DTIN0210

Clinical DeNtaltribuNe|april-June, 201010 The re-operative procedure was carried out on November 6. A marginal incision from the mesial aspect of tooth 21 and to the distal aspect of tooth 23 was made, followed by 5mm vertical releasing incisions at the mesial aspect of tooth 21, and a length of 10mm at the distal aspect of tooth 23. The mucoperiostal flap was elevated (see Figure 10), and a pathologi- cal fenestration of the cortical buccal bone was evident, appro- ximately 3mm from the marg- inal bone crest between teeth 22 & 23. An osteotomy was per- formed after which the lesion was treated by curettage. A bio- psy of the lesion was taken. The palatal cortical bone also had a pathological perforation, a root-end resection of about three millimeters of the root. The root end was inspected through the operating micro- scope, & no fracture was found. The adaptation of the white MTA to the root canal was judged as good and the operation site was inspected and rinsed with sterile saline, before being sutured with five 6-0 silk sutures. The patient was informed about the prognosis of the tooth and given post-operative instructions. Six 400mg Ibupro- fen tablets were dispensed, and the patient was instructed to take one every four hours in the first day following surgery. A prescription of Penicillin V tablets (qds 660 mg *4) for seven days was also given. The sutures were removed on November 13, and there was evidence of good soft tissue healing. The patient experi- enced no discomfort from the surgical site. The temporary filling and cotton pellet were removed during the post-treatment resto- ration procedure, and replaced by a composite restoration (35 per cent phosphoric acid, Adper, Scotchbond, Filtek Flow (A3) in the apical part, Filtek Supreme (A3D and A2B) in the coronal part). Teeth 21 and 23 maintained vitality. The histo- logical report of the lesion showed a partial epithelium lined cystic wall with intense chronic to acute inflammation, consistent with a radicular cyst. Result Prognosis The patient’s long-term prog- nosis is uncertain, due to the thin root canal walls and risk of fracture. Follow-up On November 13 for a twelve- month post-surgery appoint- ment, the patient was still asy- mptomatic. Teeth 21 and 23 were sensitive to ice-test, and there were no periodontal prob- ing depths over four millimetres around tooth 22. The radiograph showed evidence of healing. DT Fig. 14: Suturing at the junction between the mesial vertical releasing incision and the horizontal marginal incision Fig. 15: Wound healing before removal of sutures Fig. 16: Wound healing at the junction between the mesial verical releasing incision and the horizontal marginal incision before removal of sutures Fig. 17: Wound healing after removal of sutures Fig. 18: Occlusal view after removal of sutures Fig. 19: Composite filling on the palatal aspect of tooth 22 Fig. 20: Post-operative view Fig. 21: Post-operative peri- apical radiographs Dr Nicolai Orsteen graduated from the University of Oslo in Janu- ary 2002, completing his specialist training in endodontics in June 2009. He then worked in general practiceinOslofromFebruary2002 was also a secretary on the regional dental board in Norway from 2004 to 2006. From August 2008, Nicolai worked at a specialist practice in Oslo before joining the specialist team at Endocare Richmond and Harley Street. For more informa- tion please call 020 7224 0999 email reception@endocare.co.uk or visit www.endocare.co.uk . About the author