RECIPROC sys- tem (VDW). Thepreparedareawascleaned and reﬁned with an ultrasonic diamond tip (E7D, Helse). In ad- dition to the intra-canal disin- fection process, calcium hydrox- ide (Ultradent) placed in the furcation area was exchanged every two weeks, during which time the symptoms were allevi- ated. The obturation was per- formed according to the ther- momechanical Tagger hybrid technique (Fig. 3) using the Guta- Condensor (Maillefer), TP gutta- percha cones (DENTSPLY) and the MTA-based sealer MTA-Fillapex (Angelus). After the thermome- chanical compaction, the gutta- percha was cut and vertical condensation was performed using a cold plugger. The area of the perforation was then cleaned and reﬁlled with calcium hydroxide. After 15 days, we began to seal the prepared area and initially veriﬁed that the area had dried properly. The prepared area was ﬁlled with MTA Repair HP ac- cording to the manufacturer’s in- structions, applied with the MTA Applicator (both Angelus). Clini- cal and radiographic criteria were used to determine correct ﬁlling with the material (Figs. 4 & 5), and a glass ionomer cement (3M) was applied to seal and protect the area (Fig. 6). After temporary restoration, we observed the tooth radio- graphically and found proper sealing of the furcation area with MTA Repair HP. No postoperative complications were reported. At the two-month follow-up visit, bone formation in the furcation area was detected. No further symptoms were reported (Fig. 7). Root canal treatment with the new MTA Repair HP By Dr Fábio Duarte da Costa Aznar, Brazil 1 2 3 Figs. 1 & 2: Initial clinical and radiographic appearance of tooth #36.—Fig. 3: Obturation of the root canal.—Figs. 4 & 5: Clinical photograph and radiograph of the MTA Repair HP ﬁlling.—Fig. 6: The cavity was sealed with a glass ionomer cement.—Fig. 7: Radiograph taken two months after treatment. Dr Fábio Duarte da Costa Aznar is a specialist in endodon- tics at the Hospital for Rehabilitation of Craniofacial Anomalies at the University of São Paulo in São Paulo, Brazil. He can be contacted at fabio@aznar.com.br. AD 4 5 6 7 123 456

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