#12 Pre-op on 14 Oct 2004

First Visible Pulp Space

Approx 5mm From cusp after

Removal of provisional

crown

#12 Post-perforation Repair with MTA on Mesial aspect Subcrestally

■ 14 October 2004 after MTA placed

MTA

Track Progress with: 1) Check X-Ray 2) Perio Probe Measurement

3) Staff Guidance

Signs I Ignored■ Early Out Signal with the Root ZX ■ No Good Apical Stop ■ The File Handle was exiting at a different Angle ■ I Could see the side of the Pulp Chamber BUT I

did not recognize it ■ In fact, I continued to try and discover the WL for

about another 15 minutes ■ I overlooked the fact the tooth continued to bleed

and tried to stop it with paper points

Working Length

■ 04 Nov 2004 04 Nov 2004

Cavit was placed to seal

the perforation.

The MTA had Been lost for An unknown

reasonsCavit

How was my pt Doing?■ Pt was Asymptomatic since last appt ■ Probing measurements had NOT Increased

■ CAVIT ■ Perf must always be sealed ■ Do NOT push into Cavit because it has not

completely set, it is still somewhat soft ■ File will easily go through the cavit ■ BE CAREFUL AND AVOID PROBING THE CAVIT

MAF Radiograph

■ 04 Nov 2004 04 Nov 2004

Final Obturation with MTA in area of defect and entire pulp chamber

■ 04 Nov 2004- Final

MTA placed correctly and

properly

Keys to Perforation repair

■ Same Day Perf Repair ■ Treat Only With a Pulpotomy ■ Perf must be sealed

■ Timing of perf Repair ■ Size of Perf Repair ■ Location of Perf Repair

Principals of MTA use

■ Careful use of Sodium Hypochlorite ■ Consider Peridex

■ Advise pt. to avoid occluding on that tooth for at least 4 hours

■ 3-Month Recall is important ■ Assess if Symptomatic ■ Probing depths, have they changes? ■ Any pathological changes on Radiographs