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Medical Forum / General / Dentistry / September 2005Sensitive - Pain - Root Canal
Hi there...Thank you for your input this week as I faced a lot of pain and an impending root canal. Given the subsiding of the pain over the weekend I really thought I wouldn't need the RCT, but you provided me the information I needed to better understand the situation. I was initially placed on 7 days of antibiotics rather than doing an emergency RCT. The dentist apologized yesterday for not diagnosing it right away last Thursday and just filing down the filling in hopes that it was my bad clenching that was the cause. Anyway, yesterday I had the procedure. I was literally shaking in the chair. At 36 I've only had 4 fillings previously and felt like a baby for my reaction. Other than having my mouth open for over an hour, but made easier by a bite block, it was fairly uneventful. She did have one canal that started to bleed and was able to stop it. That was the only pain. I literally felt the file poke out of the tooth. She gave me more anesthetic and it was fine after that. Now I have another quandry. She told me yesterday that she has sold the practice and purchased another practice in Napa. She has recommended that I try the new dentist that has purchased the practice, but honestly I'm a little tentative. She has recommended a post, core and crown as the next step. I'm worried about having someone I've never met do this as their first procedure on me. I know it needs to be done for the long-term health, but I'm worried about having someone drill a file into my tooth. Any suggestions? Again thank you for your input and help. > Now I have another quandry. She told me yesterday that she has sold > the practice and purchased another practice in Napa. How far is Napa? I live in Southern California and she is moving to Northern California. About 400 miles. Thanks. I don't know how ANYONE could answer this question logically/sensibly/intelligently. Suppose she died -- would you just leave it as it is???? I think that the answer to your question is pretty obvious, don't you???? > Hi there...Thank you for your input this week as I faced a lot of pain > and an impending root canal. Given the subsiding of the pain over the [quoted text clipped - 24 lines] > > Again thank you for your input and help. > I don't know how ANYONE could answer this question > logically/sensibly/intelligently. Suppose she died -- would you just leave > it as it is???? I think that the answer to your question is pretty obvious, > don't you???? > > Now I have another quandry. She told me yesterday that she has sold > > the practice and purchased another practice in Napa. She has [quoted text clipped - 6 lines] > > > > Again thank you for your input and help. Well.... if it were _my_ tooth, I know I'd want the person who did the root canal do do the drilling and impression taking for the post. I know that some of the more complexe root canals that I've done (especially on premolars with two and three canals, and lets just agree that the CEREC option, while not the only option, is quite compelling for those...) there are good reasons why I would be the best person to drill out for the post: I would know where the roots are weak and I would know which of the two or three canals are best suited to receive the post. In light of this, I would say that if you can wait till the dentist who did the root canal settles in (ie, if your tooth won't break and you have the $$$-age to go up there a few times) why don't you go get it done by her? You could arrange that by phone and the lab could be alerted that the case is a priority. Then, they could prioritize (without rushing) your post and crown and you could have the whole thing done inside of a week or so. If it has to wait, get an NTI fitted to keep stress off the tooth in the meantime. If all that is not possible, I suggest you get it done by a prosthodontist (specialist in crowns/posts/bridges/implants/dentures and all other things prosthetic in the facial area). These professionals will have much experience under their belt by the time you get to them. I do understand Jacob's point, but the above should prove to you that I think your own point also has merit. HTH SP  SignatureFinally: take out the TRASHH Gee whiz,,,,,,,,,, with a CEREC machine a GT Files, the RCT, the post, and the crown are all in one 2 hour appointment. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. 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. ...................... > >> I don't know how ANYONE could answer this question [quoted text clipped - 43 lines] > HTH > SP Steve, Do you feel comfortable obturating the RC if the tooth presents non-vital when you first see it? I, most always wait a second appointment before filling up that root canal system. Flap http://flapsblog.com > Steve, > [quoted text clipped - 5 lines] > > Flap Most of the endodontists I know are fully comfortable with obturating a canal on the first visit--so long as it can be dried. Steve > http://flapsblog.com SignatureCut the nonsense to reply Fair enough and I know my endodontist most of the times will and sometimes won't. But, they don't do a final restoration immediately after obturation. But, would you feel comfortable milling and cementing a permanent porcelain restoration at the same appointment. What if you have a blow up and need to reinstrument/retreat the canals? You would have to cut an access hole in your new porcelain crown. Then would you replace the crown? Or merely fill the access hole? It seems prudent in some cases to wait a few days - at least. > Fair enough and I know my endodontist most of the times will and > sometimes won't. But, they don't do a final restoration immediately [quoted text clipped - 9 lines] > > It seems prudent in some cases to wait a few days - at least. I don't disagree. But I don't have that nice milling machine Mancuso has. Steve SignatureCut the nonsense to reply Flap inquired: > > You would have to cut an access hole in your new porcelain crown. Then > > would you replace the crown? Or merely fill the access hole? [quoted text clipped - 4 lines] > > Steve As I understand it, DrS usually would re-access, retreat and close using another porcelain (the name of which escapes me...). This other porcelaine is not as good for full coverage, but quite good for filling access cavities. Hopefully, he'll come back with the name of the filling porcelaine. SP SignatureFinally: take out the TRASHH Cerana 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. /////////////////////// > Flap inquired: >> > You would have to cut an access hole in your new porcelain crown. Then [quoted text clipped - 14 lines] > Hopefully, he'll come back with the name of the filling porcelaine. > SP > Cerana I KNEW it was something easy like that... SP SignatureFinally: take out the TRASHH I wonder how many he has had to prep an access through? Mancuso, how about it? > I wonder how many he has had to prep an access through? > > Mancuso, how about it? I can say that I placed a Fibercore onlay on one of my wife's upper first molar, and within a few weeks had to refer her for an endo. Steve SignatureCut the nonsense to reply It may have to do with material chosen. 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. /////////////////////// >> I wonder how many he has had to prep an access through? >> [quoted text clipped - 4 lines] > > Steve > It may have to do with material chosen. I doubt it. Hindsight is 20/20, as they say. The tooth was symptomatic before I bonded the onlay. I was hoping against hope the pulp would recover, but the tooth was pretty beaten up. Steve SignatureCut the nonsense to reply > > It may have to do with material chosen. > [quoted text clipped - 3 lines] > > Steve Yeah, we sometimes will stretch out too far in our efforts to save the patient some money or aggravation. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. 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. ...................... > >> It may have to do with material chosen. [quoted text clipped - 4 lines] > > Steve > Yeah, we sometimes will stretch out too far in our efforts to save the > patient some money or aggravation. When it's on my wife, the aggravation is mutual. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 How well I understand you. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. 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. ...................... > >> Yeah, we sometimes will stretch out too far in our efforts to save the [quoted text clipped - 3 lines] > > Steve >> It may have to do with material chosen. > [quoted text clipped - 3 lines] > >Steve You know what I like to say about the 'final insult' to the pulp. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >> It may have to do with material chosen. > > [quoted text clipped - 6 lines] > You know what I like to say about the 'final insult' to the pulp. > -- IIRC, you can only get away with 28 or 30 procedures on posteroir teeth before they blow up on you. ;-) SP SignatureFinally: take out the TRASHH >> >> It may have to do with material chosen. >> > [quoted text clipped - 10 lines] > >SP That's 2.8 to 3.0 procedures. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >> You know what I like to say about the 'final insult' to the pulp. > >> -- [quoted text clipped - 5 lines] > That's 2.8 to 3.0 procedures. > -- Rats... I wanted to see you get upset.... :-/ Just kidding! SP SignatureFinally: take out the TRASHH > I wonder how many he has had to prep an access through? > > Mancuso, how about it? I tend to think it is not too common. The treatment (and DrS's method of cementation) is intended to reduce undue tooth stress. If you only have to cut away what is weak, and then blanket the whole thing, you can save some teeth from the need of RCT. SP SignatureFinally: take out the TRASHH Endo treatment in my office has dropped way down since using CEREC. I used to do 1-3 cases of RCT each day. Now it is 2-3 cases a month. Most of those are on new patients, not patients which I have previously restored. 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. /////////////////////// >> I wonder how many he has had to prep an access through? >> [quoted text clipped - 6 lines] > > SP Ok, sorry see your answer now. But, what does this mean? Are you choosing to do less endo and referring more? Or are you saying the Cerec restorations are preventing your crown restorations from going to endo? Or? Flap http://flapsblog.com > Are you choosing to do less endo and referring more? I do all endo in the office unless I don't think the patient will pay or the patient is a PITA. > Or are you saying the Cerec restorations are preventing your crown > restorations from going to endo? yes After RCT, never. How many times have I had to cut through a CEREC to perform RCT? It happens about 1-2 times a year. I do 4-12 a week. Figure out the percentages. Conventional C&B with temporaries and impressions results in 4% needing RCT after treatment. If I cut through a PFM or a CEREC for RCT, and the restoration remains intact, I close with a Cerana pre-formed porcelain plug. These take about 15-20 minutes to place (less if you already have the patient in the chair). 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. /////////////////////// >I wonder how many he has had to prep an access through? > > Mancuso, how about it? Thanks for the reply. Where do you get that 4% statistic? Flap http://flapsblog.com I would have to hunt for it, it was from a published article in one of the "real" journals a few years back. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. 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. ...................... > Thanks for the reply. > [quoted text clipped - 3 lines] > > http://flapsblog.com > I would have to hunt for it, it was from a published article in one of the > "real" journals a few years back. Then a search on Google articles could perhaps pull it out. I'll try that tonite when I get back Cheers SP SignatureFinally: take out the TRASHH > > I would have to hunt for it, it was from a published article in one of the > > "real" journals a few years back. [quoted text clipped - 4 lines] > Cheers > SP A quick perusal showed this: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&lis t_uids=1302686&dopt=Citation ...unless I hit the wrong button... SP SignatureFinally: take out the TRASHH This was a longitudinal study of US dental work. Percentage of endo needed after restorative work. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. 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. ...................... > >> > I would have to hunt for it, it was from a published article in one of [quoted text clipped - 14 lines] > ...unless I hit the wrong button... > SP > This was a longitudinal study of US dental work. Percentage of endo needed > after restorative work. 'K thanks SP SignatureFinally: take out the TRASHH Article: "Intrapulpal temperature increases with temporary crown and bridge materials" AGD Nov/Dec 2003 "Direct fabrication of a provisional restoration following tooth preparation can add to the tooth's thermal insult. The polymerization of provisional materials may result in an intrapulpal temperature change that is capable of damaging the pulp. Histological studies by Zach and Cohen reported that 15% of pulps subjected to an intrapulpal temperature increase of 5.5 degrees Celsius became necrotic, while an increase of 20 degrees Celsius resulted in a 60% rate of irreversible pulpal necrosis.. While in vitro studies have demonstrated that temporary materials are capable of increasing intrapulpal temperature above the 5.5 degree threshold, these studies did not consider heat dissipation by intrapulpal blood flow." The article goes on to show that certain acrylic temporary materials can raise the intrapulpal temperature more than 5.5 degree Celsius. Not exactly the article I was looking for, but it does show a corelationbetween conventional C&B and pulp death. Steve M. >Thanks for the reply. > [quoted text clipped - 3 lines] > >http://flapsblog.com >The article goes on to show that certain acrylic temporary materials >can raise the intrapulpal temperature more than 5.5 degree Celsius. [quoted text clipped - 3 lines] > >Steve M. But it does reinforce your 'what's a temporary' sig <g> -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com yup >>The article goes on to show that certain acrylic temporary materials >>can raise the intrapulpal temperature more than 5.5 degree Celsius. [quoted text clipped - 5 lines] > >But it does reinforce your 'what's a temporary' sig <g> > >The article goes on to show that certain acrylic temporary materials > >can raise the intrapulpal temperature more than 5.5 degree Celsius. [quoted text clipped - 10 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com One way around this could be to take the impression and m ake a poly siloxane positive impression of that and build the temp on that. SP SignatureFinally: take out the TRASHH >> >The article goes on to show that certain acrylic temporary materials >> >can raise the intrapulpal temperature more than 5.5 degree Celsius. [quoted text clipped - 14 lines] >siloxane positive impression of that and build the temp on that. >SP Or make the temp out of bis-acryl, it doesn't seem to heat up on setting at all. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>>>The article goes on to show that certain acrylic temporary materials >>>>can raise the intrapulpal temperature more than 5.5 degree Celsius. [quoted text clipped - 16 lines] > > Or make the temp out of bis-acryl, it doesn't seem to heat up on setting at all. Come to think of it, I've never noticed an exotherm. I wouldn't expect to notice it on light-cured resins sitting under a quartz halogen bulb, but you're right--I don't notice it with self-cure resins either. Anyone know why this might be? Steve > -- > > W_B > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > >One way around this could be to take the impression and m ake a poly > >siloxane positive impression of that and build the temp on that. [quoted text clipped - 6 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com A-HA!!!! Thanks SP SignatureFinally: take out the TRASHH > > >One way around this could be to take the impression and m ake a poly > > >siloxane positive impression of that and build the temp on that. [quoted text clipped - 10 lines] > Thanks > SP As I said from my Dad's computer: I tried the Fill-In stuff from Kerr... I was surprised at the intensity of the exothermic RX.... I will definitey consider pulling 'em off if I use 'em, like I do acrylic temps. Ta..DA! SP SignatureFinally: take out the TRASHH I wonder how many he has had to prep an access through? Mancuso, how about it? Flap http://flapsblog.com I answered this already 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. /////////////////////// >I wonder how many he has had to prep an access through? > [quoted text clipped - 3 lines] > > http://flapsblog.com Sorry, I missed it. What is the answer again? Flap http://flapsblog.com Very few. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. 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. ...................... > Sorry, I missed it. > [quoted text clipped - 3 lines] > > http://flapsblog.com When was the last time you had to re-open a RCT tooth after final obturation? I finally realized that this only happens to me about once every 5-6 years. Why wait for the one very rare case? If I have to cut through the porcelain to re-treat, who cares? I can re-mill the porcelain while treating the RCT. No time lost. No lab cost.> Material cost is about $30. Why wait? Does the patient want to have two separate appointments which total 3 1/2 hours, or one appointment of less than 2 1/2 hours? Does the patient want to pay extra for a core build-up, which is one more thing which can fail? .-- --------------============-------------========= 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. /////////////////////// > Fair enough and I know my endodontist most of the times will and > sometimes won't. But, they don't do a final restoration immediately [quoted text clipped - 9 lines] > > It seems prudent in some cases to wait a few days - at least. Fair enough. But, what about an anterior tooth? Do you do a Cerec crown for say #8 and #9? And the aesthetics? Flap http://flapsblog.com On a patient over the age of 45, one shade is all there is on an anterior tooth. You often do not need any characterization of the shade. If you are doing a pair of teeth on the 45+ generation, you simply choose A-2, A-3, etc. mill and bond. If you have a younger patient, or someone with charactization you need to match, you book an extra 10-30 minutes (depending on your speed), stain and glaze. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. 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. ...................... > Fair enough. > [quoted text clipped - 7 lines] > > http://flapsblog.com >Fair enough and I know my endodontist most of the times will and >sometimes won't. But, they don't do a final restoration immediately >after obturation. > >But, would you feel comfortable milling and cementing a permanent >porcelain restoration at the same appointment. Have seen him do it in person, more than once. >What if you have a blow up and need to reinstrument/retreat the canals? If that happens it is likely that the canals were poorly instrumented the first time, or there is a missed canal. In either case one should reconsider performing endodontic treatment. >You would have to cut an access hole in your new porcelain crown. Then >would you replace the crown? Or merely fill the access hole? > >It seems prudent in some cases to wait a few days - at least. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com As long as the canal stays dry after using the GT Files, I obturdate. Depending on the circumstances, I have (on occasion), placed CaOH for a few minutes into canals which weep blood, cleaned it back out and if it stays dry now, obturate it. That would be for cases where the patient will have a hard time getting back. If I get purulence on the paper point after rinsing out the canal (after final file), then I will wait a week or two. I would say that is probably one out of 50 cases. 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. /////////////////////// > Steve, > [quoted text clipped - 7 lines] > > http://flapsblog.com Thanks for your answer. I replied previously. Flap http://flapsblog.com Wow, thank you guys. I truly appreciate your response to my post. I appreciate that you understood my perdicament, rather than the response I received from Jacob. I have definitely thought about seeing her when she settles in in Napa. She found 4 canals in the tooth, and as I said, one - the longest she said something like 17 bled. The concern I had was how could someone who never saw the tooth be able to place a screw in the middle of the tooth and canal. She shared that the person she sold the practice to is 32 and is very nice. I like nice, which my current dentist is, but I also want to know I won't lose a tooth in this situation. I have had few dental procedures done other than my 6 mo cleaning and checks and I'm very tentative. Again, thank you for your response. > I also want to know I won't lose a tooth in > this situation. I have had few dental procedures done other than my 6 > mo cleaning and checks and I'm very tentative. Again, thank you for > your response. Again: if you want to be sure, you want a prosthodontist, or your original dentist. SP SignatureFinally: take out the TRASHH No guarantees in dental work. You might still lose the tooth. No way to tell if there is a crack starting to grow in the root system without extracting the tooth. You go with the course of treatment most acceptable and the vast majority of such teeth are fine. Any dentist who is good enough to work in your mouth can place a post and crown. This is not difficult. So long as proper methods are followed, it works well. Personally, I stopped using posts in molars a few years back. Studies show that the posts do NOT make the tooth any stronger, and could weaken the root in some cases. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. 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. ...................... > Wow, thank you guys. I truly appreciate your response to my post. I > appreciate that you understood my perdicament, rather than the response [quoted text clipped - 8 lines] > mo cleaning and checks and I'm very tentative. Again, thank you for > your response. >Steve, > >Do you feel comfortable obturating the RC if the tooth presents >non-vital when you first see it? Yep. >I, most always wait a second appointment before filling up that root >canal system. Why ? I don't. The only time I don't obturate is when the canal won't dry. >Flap > >http://flapsblog.com -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >I, most always wait a second appointment before filling up that root > >canal system. [quoted text clipped - 13 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com So, I assume you'd place some Ca(OH)2? Thanks SP SignatureFinally: take out the TRASHH >> >I, most always wait a second appointment before filling up that root >> >canal system. [quoted text clipped - 18 lines] >Thanks >SP Yes indeed, mix with anesthetic w/o vasoconstrictor. Place with spiral filler, dry up xs liquid and place a good temp. (IRM or Fuji 9, no Cavit) -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Yes indeed, mix with anesthetic w/o vasoconstrictor. > Place with spiral filler, dry up xs liquid and place a good > temp. (IRM or Fuji 9, no Cavit) > -- 'K... thanks, you said this once before and I'd forgotten. Re no Cavit: is that because you feel it doesn't seal well; or is it because it has too much CaO in it; or is it because it comes from the Frogs? Thanks SP SignatureFinally: take out the TRASHH >> Yes indeed, mix with anesthetic w/o vasoconstrictor. >> Place with spiral filler, dry up xs liquid and place a good [quoted text clipped - 6 lines] >Thanks >SP Cavit doesn't seal well, IOW it leaks. Because it comes from the Frogs is just a bonus. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>>Yes indeed, mix with anesthetic w/o vasoconstrictor. >>>Place with spiral filler, dry up xs liquid and place a good [quoted text clipped - 14 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com My Cavit is from Germany. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> Cavit doesn't seal well, IOW it leaks. >> Because it comes from the Frogs is just a bonus. I like Cimpat as it is packaged in syringes similar to composites, and you can back up the screw on the end to keep material from coming out after you have dispensed the desired amount. Material characteristics are just as good (or bad) as Cavit. Signature/ Amatus / > >>>>Yes indeed, mix with anesthetic w/o vasoconstrictor. [quoted text clipped - 19 lines] > > Steve >>> Cavit doesn't seal well, IOW it leaks. >>> Because it comes from the Frogs is just a bonus. [quoted text clipped - 3 lines] >have dispensed the desired amount. Material characteristics are just as >good (or bad) as Cavit. Lately I have been using bonded fuji 9 if a second endo appt is needed. Easy to place/remove, excellent seal. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Lately I have been using bonded fuji 9 if a second endo appt is needed. > Easy to place/remove, excellent seal. > - I have been wondering about this since you said it: How to not plug your canals? I imagine you pack cotton into the lower part of the access cavity before etching the thing, change the coton before applying bonding and then what?. Do you place a wet cotton before placing the Fuji-9? Also, if Fuji-9 is what you want to do, then why not place a coton pellet, some Cavit/Cimpat over that and then Fuji 9 over it? That way you get the theraputic effect of CaO in the stuff. FWIW, where you would use Fuji-9 here, I'd be using Geristore, as you can squeeze out just as much as you need, where as using Fuji-9 would be wasteful, IMO, as you surely don't need a full capsule for plugging an access cavity.... do you? I also find Geristore easier to pack: just wait 'till it starts to harden (autocure) and shape it. Then zap it with the light. Thanks SP SignatureFinally: take out the TRASHH >> Lately I have been using bonded fuji 9 if a second endo appt is needed. >> Easy to place/remove, excellent seal. [quoted text clipped - 5 lines] >bonding and then what?. Do you place a wet cotton before placing the >Fuji-9? CaOH in the canals and the pulpal floor, dry cotton pellet, Changed after the etch rinse. >Also, if Fuji-9 is what you want to do, then why not place a coton >pellet, some Cavit/Cimpat over that and then Fuji 9 over it? That way >you get the theraputic effect of CaO in the stuff. Cavit takes too long to set, and it is another step that just slows you donw. >FWIW, where you would use Fuji-9 here, I'd be using Geristore, as you >can squeeze out just as much as you need, where as using Fuji-9 would be [quoted text clipped - 4 lines] >Thanks >SP I dunno about wasteful, sometimes have to use two capsules on severely broken down teeth, one for the 'endo build up' and one to seal. You can pack the fuji 9 with the light cure coating on a micro brush. Just don't think that I need another material. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > I dunno about wasteful, sometimes have to use two capsules on > severely broken down teeth, one for the 'endo build up' and one [quoted text clipped - 6 lines] > > W_B OK... so if you use it to build up the crown, I assume you just leave it there and then prep it down for a crown? thanks SP SignatureFinally: take out the TRASHH >> I dunno about wasteful, sometimes have to use two capsules on >> severely broken down teeth, one for the 'endo build up' and one [quoted text clipped - 11 lines] >thanks >SP Yep, saves time. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Yep, saves time. > -- > > W_B > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com Good. I splathered an upper first molar with two caps of Fuji 9 for an endo today, in fact. Sure does go in easy. Thanks SP SignatureFinally: take out the TRASHH > Just don't think that I need another material. Always best to limit the number of materials you have to inventory. Signature/ Amatus / > >>> Lately I have been using bonded fuji 9 if a second endo appt is needed. [quoted text clipped - 38 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com >> Just don't think that I need another material. > >Always best to limit the number of materials you have to inventory. My thoughts exactly. I will always like one better than the others. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > FWIW, where you would use Fuji-9 here, I'd be using Geristore, as you > can squeeze out just as much as you need, where as using Fuji-9 would be > wasteful, IMO, as you surely don't need a full capsule for plugging an > access cavity.... do you? I also find Geristore easier to pack: just > wait 'till it starts to harden (autocure) and shape it. Then zap it with > the light. The studies I read all show good sealing of Cavit type material for 3-8 months (depending on which study you read). If I recall correctly, some studies were done with dyes and others were done with live cultures. The problem with Cavit is leaving it in the tooth long-term. Leaving it in the tooth post-RCT for a year could necessitate re-treatment of the RCT due to contamination of the gutta percha seal down through the root system. Signature/ Amatus / > >> Lately I have been using bonded fuji 9 if a second endo appt is needed. [quoted text clipped - 19 lines] > Thanks > SP > The studies I read all show good sealing of Cavit type material for 3-8 > months (depending on which study you read). If I recall correctly, some [quoted text clipped - 4 lines] > > -- I heard you only could leave it for three months. That was in my Perio course in May/June Thanks SP SignatureTake out the TRASH to reply >> The studies I read all show good sealing of Cavit type material for 3-8 >> months (depending on which study you read). If I recall correctly, some [quoted text clipped - 9 lines] >Thanks >SP Really we should also move on from GP and switch to Resilon. There is a bond between dentin and the special sealer. Cavit shouldn't be used as a temp for RCT. Fuji9 or comparable is much better. This is called the 'monoblock' fill. For GP's you should consider the RC seal to be from the apex to the cusp tip. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Really we should also move on from GP and switch to Resilon. > There is a bond between dentin and the special sealer. [quoted text clipped - 5 lines] > the apex to the cusp tip. > -- I heard the guys at UltraDent saying the same. They have their own type of resin filling. What's your impression of Resilon since you've been using in in big vs small canals? Thanks SP SignatureTake out the TRASH to reply >> Really we should also move on from GP and switch to Resilon. >> There is a bond between dentin and the special sealer. [quoted text clipped - 14 lines] >Thanks >SP Gotta admit that I haven't made the jump yet. Want to discuss it with Dr. Endo first, and we have just been too busy to get together. I don't think that canal size will make any difference. Resilon handles just like GP, and I am planning to use manual lateral condensation with this new material. I don't believe the fancy backfill unit is necessary, it certainly wouldn't be much faster in my hands. Remember you are going to prepare the canal with a significant taper and enlarge the apical prep to about a 30 to 40 depending on the tooth. It has been shown that even with GP, *if a good coronal seal is established*, RCT is still in the high 90's % sucess rate. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Remember you are going to prepare the canal with a > significant taper and enlarge the apical prep to about [quoted text clipped - 3 lines] > *if a good coronal seal is established*, > RCT is still in the high 90's % sucess rate. OK, thanks SP SignatureTake out the TRASH to reply > > Remember you are going to prepare the canal with a > > significant taper and enlarge the apical prep to about [quoted text clipped - 6 lines] > OK, thanks > SP Actually, the UltraDent people were saying much the same thing with their version of a resin based sealer. The lady showed me how it fills in the holes made in model canals when you push the GP into the canal. Being a resin cement, I would think it would seal the lateral canals permanently. You can even down pack it with heat if you want. You have about 20 mins to play around before the auto-cure. You finish sealing and then zap it with the light then immediate core buildup. There didn't seem to be any adhesive in any of those steps. One of the Montreal Perios is also an Endo and I asked him what he thought of these types of cement systems. Unfortunately, he is Boston trained, and so Shilder is still his gold standard. He didn't knock the concept, but it seems clear to me that it's not the speciallists who will embrace the Resilon idea first. This is perhaps true with many advances in Dentistry. UltraDent also has its own brand of rotary files, supposedly designed by an Endo. I aslo saw in DT magazine that there is a new system called V-Taper. There is only three files. Of course, the creator did this 'because he wanted to help his colleagues'. So: who is brave enough to try them? Cheers SP SignatureTake out the TRASH to reply >> > Remember you are going to prepare the canal with a >> > significant taper and enlarge the apical prep to about [quoted text clipped - 22 lines] >will embrace the Resilon idea first. This is perhaps true with many >advances in Dentistry. The course I took was from two Endos who embraced the Resilon concept. The file system was the K3, forget the manufacturer. >UltraDent also has its own brand of rotary files, supposedly designed by >an Endo. I aslo saw in DT magazine that there is a new system called >V-Taper. There is only three files. Of course, the creator did this >'because he wanted to help his colleagues'. So: who is brave enough to >try them? Just happen to have a copy of an article on them sitting on the desk in front of me right now ! I would try them, free sample anyone ? <hehe> >Cheers >SP -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > The course I took was from two Endos who embraced the Resilon > concept. The file system was the K3, forget the manufacturer. the _K_ in K3 stands for Kerr (as in K files). That's their catch phrase in our throw away journals. Don't rightly know what the _3_ stands for... Personally, I tried the Sequence rotary system from Brassler, and while I find them easier to use than ProFile GT's, I don't find they are thick enough to handle big canals. They are really good in the smaller ones though, and thier adjusted paper points and GP set is within acceptable tolerances. Though if you do vertical condensation of GP (which _you_ don't do) you should still lop off a mm or so off the tip before pushing on it with heated pluggers. SP continued to blah-blah like a sick cow: > >UltraDent also has its own brand of rotary files, supposedly designed by > >an Endo. I aslo saw in DT magazine that there is a new system called [quoted text clipped - 5 lines] > front of me right now ! > I would try them, free sample anyone ? <hehe> I'm sure they have a cheap starter kit. Personally, I've gone back to ProFile GT. I can at least use a ThermoFil in the bigger straight canals. (Shame shame shame.... stuff it: they work in my hands). The newer plasticized carriers are easy to heat-cut off and also easy to drill out for posts. In case you're interested (well, maybe someone _else_ is): ProFile GT's also have matched paper points and GP's to the file at the apex. Makes it easier for the vertical warm condensation people like me. Cheers SP SignatureTake out the TRASH to reply > I like Cimpat as it is packaged in syringes similar to composites, and you > can back up the screw on the end to keep material from coming out after you > have dispensed the desired amount. Material characteristics are just as > good (or bad) as Cavit. 10-Q for this. I've never known a real dentist to use Cimpat. SP SignatureFinally: take out the TRASHH > 10-Q for this. I've never known a real dentist to use Cimpat. > SP Maybe I am artificial? <g> Signature/ Amatus / > >> I like Cimpat as it is packaged in syringes similar to composites, and [quoted text clipped - 6 lines] > 10-Q for this. I've never known a real dentist to use Cimpat. > SP > > 10-Q for this. I've never known a real dentist to use Cimpat. > > SP > > Maybe I am artificial? <g> Just unreal... Will the real the only and the true to life A.C. please stand up; please stand up; please stand up.... M&M wannabe SP SignatureTake out the TRASH to reply >Re no Cavit: >>>is that because you feel it doesn't seal well; or is it because it has [quoted text clipped - 13 lines] > >Steve Just as bad. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com ze part-Quebec-Frog SP ask-ed: > >'K... thanks, you said this once before and I'd forgotten. Re no Cavit: > >is that because you feel it doesn't seal well; or is it because it has [quoted text clipped - 5 lines] > Because it comes from the Frogs is just a bonus. > -- 'K.... are there any other nationalities that carry animal nicnames like that? There's Kiwis (NewZealanders), Limeys (Brits)....?... SP SignatureFinally: take out the TRASHH >ze part-Quebec-Frog SP ask-ed: >> >'K... thanks, you said this once before and I'd forgotten. Re no Cavit: [quoted text clipped - 10 lines] >that? There's Kiwis (NewZealanders), Limeys (Brits)....?... >SP What kind of animal is a Lime ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com Its a greenish-yellow bird that resembles a turkey ..... -- Joel34 > Its a greenish-yellow bird that resembles a turkey ...... Thiis has what to do with a root canal????? Same nonsense from Joel > >'K.... are there any other nationalities that carry animal nicnames like > >that? There's Kiwis (NewZealanders), Limeys (Brits)....?... [quoted text clipped - 6 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com ???? You've never gone lime shooting??? SP SignatureFinally: take out the TRASHH > >'K.... are there any other nationalities that carry animal nicnames like > >that? There's Kiwis (NewZealanders), Limeys (Brits)....?... [quoted text clipped - 6 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com .... In the Fruit Basket... there is NO ONE to hear you scream...... SP SignatureFinally: take out the TRASHH > 'K.... are there any other nationalities that carry animal nicknames like > that? There's Kiwis (NewZealanders), Limeys (Brits)....?... Limey does not refer to any animal I know of Signature/ Amatus / > > ze part-Quebec-Frog SP ask-ed: [quoted text clipped - 11 lines] > that? There's Kiwis (NewZealanders), Limeys (Brits)....?... > SP > > 'K.... are there any other nationalities that carry animal nicknames like > > that? There's Kiwis (NewZealanders), Limeys (Brits)....?... > > Limey does not refer to any animal I know of Well... JME knows everything, and he says it a kind of turkey caught at a traffic intersection... SP SignatureFinally: take out the TRASHH > Cavit doesn't seal well, IOW it leaks. > Because it comes from the Frogs is just a bonus. > -- Seriously... in Franklin Weine's book, he speaks of making IRM at the beginning of the day, storing it in a hermetic bottle with a drying agent in it, much like you'd find in pill bottles to keep them dry. I tried that a few years ago and I never found it worked. About a half-hour later, the stuff was as hard as a rock. Still, if it worked, it could save time, as you'd just spoon it out like Cavit. (And it wouldn't say : BUD... Wise... 'er... when you packed it...) Have you tried this and if so what am I doing wrong ( I mean apart from getting outta bed in the morning ). 10-Q SP SignatureFinally: take out the TRASHH >> Cavit doesn't seal well, IOW it leaks. >> Because it comes from the Frogs is just a bonus. [quoted text clipped - 19 lines] >10-Q >SP Never tried it. I use the IRM capsules, you have to fiddle with your triturator time a bit to get the mix time right. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Never tried it. > I use the IRM capsules, you have to fiddle with your triturator time > a bit to get the mix time right. > -- OH, blimy.... those *&&?%%$$$ IRM caps.... I've lost as many as I've gotten to work. You're right though that it's fun when it _does_ work. Thanks SP SignatureFinally: take out the TRASHH >> Never tried it. >> I use the IRM capsules, you have to fiddle with your triturator time [quoted text clipped - 6 lines] >Thanks >SP If it comes out crumbly put it back in the triturator for 2 more seconds. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > If it comes out crumbly put it back in the triturator for 2 more seconds. > -- > > W_B > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com I think I'll try to get a deal on the stuff next week at the annual congress in Montreal. It came out like that half the time (no joke). I'll try that. Thanks SP SignatureFinally: take out the TRASHH > OH, blimy.... those *&&?%%$$$ IRM caps.... I've lost as many as I've > gotten to work. You're right though that it's fun when it _does_ work. They set slowly, so mix them a couple of minutes before you are actually going to place it. Signature/ Amatus / > >> Never tried it. [quoted text clipped - 7 lines] > Thanks > SP > > OH, blimy.... those *&&?%%$$$ IRM caps.... I've lost as many as I've > > gotten to work. You're right though that it's fun when it _does_ work. > > They set slowly, so mix them a couple of minutes before you are actually > going to place it. I'm gonna get me some samples and try it again. Thanks SP SignatureTake out the TRASH to reply > Seriously... in Franklin Weine's book, he speaks of making IRM at the > beginning of the day, storing it in a hermetic bottle with a drying [quoted text clipped - 3 lines] > it could save time, as you'd just spoon it out like Cavit. (And it > wouldn't say : I buy IRM in capsules and mix it in the tirturator (don't throw those babies out). I keep a bottle of IRM powder on hand and dispense a tiny bit to dip the instrument in (keeps the IRM from sticking to the instrument). The extra powder makes the surface set a "bit" faster so you can condense it better. I probably use one capsule of IRM every 3 months. Much faster to place other filling materials and studies do show any advantage of the Eugenol to the pulpal tissues--long term. Signature/ Amatus / > >> Cavit doesn't seal well, IOW it leaks. [quoted text clipped - 20 lines] > 10-Q > SP > Much faster to > place other filling materials and studies do show any advantage of the > Eugenol to the pulpal tissues--long term. I think you meant to say 'studies do NOT show any advantage of Eugenol to the papal tissues'. SP SignatureFinally: take out the TRASHH</ |
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