EndoRez: Endo/Perio Case Study

EndoRez root canal sealer made by Ultradent is my choice for filling root canals.  It is easy to use and is very hydrophilic making it ideal for flowing into tiny cracks, crevices and accessory canals.  Injecting the sealer with a very thin needle within a millimeter of the apex before obturating with gutta percha ensures that the canals are filled completely.  However, in some cases using this technique overfills can happen.  The manufacture insist that the body is able to absorb the excesses over time and I have seen this happen, though slower than the over zealous salesman claimed (years, not months).  This is a case presentation of one such overfilling where EndoRez may have exacerbated an endo/perio lesion. This 70 year old white male presented with a toothache in tooth #30.  It was noted that the tooth had locally severe periodontal disease, periapical pathosis and a draining endo/perio lesion through the facial furcation probing 10+mm.  The tooth had a previously placed crown with recurrent decay at the D/F margins.  The tooth would have been a good candidate for extraction and implant/crown placement, but the patient wanted to try and save it.  Root canal therapy was completed with EndoRez sealer and gutta percha obturation.  An overfill was noted to have flown out of the tooth's MF apex and through the parulus into the furcation.

WL Film	Post-op	1 year post-op	Extraction	NaOCl cleaned tooth	Removed EndoRez

Although there was a poor prognosis assigned to this tooth before treatment, this case illustrates the problematic overfilling of the EndoRez system for obturating root canal fillings.  I believe if an overfill is accidentally expressed through a parulus that is associated with the PDL of a tooth, it could artificially keep the pathological communication with the oral cavity open long enough for periodontal disease to establish itself.  Whereas, if the overfill had not occurred in this fashion the parulus would have had a better chance of healing and extending the life of the tooth. Side note: The patient said at the extraction appointment one year post-endo, "He said I should have taken this tooth out a years ago, and now I believe him.  Get'r out!"

References:

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