The Endo Fix

Category: Large Lesion

Decompression of a Dens in Dente Central Incisor

Large Lesion, Tips, Tricks, and Hacks

This was was an interesting tooth. It had a large talon on the palatal leading to a c shaped dens in dente or tooth within a tooth. There was a very large apical finding. Symptoms didn’t resolve after the first round of calcium hydroxide. So we added a decompression. The main goal of a decompression is to shrink the “lesion” and decrease the likelihood of collateral damage. In this case, surgery would have almost certainly devitalized the adjacent lateral incisor.

Decompression or true marsupialization works on the theory that creating a drain makes the epithelium creep inward along the bone pushing the cyst or granuloma outwardly. Otherwise it works by traumatically disrupting things allowing for subsequent healing. Marsupialization is a pretty slow process. We created a flange on a piece of surgical tubing, then sutured into place. The patient had instructions to irrigate a couple times a day with chlorhexidine. In this case we kept it in for over 3 months. This was a longer term calcium hydroxide case. We root-filled at about a year. Complete radiographic clearing was realized over time.

Dens Invaginatus

Daily Fix, Large Lesion

Sometimes the development of the tooth goes a little haywire and another tooth begins to develop within a tooth, but not completely. So we end up with this invagination leading to the pulp and sometimes it doesn’t completely close off. Such a situation set the pulp up for an early death as can be seen here by the lack of root development and divergent open apices. Here we have a a pretty large finding imaging wise and a swelling. We changed the calcium hydroxide medicine out over 5 months and ultimately filled the apical 5mm with MTA and then reinforced the rooth with a fiber post. At 4 years post op there appears to be complete radiographic clearing and retained radio-opacity from the calcium hydroxide.

IGT of a Lateral

Daily Fix, Large Lesion

Suffolk Endodontist

 

The porcelain crown attempted to correct the spacing caused by a peg lateral and as such the center of the canal was located pretty far distal to the crown. Using the imaging to guide the therapy (Image Guided Therapy or IGT) the access was planned for this particular tooth extending through the incisal edge along the long axis of the tooth. A thin fiber place was placed. The tooth was left in CaOH until there was evidence of radiographic healing.