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Medical Forum / General / Dentistry / November 2005

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For George Chatzipetros

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Sherry - 05 Nov 2005 01:01 GMT
Can I call you "Chatty" for short?

Actually, I asked the endo if the decay came from the missed canal and he
told me that it hadn't.  Part of the canal that my dentist missed had
calcified and the endo is still trying to find it.  So, it appears that he
just didn't clean out decay that was in there.  My understanding of a root
canal was that the dentist would clean up the tooth and fill the canals.  I
assumed, maybe wrongly, that this would entail getting rid of any decay in
the tooth.  The dentist obviously didn't do a very good job of "cleaning up"
the tooth.  It's a pretty big tooth so I don't think the reason that he
didn't clean the decay out was to leave enough tooth to hold a rubber dam.
All I know is that he left me sitting in the chair to call my dentist and
tell him what the problem was and the dentist said he would pay for the endo.
The endo took the decay out and is in the process of redoing the root canal.
He even took the tooth down so that there was no chance of my biting down on
it and causing more problems so I am pretty sure that was ample tooth there
to begin with.

Like I said it my other posts, I had two teeth side-by-side done at the same
time.  All of syptoms went away after he took the infection out of my molar,
but some are beginning to come back.  I am now wondering if maybe the dentist
left decay in the other tooth as well.  I go back to the endo on the 9th so I
will have to ask him.  Symptoms aren't quite as drastic and the tooth is much
smaller so maybe there's not as much infection in that one.
Joel M. Eichen - 05 Nov 2005 09:49 GMT
>Can I call you "Chatty" for short?

We call him Chatster for short .........
George Chatzipetros - 05 Nov 2005 16:47 GMT
Hi Sherry, I prefer George C or Big G :)
The stated goal of root canal treatment is to clean and seal the root
canals. The coronal portion of the tooth is of little interest to us
while doing the root canal treatment. We will of course typically
remove gross decay as we access the pulp chamber and root canals, but
complete eradication of decay is not within the scope of root canal
treatment; it is a goal for restorative procedures like cavity
preparation for fillings or crown preparation. Of course, nowadays
general dentists usually prefer to do both procedures at once, ie root
canal treatment + build-up and crown prep, so they will routinely
remove all decayed tooth tissue along with cleaning the canals.
My point is leaving a little decay behind after RCT but before a crown
won't kill you. Your big problem at the moment is the active infection
that is possibly coming from that calcified canal. Unless this matter
is addressed, there is a good chance you might lose the entire tooth.
Focus on the important stuff.

Regards,
George
W_B - 07 Nov 2005 17:15 GMT
>Hi Sherry, I prefer George C or Big G :)
>The stated goal of root canal treatment is to clean and seal the root
[quoted text clipped - 4 lines]
>treatment; it is a goal for restorative procedures like cavity
>preparation for fillings or crown preparation.

Actually the newest concept is the 'monobloc' and the coronal
seal is just as important as the RC seal.

Remove *all* decay !
--

W_B
Take out the G'RBAGE
wubbabubbazG@RBAGEyahoo.com
George Chatzipetros - 07 Nov 2005 19:18 GMT
George, root canal treatment cannot provide a coronal seal by
definition. The coronal seal is provided by the restoration placed
AFTER the RCT. I will agree that the coronal seal is probably the most
important thing.

George
W_B - 07 Nov 2005 20:44 GMT
>George, root canal treatment cannot provide a coronal seal by
>definition. The coronal seal is provided by the restoration placed
>AFTER the RCT. I will agree that the coronal seal is probably the most
>important thing.
>
>George

I disagree.
The coronal seal can be the build up done after the endo.

I use Fuji 9 immediately after finishing any endo, and that
provides the 'coronal seal'. The crown can be done later,
or a Cerec can be placed the same appointment.

The latest endo course I took recommended placing a
coronal seal even if it was a bonded resin 'cap' over
the RC fill material until the GP could prepare for a crown.

Latest theory/research suggests that any RC fill that is
exposed to the oral environment for a length of time
should be retreated before final restoration is placed.
--

W_B
Take out the G'RBAGE
wubbabubbazG@RBAGEyahoo.com
George Chatzipetros - 08 Nov 2005 07:05 GMT
Yes, but that means exposure for more than 3 months. Temporary
materials usually provie a good seal for a month or so. And you said it
yourself: the coronal seal is the biuldup AFTER then endo, which means
that the endo in itself does not provide any coronal seal at all. You
just combine 2 procedures in a single visit.

George
Dartos - 08 Nov 2005 14:09 GMT
In practice, I'm not sure there is a great problem with this
approach, but many experts today are indeed advocating materials
that seal better than Cavit or IRM (as well as complete decay
removal) when finishing a root canal.

You've just spent a lot of time and effort to clean, shape, and
disinfect the canal system.  You may as well do your best to
reduce any future contamination.  It doesn't take long to bond
some composite over the canals (a good alcohol scrub is needed to
get rid of any residual root canal cement before etching).  I use
opaque flowable so it is easily visible if someone has to go back
in there at a later date.

Dartos

> Yes, but that means exposure for more than 3 months. Temporary
> materials usually provie a good seal for a month or so. And you said it
[quoted text clipped - 3 lines]
>
> George
W_B - 08 Nov 2005 18:13 GMT
Agree completely.

From my latest endo course notes about final irrigation.

1) Irrigation

NaOCl cannot be final rinse

EDTA 'Smear Clear' Quaternary Ammonioum compound
--or--
2% ChlorHexadine Gluconate  CHX <-- last irrigant.

You can use all three in the above order.

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
I remove residual grossman's with Cavilax or Cavidry

>In practice, I'm not sure there is a great problem with this
>approach, but many experts today are indeed advocating materials
[quoted text clipped - 18 lines]
>>
>> George

--

W_B
Take out the G'RBAGE
wubbabubbazG@RBAGEyahoo.com
W_B - 08 Nov 2005 17:58 GMT
>Yes, but that means exposure for more than 3 months. Temporary
>materials usually provie a good seal for a month or so. And you said it
[quoted text clipped - 3 lines]
>
>George

I don't see it as two different procedures.

Root Canal Therapy should be considered from
root tip to cusp tip.

Rubber dam only comes off after the Fuji 9 has set.
--

W_B
Take out the G'RBAGE
wubbabubbazG@RBAGEyahoo.com
 
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