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Medical Forum / General / Dentistry / October 2004Failed Apicoectomy
Had root canal. Still infected. Had apicoectomy, waited 6 months. Seems it is still infected. Endodontist said large dark region around tip may NOT be infected - just "connective tissue" that grew in before bone could. I am doubtful. Particularly as I can *feel* the 'infection' ebb and flow - the same as it did before all of this. And the x-ray is basically identical to those taken earlier. Endo said he cannot be sure it is infected - even if ihe goes back in to take a look. I said I want that infection out of there at any cost. He said even extraction may leave an infection there if it is in the bone. I am utterly exasperated with no clear idea about what to do. I don't have unlimited funds to get a bunch of second opinions and I've already blown a bundle trying to fix this problem. 1) How likely is it that this new x-ray is showing something other than an infection? 2) Is there another way to determine whether the site is infected? 3) An extraction could leave the site infected ... really??? Thank you all kindly. Wait. Give it some time. Unless it really hurts I would wait and see how things heal. jwn dds > Had root canal. Still infected. Had apicoectomy, waited 6 months. > Seems it is still infected. [quoted text clipped - 23 lines] > > Thank you all kindly. > Had root canal. Still infected. Had apicoectomy, waited 6 months. > Seems it is still infected. [quoted text clipped - 23 lines] > > Thank you all kindly. Understand that I am going to talk averages here--your case may be different. If the tooth is tender over the tip of the root, it is very likely there is residual infection. However, scar tissue doesn't look too different from a chronic abscess, so it can't always be ruled out by x-ray. Many teeth that have failed root canals do not respond to apicoectomy. There may be a small canal the endodontist has missed. Commonly there is an undiagnosed root fracture. The location of the dark area on x-ray can give a clue to this. The chances of the infection remaining after extraction are very, very small. Steve >> Had root canal. Still infected. Had apicoectomy, waited 6 months. >> Seems it is still infected. [quoted text clipped - 37 lines] > >Steve Yeah, what he said. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > > Understand that I am going to talk averages here--your case may be > >different. [quoted text clipped - 14 lines] > > W_B Is there no way to do a puncture biopsy through the bone, in this case? Jes' wonderin' SP  SignatureNot a real Addy, yet >Is there no way to do a puncture biopsy through the bone, in this case? >Jes' wonderin' >SP No. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>Is there no way to do a puncture biopsy through the bone, in this case? >>Jes' wonderin' >>SP > >No. Bigger question ......... can one do a puncture biopsy though the epidermis? >>>Is there no way to do a puncture biopsy through the bone, in this case? >>>Jes' wonderin' [quoted text clipped - 4 lines] >Bigger question ......... can one do a puncture biopsy though the >epidermis? Impossible to be sterile through the epidermis. Fuggeddaboudit in the oral cavity. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>Is there no way to do a puncture biopsy through the bone, in this case? >>Jes' wonderin' [quoted text clipped - 4 lines] > -- > W_B What tooth was it? You could do a block resection of the jaw, but...;-) Steve > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE >What tooth was it? You could do a block resection of the jaw, but...;-) Drastic measure. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > Understand that I am going to talk averages here--your case may be > different. [quoted text clipped - 9 lines] > > Steve Thank you. Your reply makes sense and parallels what my endodontist said. He offered three ideas about what to do: 1) go back in and this time fill the area with calcium sulphate - if only to alleviate my concerns about the dark area on the x-ray, 2) redo the root canal, 3) wait another 6 mos. (also advice offered here, I noted). This is the advice he finally settled upon. Your view on this? Do you know of another method of ascertaining the presence of an infection? Seems a simple needle extract from the affected area should provide a lab specimen. (My endodontist said perhaps a University can do this but wasn't sure.) Thank you. >> Understand that I am going to talk averages here--your case may be >> different. [quoted text clipped - 22 lines] >3) wait another 6 mos. (also advice offered here, I noted). This is >the advice he finally settled upon. Your view on this? Would be my first choice, bone heals slowly, may even take a year. As long as there is *no* pain. >Do you know of another method of ascertaining the presence of an >infection? Not really, diagnosis is determined by objective signs and symptoms. Can you post a picture of an x-ray of this area ? It would be better than shooting in the dark for us. > Seems a simple needle extract from the affected area >should provide a lab specimen. (My endodontist said perhaps a >University can do this but wasn't sure.) Unreliable and almost impossible to do in the oral cavity. >Thank you. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >> Understand that I am going to talk averages here--your case may be >>different. [quoted text clipped - 17 lines] > 1) go back in and this time fill the area with calcium sulphate - if > only to alleviate my concerns about the dark area on the x-ray, This will make for a prettier x-ray, but won't address any infection issues (if any) > 2) redo the root canal, This MAY work. Is this the same endodontist that did the original root canal treatment? If not, and especially if this endodontist uses an operating microscope (becoming pretty standard for endodontists in the US), there is always the chance that he may find another canal. But if the same endodontist is treating you, and magnification was used before without finding any additional canals AND assuming this is a high-quality endodontist AND assuming there were no known special problems with this tooth (root perforations, blocked canals, etc.), it is very likely a retreat will not accomplish anything. The endodontist should give you some guidance in this regard; he should be able to hazard an educated guess as to whether he is likely to find anything overlooked on the first try that could make the difference between failure and success. I think the assessment of Dr. Steve M and WB may be correct--there may well be a fracture. But this is far from a certainty. > 3) wait another 6 mos. (also advice offered here, I noted). This is > the advice he finally settled upon. Your view on this? On the one hand, the chances of this turning into a roaring toothache are fairly small (though not zero). My feeling is that if there is discomfort after 6 months, there will PROBABLY be discomfort after 12 months. There are 3 possible outcomes: 1) The tooth recovers--obviously, this is the hoped-for outcome. 2) The tooth gets worse--if there is a fracture, sooner or later the tooth will deteriorate. Typically, if there is a vertical root fracture, infection will spread from the salive down the fracture by capillary action, eventually leading to looseness of the tooth, some swelling and soreness. The treatment is extraction--any other treatment is a waste of time. 3) The tooth remains the same. If this remains about the same, you really have to look at your level of discomfort about the tooth. You can continue to wait indefinitely of course, and follow clinically and by x-ray. While this option may not give you psychological peace, it will give the greatest chance that any subsequent treatment performed will be appropriate. > Do you know of another method of ascertaining the presence of an > infection? Seems a simple needle extract from the affected area > should provide a lab specimen. (My endodontist said perhaps a > University can do this but wasn't sure.) In practice, this isn't done to my knowledge. The sample is too likely to be contaminated by saliva, and if the needle is misdirected I'd guess it's easy to get a false negative as well. Steve > Thank you. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > > He offered three ideas about what to do: > > [quoted text clipped - 3 lines] > This will make for a prettier x-ray, but won't address any infection > issues (if any) First off, thank you very much for your very helpful replies thus far. On the calcium sulphate - your view and the endodontists' are identical. > > 2) redo the root canal, > [quoted text clipped - 13 lines] > I think the assessment of Dr. Steve M and WB may be correct--there may > well be a fracture. But this is far from a certainty. Read and understood. (In fact, it was a *dentist* who did the root canal). > > 3) wait another 6 mos. (also advice offered here, I noted). This is > > the advice he finally settled upon. Your view on this? [quoted text clipped - 16 lines] > will give the greatest chance that any subsequent treatment performed > will be appropriate. A bit of a news flash here: To get to the heart of the matter, in the past 12 hours I've wiggled the tooth a bit and poked the gum firmly (once, a few times) with my finger up toward the root tip. This always exacerbated the problem before and, sure enough :-), it has exacerbated it again. I can now *taste* the 'infection'. Some of you will roll your eyes here, I imagine. I suspect the infection leaks out at the gumline at the rear of this upper lateral. Is this common? Or likely? Or uncommon? Impossible?? In any event, the feeling now of slight swelling, the taste, and slight physical awareness in the gum is similar to what it was before any work was done (though now the swelling is minor). I feel convinced the infection exists. Yes? Someone placed a wager on this being a root fracture though the original message is missing in my google news session ... Can the endodontist find a confirmation of this? Then, according to advice here and with the support of the endodontist, it seems the next move is reasonably clearcut: extraction. Have I got this right? Thank you all. >To get to the heart of the matter, in the past 12 hours I've wiggled >the tooth a bit and poked the gum firmly (once, a few times) with my >finger up toward the root tip. This always exacerbated the problem >before and, sure enough :-), it has exacerbated it again. I can now >*taste* the 'infection'. Some of you will roll your eyes here, I >imagine. Don't do that !!! >I feel convinced the infection exists. Yes? Who knows at this point, quit messing with it. >Someone placed a wager on this being a root fracture though the >original message is missing in my google news session ... I bet $2, SM raised me $4 and I called. >Can the endodontist find a confirmation of this? Then, according to >advice here and with the support of the endodontist, it seems the next >move is reasonably clearcut: extraction. If the root is vertically fractured then yes. >Have I got this right? > >Thank you all. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>>He offered three ideas about what to do: >>> [quoted text clipped - 59 lines] > *taste* the 'infection'. Some of you will roll your eyes here, I > imagine. If you can express pus out of the gum, no doubt the dentist or endodontist can too and generally ascertain the source of the infection. It very likely is the tooth, but you cannot rule out other sources, such as periodontal. > I suspect the infection leaks out at the gumline at the rear of this > upper lateral. Is this common? Or likely? Or uncommon? > Impossible?? Quite possible. > In any event, the feeling now of slight swelling, the taste, and > slight physical awareness in the gum is similar to what it was before > any work was done (though now the swelling is minor). > > I feel convinced the infection exists. Yes? Assuming you are tasting pus, yes. We cannot assume automatically it is from this tooth though. Sometimes a gum boil will open on the gum. We will sometimes push a gutta percha point into the opening and attempt to trace the path of infection, and take an x-ray with the gutta percha point in place. This usually makes the source of the infection obvious. > Someone placed a wager on this being a root fracture though the > original message is missing in my google news session ... > > Can the endodontist find a confirmation of this? Then, according to > advice here and with the support of the endodontist, it seems the next > move is reasonably clearcut: extraction. IF it is a fracture, the only solution is extraction. I think this is likely, but by no means certain. It is not always easy to detect a fracture--it need not be separated, and is usually not visible on x-ray. However, the pattern of bone loss on x-ray frequently suggests a fracture, and this is sometimes only confirmed on extraction. Those dentists who have intraoral cameras or operating microscopes can sometimes visualize the fracture, but not always. Steve > Have I got this right? > > Thank you all. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > If you can express pus out of the gum, no doubt the dentist or > endodontist can too and generally ascertain the source of the infection. [quoted text clipped - 6 lines] > > Quite possible. A PAX with a few GP points inserted into the gingival opening should leave little doubt as to where this pus is coming from. If one can insert a few GP points that go deep, it's usually perio. If only one thin one that goes deep, it's usually Endo or Fracture. This is what I learned from the Local Endo Guy when faced with similar situations. HTH SP SignatureNot a real Addy, yet >> If you can express pus out of the gum, no doubt the dentist or >> endodontist can too and generally ascertain the source of the infection. [quoted text clipped - 15 lines] >HTH >SP The perio/endo leison is usually a vertically fractured root. Extremely poor prognosis. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >I said I want that infection out of there at any cost. He said even >extraction may leave an infection there if it is in the bone. NAH! You are unduly concerned. Whatever it is (granulation tissue, most likely) it is walled off so do not fear. Joel >1) How likely is it that this new x-ray is showing something other >than an infection? VERY! Granulation tissue means connective tissue that will not organize itself into bone. (SIMPLE EXPLANATION - not exactly precise). >2) Is there another way to determine whether the site is infected? What means "infected?" That means presence of bacteria, viruses, etc. Are you aware that our entire bodies are covered with bacteria? They slide in and out of our fingernail beds and every orifice? >3) An extraction could leave the site infected ... really??? Nah. If you yank it, the dark radiolucency (ball) comes out. If it did not that would be NICO, that is nonsense. Joel M. Eichen DDS >Thank you all kindly. > >2) Is there another way to determine whether the site is infected? > > What means "infected?" That means presence of bacteria, viruses, etc. > Are you aware that our entire bodies are covered with bacteria? Of course. And I am also aware that an infection at the tip of a root can spread, evidently did spread (to adjacent two teeth - which *did* respond to apicoectomies) and should be dealt with. And you didn't address my question. But thanks anyway ... > >3) An extraction could leave the site infected ... really??? > > Nah. If you yank it, the dark radiolucency (ball) comes out. > > If it did not that would be NICO, that is nonsense. So you are certain of that. And if the infection remained ... sounds like your world would be rocked. Anyway, thanks for you reply. >> >2) Is there another way to determine whether the site is infected? >> [quoted text clipped - 3 lines] >Of course. And I am also aware that an infection at the tip of a root >can spread, NOPE! I have never seen a locus of infection (periapical - around the root tip) that was NOT WALLED OFF! Joel >evidently did spread (to adjacent two teeth - which *did* >respond to apicoectomies) and should be dealt with. [quoted text clipped - 11 lines] > >Anyway, thanks for you reply. >Had root canal. Still infected. Had apicoectomy, waited 6 months. >Seems it is still infected. [quoted text clipped - 17 lines] >1) How likely is it that this new x-ray is showing something other >than an infection? relatively common >2) Is there another way to determine whether the site is infected? no not really >3) An extraction could leave the site infected ... really??? Strongly disagree ! >Thank you all kindly. $2 says that the root is vertically fractured. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > $2 says that the root is vertically fractured. I'll take that bet and raise you $4 >> $2 says that the root is vertically fractured. > >I'll take that bet and raise you $4 I see your raise and call... -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com Okay, Put the root on the table so we can check. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >>> $2 says that the root is vertically fractured. [quoted text clipped - 8 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com >Okay, Put the root on the table so we can check. And take photomicrographs. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > Okay, Put the root on the table so we can check. I would tend to agree, as long as the exo was done as a flap procedure to expose the vertical fracture. JMO SP SignatureNot a real Addy, yet > relatively common > > [quoted text clipped - 9 lines] > > $2 says that the root is vertically fractured. Then a simple flap procedure **should** be able to locate that fracture, I think. Why not have an oral surgeon look at it and see if s/he thinks it is worth the risk in doing this exploration? SP SignatureNot a real Addy, yet >>relatively common >> [quoted text clipped - 14 lines] > it is worth the risk in doing this exploration? > SP I've sent a patient to a local surgeon for an apico; he flapped it and saw the fracture, and extracted the tooth instead. Since the bone loss is usually overlying the fracture, it should usually be possible to see. Steve >>>relatively common >>> [quoted text clipped - 20 lines] > >Steve You guys need to be able to discern a vertical fracture on radiograph. Shall I teach ya'll ? -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >> Then a simple flap procedure **should** be able to locate that fracture, > >> I think. Why not have an oral surgeon look at it and see if s/he thinks [quoted text clipped - 13 lines] > -- > W_B Sure... Please do. It would be great to be able to do that with authority. And feel free to make it as chalk full of sarcastic comments as you can. Thanks SP SignatureNot a real Addy, yet >> >> Then a simple flap procedure **should** be able to locate that fracture, >> >> I think. Why not have an oral surgeon look at it and see if s/he thinks [quoted text clipped - 19 lines] >Thanks >SP Allright, listen up students. How to detect a vertically fractured root from a radiograph. There will be a lateral radiolucency about midway from the apex to the DEJ. The tooth will be symptomatic upon percussion and will be sensitive to cold and hot and is lingering. If the patient has any parafunction, the symptoms will be worse in the AM Otherwise the symptoms will be worse after a meal or later in the afternoon. There is no sucess in endodontically treating a tooth with the above described symptoms. In the extreme case a 'root amputation' may be sucessful. Hemisection is another consideration. This should only be considered as a final option for the patient that is willing. The sucess rate is less than 25% -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>>>>Then a simple flap procedure **should** be able to locate that fracture, >>>>>I think. Why not have an oral surgeon look at it and see if s/he thinks [quoted text clipped - 49 lines] > -- > W_B Nice perspective--thanks. Steve > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE > This should only be considered as a final option for the > patient that is willing. [quoted text clipped - 4 lines] > -- > W_B ...Jahwoll, herr Bologna-meister... this is good. I will archive and study again (as I have done with a lot o' stuff from here...). Danka Soon, as soon as I get the f*&?%ing Sympatico straightened out, I'll move my site and post a case of a six-year-old that is scaring the sh*&*?%t outta me... He's losing his left upper first primary molar (root resorption complete) and his upper first permanent molars are only just starting to pierce the gum behind the second primary molars... This is not what is worrying me... It's the lesion I think I see in the B/W and PAX in the middle of the developing 1st premolar (lucency) corresponding to a large ulcer between those two primary molars... Painful... hope it is just a case of precocious eruption. Fingernails, skin, hair, eyes are all OK, no exocrine disorders, no malformations, no systemic problems. Thanks SP SignatureNot a real Addy, yet >>>>relatively common >>>> [quoted text clipped - 27 lines] > -- > W_B Sure. I've inferred the presence of a fracture if there is a radiolucency centered away from any canal orefice, esp. if it communicates with the crestal bone. Anything else to look for? Steve > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE > Sure. I've inferred the presence of a fracture if there is a >radiolucency centered away from any canal orefice, esp. if it >communicates with the crestal bone. Anything else to look for? > >Steve Exactly, if you can spot that, you are well on your way. Look for the lateral radiolucency about half way up the root. Very rarely will you find a buccal fistula. That is more common than most think. The best recommendation is exodontia. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >> Sure. I've inferred the presence of a fracture if there is a >>radiolucency centered away from any canal orefice, esp. if it [quoted text clipped - 11 lines] > -- > W_B Thanks! Steve > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE OK, still following the discussion, thanks. For what it's worth: as mentioned, the upper lateral was one of three teeth (the others were the upper front teeth) each receiving both RCT and apico. These others have crowns - old ones that may be replaceable depending on the results of *this* problem and other factors. The whole thing is quite complex - particularly given the potential requirement for a relatively large and prohibitively costly *bridge*. Add to this the controversial assessment of a gastroenterologist - yes, this just keeps getting better - who, in trying to address a long-standing and resilient GI infection pointed to a possible source as a 'mouth infection'. (Yes, I know the controversy surrounding so-called focal infections.) Understood now - thanks to the discussion here - is the need to determine the source of the alleged infection around this tooth. Perio, endo, other. And the challenge in making this determination - and the procedure(s) possible in fixing the damn thing. Again, thanks to all. > >>relatively common > >> [quoted text clipped - 20 lines] > > Steve > OK, still following the discussion, thanks. > [quoted text clipped - 12 lines] > as a 'mouth infection'. (Yes, I know the controversy surrounding > so-called focal infections.) I've never heard of any controversy with regards focal infection vis a vis dental infections and GI infections. Steve > Understood now - thanks to the discussion here - is the need to > determine the source of the alleged infection around this tooth. [quoted text clipped - 27 lines] >> >>Steve >> Add to this the controversial assessment of a gastroenterologist - >> yes, this just keeps getting better - who, in trying to address a [quoted text clipped - 6 lines] > >Steve We agree. Joel > > Add to this the controversial assessment of a gastroenterologist - > > yes, this just keeps getting better - who, in trying to address a [quoted text clipped - 6 lines] > > Steve Could you elaborate? Are dental infections - particularly of the type I seem to have (leaking into the mouth) - considered to be a source of GI tract infection? Bacterial overgrowth? Flora imbalance? The endodontist was not receptive to the first of these ideas as proposed by the gastroenterologist. I have been unable to confirm the link in the scientific literature although there is plenty of discussion to this effect out there. But I am neither a gastro nor an endo nor a professional medical researcher. What are you implying here? And Joel? Is it time to post to a gastro group, as well? >>>Add to this the controversial assessment of a gastroenterologist - >>>yes, this just keeps getting better - who, in trying to address a [quoted text clipped - 8 lines] > > Could you elaborate? I've simply never heard of this connection. > Are dental infections - particularly of the type I seem to have > (leaking into the mouth) - considered to be a source of GI tract > infection? Bacterial overgrowth? Flora imbalance? Not to my knowledge. > The endodontist was not receptive to the first of these ideas as > proposed by the gastroenterologist. I have been unable to confirm the [quoted text clipped - 3 lines] > > What are you implying here? I don't think I'm implying anything. I am not a gastroenterologist. The stomach is, however, quite tolerant of some pretty demanding environmental changes. Gastritis is usually not bacterial to my knowledge, though of course peptic ulcer has lately been associated with helicobacter pylori. This is not a bacterium we see in the mouth normally, nor is it associated with dental infection. And Joel? > Is it time to post to a gastro group, as well? Probably. Steve Extraction would not leave it infected. Oxygen hitting gram - bacteria from infection would kill them all. Wouldn't jump to anything even if xray shows nothing different until have pain in tooth. May take a long time to heal. If apico was done right antibiotics can clear up residual infection. JOsh > Had root canal. Still infected. Had apicoectomy, waited 6 months. > Seems it is still infected. [quoted text clipped - 23 lines] > > Thank you all kindly. > Extraction would not leave it infected. Oxygen hitting gram - bacteria from > infection would kill them all. Agree with your conclusion, but not with your premise. What gram negative bacteria did your culture disclose, Doctor? Steve Wouldn't jump to anything even if xray shows > nothing different until have pain in tooth. May take a long time to heal. > If apico was done right antibiotics can clear up residual infection. JOsh [quoted text clipped - 26 lines] >> >>Thank you all kindly. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> Extraction would not leave it infected. Oxygen hitting gram - bacteria from >> infection would kill them all. [quoted text clipped - 3 lines] > >Steve And O2 only kills obligate anaerobes. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>> Extraction would not leave it infected. Oxygen hitting gram - bacteria from >>> infection would kill them all. [quoted text clipped - 5 lines] > >And O2 only kills obligate anaerobes. Gotta be careful here or the ozonologists will be back in here ........ Joel > >And O2 only kills obligate anaerobes. > > Gotta be careful here or the ozonologists will be back in here > ........ Don't look now, but I think Ray Bertolotti has come out in favor of the ozonolysis technonogy... I'll be able to say more after the lecture in Toronto of the 24th of this month. Stay tuned SP SignatureNot a real Addy, yet >> >And O2 only kills obligate anaerobes. >> [quoted text clipped - 6 lines] >Stay tuned >SP MEANS nothing! If its rotted, it needs to be drilled! If it is not rotted, then it does not REQUIRE drilling, but it can be drilled. OZONOLOGISTS - another little gimmick for stealing YOUR good patients! Joel > MEANS nothing! > [quoted text clipped - 6 lines] > > Joel Yeah, but they're gonna win the game for a few years... until people get wise. SP SignatureNot a real Addy, yet > Josh Brower : Probably just an alias of Joel's > > Josh Brower : > > Probably just an alias of Joel's Nope, practices in Iowa. carabelli >> > Josh Brower : >> [quoted text clipped - 3 lines] > >carabelli Plus ... I think he got referred here from one of the extraneous newsgroups ... although I am just guessing ..... Joel >> Josh Brower : > >Probably just an alias of Joel's Nope, I thought so too until I checked his IP. > >> Josh Brower : > > > >Probably just an alias of Joel's > > Nope, I thought so too until I checked his IP. Good job Joel - wait a minute........... carabelli >> Josh Brower : > >Probably just an alias of Joel's JME is not that clever. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>> Josh Brower : >> >>Probably just an alias of Joel's > >JME is not that clever. WTK is? BTK is? > Extraction would not leave it infected. Oxygen hitting gram - bacteria > from > infection would kill them all. Wouldn't jump to anything even if xray > shows > nothing different until have pain in tooth. May take a long time to heal. > If apico was done right antibiotics can clear up residual infection. JOsh If pushing on the swelling over the root tip expressed pus out the gingival crevice, then there is a fistula draining there. If the tract runs up the side of the root, in the absence of periodontal disease, you can be pretty well certain of a fractured tooth, (when the history is such as this one). Come on folks, even crummy RCT usually work very well, so long as the root does not have a fracture. Even most of the "missed" canals do not generally lead to RCT failure. Reasonable appearing RCT on radiographs with pus leaking out a very narrow tract along the root is virtually always a vertical fracture. It does not matter if the RCT was done by a GP or a specialist BTW. It only matters if it was done well. I have seen fantastic RCT by GP's and lousy one by specialists. Of course, the opposite has also been seen. >> Extraction would not leave it infected. Oxygen hitting gram - bacteria >> from [quoted text clipped - 7 lines] >side of the root, in the absence of periodontal disease, you can be pretty >well certain of a fractured tooth, (when the history is such as this one). Takes an astute practitioner to diagnose that. Alas, most are not. >Come on folks, even crummy RCT usually work very well, so long as the root >does not have a fracture. Well, mostly. >Even most of the "missed" canals do not generally >lead to RCT failure. Disagree here. >Reasonable appearing RCT on radiographs with pus >leaking out a very narrow tract along the root is virtually always a >vertical fracture. Especially if there is a lateral radiolucency. Non-Restorable --->EXT >It does not matter if the RCT was done by a GP or a specialist BTW. It only >matters if it was done well. True, > I have seen fantastic RCT by GP's and lousy >one by specialists. Of course, the opposite has also been seen. True again. Damn, don't ya'll give me anything to say ? Between SM and SB 'youseguys' cover most of the bases. Leaves me little to comment on, of course *except* endo. Carry on malasuertes, [look it up] BTW might be kidding, maybe not... you will never know. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>Even most of the "missed" canals do not generally >>lead to RCT failure. > >Disagree here. Many of these canals such as MB-2 share the same foramen with the other canals and often calcify. >Extraction would not leave it infected. True >Oxygen hitting gram - bacteria from >infection would kill them all. HorseHockey ! O2 only kills obligate anaerobic bacteria ! Not all Gram negative bacteria are obligate anaerobes ! Who taught you micro anyway ? Regardless, you didn't listen very closely. >Wouldn't jump to anything even if xray shows >nothing different until have pain in tooth. Agreed >May take a long time to heal. Duh, bone heals slowly. >If apico was done right antibiotics can clear up residual infection. JOsh How many apicos have you done, JOsh ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>Extraction would not leave it infected. > [quoted text clipped - 4 lines] > >HorseHockey ! Wow! What an interesting idea .......... You get the horses on skates ,,,,, and then ,,,,,,,,,, >O2 only kills obligate anaerobic bacteria ! > [quoted text clipped - 15 lines] > >How many apicos have you done, JOsh ? |
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