Clinical cases
 Carlos Bóveda Z.


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  The invited case # 3 : Dr. Peter D. Cancellier

Our third guest was Dr. Peter D. Cancellier. Dr. Cancellier graduated from the University of the Pacific with degrees in Biology and Communications Arts. He obtained his Doctor of Dental Surgery degree from the University of the Pacific School of Dentistry in 1982. In 1988 completed a two year residency in endodontics at the Veterans Administration Medical Center in Long Beach, California. Since then he has practiced endodontics in Encinitas, California. Dr Cancellier mantains his own web site ( and lectures internationally on endodontics.

 (click on the images to enlarge) 

Preop xray 16 year old white female presents from out of state with buccal fistula between maxillary right lateral #7 and central #8. Radiograph reveals dens-in-dente at #8. Mesial part of #8 tests vital. Tooth #7 tests vital. Gutta percha probe in fistula points to #8.

Access Photograph. At the moment Dr. Cancellier treated only the central canal of #8 with the hope of resolving the fistula without surgical intervention. RCT completed in one visit using warm gutta percha and CRCS sealer (nonstaining calcium hydroxide sealer)

Fistula Xray of gutta percha probe pointing to #8 lesion. Six month recall. The fistula did not heal.

Locate Photograph. Two more canals are located in tooth #8. Both were vital. Both canals are cleaned and shaped and filled with warm gutta percha and CRCS sealer.

Root-end surgery is performed at the same visit. Lesion was removed and sent for histologic evaluation. It was diagnosed as a periradicular cyst. A very large canal was found with granulation or necrotic pulp tissue in it. It was possible to see the original root canal filling at the coronal extent of the large apical canal space. Obtura gutta percha was injected into this apical space leaving 3mm space. An acid-etched, Tenure bonded, Geristore root-end filling was placed into the retroprep and over the apical surface.

6 month recall xray shows some healing. The fistula healed within three weeks of the surgery. The tooth is asymptomatic and pocket depths are normal.

12 month recall shows more healing, though a dome-shaped radiolucency persists. This is the shape of the Geristore retrofilling that covered the root-end surface. However, further evaluation is necessary.

24 month recall shows much more healing.

Clinical cases by prior guests :

# 1 - Dr. Gary Carr

# 2 - Dr. Yosef Nahmias

¿Do you have an interesting clinical case that you would like to share with all of us ? Please send us an e-mail to

 Carlos Bóveda Z. July 1999