apical perforation

[zoroe]

hello, I'm a dental student in thailand. I've got problem in endodontics treatment. I can't solve it. I want some suggestion T^T.

 

history: thai man ,age 41 years , medical status: hypertension ( amlodipine,valsartan)

 

Dx: #22 pulp necrosis with asymtomatic apical periodontitis (periapical lesion at mesial of root apex , apical third of root curve to distal

 

working lenght determination: 18 mm (with IAF#20), pre-curve file at apical third

 

Try main cone : shorter than working lenght , because of ledge at apical thid, so I tried to by pass the ledge by small file eg. no 15,20.

but when I inserted K-file #40 , I found no apical stop and Patient felt sensitivity . I found some bleed at the end of paper point . so that I medicated canal with calcium hydroxide paste and temporary stopped with cavit ,IRM

 

next visit, I confirmed the working lenght by insert file # 55 which slightly fit at working lenght (18 mm) and radiographic was taken, from the periapical radiogrph showed apical perforation

 

then inserted main cone #60 (16.5 mm) to identify the perforation . periapical radiograph showed the main cone is far from perforation 0.5mm (the perforation at 17 mm)

 

then I inserted file # 15 (pre-curve) to find the original canal which is near the artificial canal (perforate)

 

I think that I should clean and shape the original canal before and repair the perforation with MTA. But I don't know how to close the apical perforation without involve the original canal that clean and shaped already or using the other technique of obturation.

 

Help me please, Thank you T T

 

e-mail :zoroe_won@hot