apical perforation

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zoroe

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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

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Although you have a good description here, this is not the most likely place to get advice that will help you. An apical perforation is difficult to deal with and I'm a little confused why you are coming to an online student forum. You might try dentaltown.com, they have a lot more endodontists in their endo forum who may be able to help, you can also post radiographs which will help them see and understand what you are talking about. But, probably the best place to seek advice, is from your instructors at the dental school you are at. Hopefully they can guide you more fully than replies from a forum.
 
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