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Medical Forum / General / Dentistry / September 2007

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endo questions

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dacconverter - 15 Sep 2007 21:36 GMT
1. While doing endo, suppose you came upon an accessory canal. As of
current, there is no literature that suggests obturation ( or
otherwise ) of accessory canals. So what would you do? Would you
obturation it?

2. How likely is it to have perforated through the furcation but still
not see any blood?

3. In reference to the above question, on its radiograph, you see a
slight grayish radioluency in the shape of a vertical tube right in
the middle of the furcation. How likely is it that this is a
perforation?

4. To what extent do you obturate canals? 0.5 mm short of the apex?
0.5 mm past the apex?

5. Would you do an endo on a premolar with 3/4 horizontal bone loss?
( assuming a mobility of just grade 1 and there are no existing caries
or failing restoration on the tooth )

6. Suppose you get an emergency patient with an irreversible pulpitis
and having all the related acute symptoms. And you are to do a
pulpotomy; you can't do a full root canal treatment because the
patient can't afford it at the moment and isn't sure if he wants to
withstand the procedure.

a. Would you apply some CaOH inside the canals before temporarily
filling it?

b. Do you use Cavit or IRM as the temporarily filling material?

c. To what extent would you instrument the canals just for the
pulpotomy?

d. Do you usually recommend or prescribe to the patient pain meds
right after the pulpotomy? If so, which meds are they?

e. On average, how long does it take for your patients to feel
acceptably comfortable from the onset of the pulpotomy, with or
without meds? 24 hrs? 48 hrs? Never?

f. Even a few days after the pulpotomy, suppose the patient is still
suffering from throbbing pain, even with pain meds? Assuming that you
can't finish the root canal trmt, what would you do? Would you re-do
the pulpotomy?

g. More importantly, in regards to the above question, what would you
wish having done differently during the pulpotomy so that the patient
wouldn't be feeling the pain?
Steven Bornfeld - 15 Sep 2007 22:39 GMT
    Geez, these seem like homework questions.  Let's see how I do:

> 1. While doing endo, suppose you came upon an accessory canal. As of
> current, there is no literature that suggests obturation ( or
> otherwise ) of accessory canals. So what would you do? Would you
> obturation it?

    More to the point, how COULD you obturate it?  In warm gp techniques
you will sometimes see a fill of accessory canals.  Sometimes you will
see sealer even with cold gp.  But I don't know anyone who suggests
these "fills" are complete.

> 2. How likely is it to have perforated through the furcation but still
> not see any blood?

    The operator?  If this is a periodontally involved tooth with furcation
involvement, quite likely.  If not, and you really zoom through the
furca, you'll probably see blood.

> 3. In reference to the above question, on its radiograph, you see a
> slight grayish radioluency in the shape of a vertical tube right in
> the middle of the furcation. How likely is it that this is a
> perforation?

    Sorry--I believe I've seen binary files posted to this ng, but I don't
see any radiograph.

> 4. To what extent do you obturate canals? 0.5 mm short of the apex?
> 0.5 mm past the apex?

    Neither.  I fill to the apical constriction I've created just short of
the canal exit, which of course may be at some distance from the
radiographic apex.

> 5. Would you do an endo on a premolar with 3/4 horizontal bone loss?
> ( assuming a mobility of just grade 1 and there are no existing caries
> or failing restoration on the tooth )

    There are circumstances where this might be advisable--perhaps an
overdenture is planned.  Is there any pulpal problem (since you say
there's no caries and no failing restoration)?

> 6. Suppose you get an emergency patient with an irreversible pulpitis
> and having all the related acute symptoms. And you are to do a
[quoted text clipped - 4 lines]
> a. Would you apply some CaOH inside the canals before temporarily
> filling it?

    Not necessarily.  If the tooth may be extracted, and assuming the tooth
is still vital, I may not enter the canals.  If you are doing a
pulpotomy (as opposed to pulpectomy) you are not going into the canals.

> b. Do you use Cavit or IRM as the temporarily filling material?
>
> c. To what extent would you instrument the canals just for the
> pulpotomy?

Zero (by definition).

> d. Do you usually recommend or prescribe to the patient pain meds
> right after the pulpotomy? If so, which meds are they?

    Depends.

> e. On average, how long does it take for your patients to feel
> acceptably comfortable from the onset of the pulpotomy, with or
> without meds? 24 hrs? 48 hrs? Never?

    Off the top of my head, I'd expect them to feel at least somewhat
better within 24 hours.

> f. Even a few days after the pulpotomy, suppose the patient is still
> suffering from throbbing pain, even with pain meds? Assuming that you
> can't finish the root canal trmt, what would you do? Would you re-do
> the pulpotomy?

    No.  What possible rationale would there be for repeating an
ineffective treatment?

> g. More importantly, in regards to the above question, what would you
> wish having done differently during the pulpotomy so that the patient
> wouldn't be feeling the pain?

    I'd wished I'd turned on the 20/20 hindsight glasses.  Oh wait--they
only work afterwards.  Nevermind.

Steve
Steven Fawks - 16 Sep 2007 03:22 GMT
Sounds like a fishing trip to me.

Steve
dacconverter - 16 Sep 2007 13:32 GMT
> Sounds like a fishing trip to me.
>
> Steve

huh?
Amatus Cremona - 16 Sep 2007 15:17 GMT
Kindly explain your background and the reason for your post, and we may be
more likely to give you the details you desire.

>> Sounds like a fishing trip to me.
>>
>> Steve
>
> huh?
Dartos - 17 Sep 2007 20:49 GMT
>>Sounds like a fishing trip to me.
>>
>>Steve
>
> huh?

From what dental school did you graduate?

What is your favorite composite bonding system and why?

:-)
D
Newbie@bix.nex - 17 Sep 2007 00:43 GMT
>Sounds like a fishing trip to me.
>
>Steve

With bad bait to boot.
Amatus Cremona - 16 Sep 2007 15:15 GMT
Another legal assistant hunting for free research ????

> 1. While doing endo, suppose you came upon an accessory canal. As of
> current, there is no literature that suggests obturation ( or
[quoted text clipped - 45 lines]
> wish having done differently during the pulpotomy so that the patient
> wouldn't be feeling the pain?
Newbie@bix.nex - 17 Sep 2007 00:44 GMT
Write your own term paper.
dacconverter - 17 Sep 2007 01:06 GMT
On Sep 16, 7:44 pm, New...@bix.nex wrote:
> Write your own term paper.

I just wanted to do some polling on how the dentists here approach
endo.

Sheesh !
Newbie@bix.nex - 17 Sep 2007 01:25 GMT
>On Sep 16, 7:44 pm, New...@bix.nex wrote:
>> Write your own term paper.
[quoted text clipped - 3 lines]
>
>Sheesh !

OK fair enough.

How long have you been practicing ?
Answer that and I'll answer your endo quesitons.

I don't view referrals to specialists as "lost revenue".
Specialists are there for a purpose, use when your skills
aren't adequate for the best care for the patient.
Amatus Cremona - 17 Sep 2007 14:23 GMT
We get a fair number of legal assistants coming here thinking they will get
free opinions to support a legal case.  We don't mind passing out free
advice and information to people who need it, but if someone is going to
profit from the information, they should pay for it.

Your list of questions seemed to focus on a topic which would be asked by
the typical legal assistant hunting for free information.  Sorry if it
mis-read your posting.  We get kind of calloused after a while.

Are you a fresh graduate, or a seasoned one.??

Signature

/

Amatus

/

> On Sep 16, 7:44 pm, New...@bix.nex wrote:
>> Write your own term paper.
[quoted text clipped - 3 lines]
>
> Sheesh !
Dartos - 17 Sep 2007 20:54 GMT
Especially the accessory canal and perforation questions.

JMO,
D

> We get a fair number of legal assistants coming here thinking they will get
> free opinions to support a legal case.  We don't mind passing out free
[quoted text clipped - 6 lines]
>
> Are you a fresh graduate, or a seasoned one.??
 
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