Resolving a Fistula

January 27, 2022

As part of a year-long celebration to mark BISCO's 40th anniversary, we asked dentists to submit their best cases featuring BISCO products. We hope this case continues to inspire you and your team!  To view all the cases selected and published click on BISCO's BEST: Cases to Inspire You

Case Study: Resolving a Fistula

The fistula was present for two months before the patient sought help at this doctor’s endodontic practice.

Courtesy of Andrés E. López, DDS

Case description: A 28-year-old female presented to my endodontic practice with a ?stula on the lower left molars that hadn’t resolved after 2 months.

I completed a clinical, radiographic and photographic analysis. The tooth had a provisional restoration (IRM) and cotton in the pulp chamber. The pre-operative x-ray revealed the presence of a fractured file in the mesiolingual canal.
I isolated the tooth, removed the caries, placed the matrix, selective etched, applied CHX 2%, and completed distal deep margin elevation (DME). I then placed All-Bond Universal on the distal composite. Single session endodontics was performed on the fractured file. Obturation was made with bioceramics cement and gutta-percha.
Next, I carefully cleaned the pulp chamber, applied All-Bond Universal and Core-Flo DC Lite to build the core structure. The patient was prescribed antibiotics.
When the patient returned 10 days later for her second visit, the fistula had disappeared. I completed absolute isolation, removed occlusal and mesial caries on the upper-right third molar, applied in deep areas, selective etched, applied CHX 2% and All-Bond Universal, then layered the composite.
The preparation for an overlay on the lower left molar was also performed. The rubber dam was removed, the retractor cord placed, preparation completed, and digital impression taken. 
When the patient returned for the third visit, we again completed absolute isolation, prophylaxis, selective acid etching, placed All-Bond Universal, and cemented the lithium disilicate overlay with Duo-Link Universal adhesive resin cement.
Figure 1: Upper left, pre-operative image; upper right, after endo and build-up; lower left, the CAD design; lower right, lithium disilicate overlay in place. 
Figure 2: Pre-endo deep margin elevation; matrix is placed; endodontics completed.
Figure 3: Removal of caries; TheraCal LC used in deep dentin; selective etch used; All-Bond Universal applied; the layered composite restoration; preparation of the lower left molars; cord retraction completed to take digital impressions.
Figure 4: Occlusal view with isolation; occlusal view with retraction cord; occlusal view of digital model. 
Figure 5: X-ray images of endodontics—upper left, pre-operative image; upper right, working length; lower left, obturation and build-up with Core-Flo DC Lite; lower right, lithium disilicate in place, Case finished. 
Figure 6: Selective etch. 
Figure 7: All-Bond Universal was applied. 
Figure 8: The lithium disilicate overlay. 
Figure 9: All-Bond Universal was light-cured. 
Figure 10: The final x-ray post-op. 
Figure 11: The final restoration. 
BISCO products used: All-Bond Universal, Core-Flo DC Lite, TheraCal LC, Duo-Link Universal
Tags: Bonding, Core-Flo DC Lite, TheraCal LC