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Endodontics &
Dental Traumatology
ISSN 0109-2502
Case report
Clinical success in endodontic surgery depends on numerous factors such as disinfection and debridement
of the root canal and its hermetic seal with well-tolerated materials (1). These parameters are interdependent, for example, in cases where the choice of a
root-filling material determines the type of preparation. Among the materials which are used for retrograde root fillings, amalgams have been the most
prevalently employed (2), but their use is questioned
today because of their disadvantages, which include
possible scattering of amalgam particles in the surrounding tissues, corrosion, and poor sealing properties. Other materials have been proposed (see 3, 4
for review). The most popular materials currently are
zinc oxide-eugenol cements either alone or reinforced
with various components such as resin (IRM, EBA,
super EBA) (5), composite resins (6) and glass ionomer
cements (7). A number of other materials are occasionally used, such as ceramic pins, aluminium oxide, or are still in their evaluation phase such as MTA
(8).
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Fig. 2. Tooth 44, which was sensitive upon mastication and mechanical mobilization, presented an unsatisfactory root filling and evidence of a radiolucency at the apex. The presence of a post
oriented the therapeutic approach towards surgical retrofilling procedure rather than conventional retreatment.
A 46-year-old man, in good health, presented for consultation because of sensitivity under a bridge during
mastication. Extraoral examination showed normal
appearance of the head and neck. Occlusion was normal. A bridge covering teeth 4447 (4546 missing)
was in place. The intraoral soft tissues were normal.
Tooth 44 presented sensitivity to percussion and palpation. No periodontal pocket was discovered. Radiologic examination showed evidence of a periapical
lesion at tooth 44 (Fig. 2).
After surgical exposure of the root end and elimination of the granulation tissue, the root end was cut
perpendicular to the long axis of the tooth and the
apex removed. A drill was chosen according to the
129
Sauveur et al.
Fig. 4. After coating the cavity with a sealer, gutta-percha was heatcompacted into the cavity, refreshed and cold burnished. Excess
filling material was removed and the tooth and bone cavity were
cleaned before suturing.
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There were advantages to using this procedure to perform retrograde root fillings. The first advantage was
that the technique is compatible with sectioning of
the root end perpendicular to the long axis of the
tooth. Mechanical stresses transmitted to the periapical tissues are thereby decreased (18). The second
advantage was that gutta-percha associated with a
sealer could be used. Recent studies indicate excellent
biological tolerance of gutta-percha associated with a
cement as a retrograde root-filling material (10). The
quality of the seal has also been examined in vitro with
dye leakage after retrograde fillings were placed, and
10.
11.
12.
References
1. Gutman JL, Harrisson JW. Surgical endodontics. Boston:
Blackwell; 1991. p. 33983.
2. Rud J, Andreasen JO, Moller-Jensen JE. A follow-up study
of 1000 cases treated by endodontic surgery. Int J Oral Surg
1972;1:21528.
3. Friedman S. Retrograde approaches in endodontic therapy.
Endod Dent Traumatol 1991;7:97107.
4. Jou Y-T, Pertl C. Is there a best retrograde filling material?
Dent Clin North Am 1997;41:55561.
5. Dorn SO, Gartner AH. Retrograde filling materials: a retrospective success-failure study of amalgam, EBA, and IRM. J
Endod 1990;16:3913.
6. Andreasen JO, Munksgaard EC, Fredebo L, Rud J. Periodontal tissue regeneration including cementogenesis adjacent
to dentin-bonded retrograde composite fillings in humans. J
Endod 1993;19:1513.
7. Zetterqvist L, Hall G, Holmlund A. Apicectomy: a comparative clinical study of amalgam and glass-ionomer cement as
apical sealants. Oral Surg Oral Med Oral Pathol 1991;71:489
91.
8. Torabinejad M, Hong C-U, Lee S-J, Monsef M, Pitt Ford TR.
Investigation of mineral trioxide aggregate for root-end filling
in dogs. J Endod 1995;21:6037.
9. Marcotte LR, Dowson J, Rowe NH. Apical healing with retro-
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