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RO0211

I 21 case report _ retreatment I roots2_2011 flared with a combination of Gates-Glidden burs and rotaryNiTiinstruments.Underhighmagnification,an additional root-canal space was found in the distal root (Fig. 4). Remnants of the previous root-canal filling material were removed with a combination of hand files and rotary instruments, and patency was achieved with small stainless-steel hand files. Work- ing length was calculated with an apex locator (Root ZX mini, J. Morita) and PathFile (DENTSPLY Maillefer) rotary instruments were used for pre-flaring. The mesial root canals were instrumented to 40/.04 and the distal to 50/.04 with rotary instru- ments (BioRace, FKG). The smear layer was removed through one-minute irrigation with 17% EDTA (Ultradent). Passive ultrasonic irrigation was per- formedwith2.5%NaClOandESIneedles(EMS),three times for one minute each in every canal. The canals were dried and Ca(OH)2 was placed with a Lentulo spiral(DENTSPLYMaillefer)asanintra-canalmedica- ment. Cavit G (3M ESPE) was used as temporary fill- ing material. The patient was given oral and written post-operative instructions and was told to return after 15 days. At the second appointment, the anti-microbial irrigation regimen was repeated and the canals were dried with sterile paper points. Gutta-percha points were placed in the canals and a master-cone radi- ographwastaken(Fig.5).ThesealerusedwasAHPlus (DENTSPLY DeTrey). The continuous wave of conden- sation technique was applied during obturation with System B (SybronEndo) at 4mm from the apical terminusofthecanal,andback-fillingwasdonewith thermo-plasticised gutta-percha using the Obtura III Max (Obtura Spartan). Care was taken not to accidentally push sealer into the perforation site. The mesiolingual root canal was back-filled to a level apical of the perforation (Fig. 6). After obturation, white MTA, delivered with the MTA gun (both DENTSPLY Maillefer), was used to sealtheperforationsite.Asrequestedbythereferring dentist,nopostspacewasleftinthedistalrootcanal, as he wished to create his own space to place an intra-radicular post (Fig. 7). Cavit-G was used as temporary filling material. The patient was referred back to the dentist for the final restoration and was told to return after a six-month period for a recall examination. At the recall appointment seven months later, the radiograph showed no evident radiolucency in the peri-radiculartissuesofthetooth(Fig.8).However,it also revealed that the new post had not been placed at the adequate length. The general dentist was contacted and reassured me that a new dowel and PFM crown would be placed. _Conclusion Advances in technology and biomaterials have not yet been proven to enhance overall success rates in endodontics.3 Root perforations can affect prog- nosis in a negative way.1 Nevertheless, the OM allows clinicianstoworkwithgreatprecisionevenunderthe most demanding circumstances,4 and MTA greatly enhances success when treating perforations in the furcal area.2 In addition, the use of ultrasonics under magnification facilitated the removal of the post despite its small size. Passive ultrasonic irrigation removed debris and necrotic tissue effectively from themesialisthmusarea,allowingobturationmaterial to fill it, as can be observed in the final X-ray (Fig. 8)._ Editorial note: A complete list of references is available fromthepublisher. Dr Konstantinos Kalogeropoulos is a post- graduate Endodontics resident at the University ofAthens Dental School.He has published in national and international scientific journals and presented a large number of oral presentations and posters at endodontic congresses. info@athensendo.gr www.athensendo.gr Dr Konstantinos Kalogeropoulos 73–75 Deinokratous Str. 11521 Kolonaki Athens Greece _about the author roots Fig. 7 Fig. 8