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Medical Forum / General / Dentistry / January 2008Endos who use biocompatible root canal fillers in NYC region?
I am looking for an endodontist in southern CT (or anywhere in the NYC region) who uses one of the newer biocompatible root canal filler materials. The ones contacted so far use only gutta percha. Anyone here know of any? Thanks. Robert, there are holistic health newspapers and magazines that I pick up at our local bookstore. For years I have seen the name Lewis Gross. He's in the Wall Street area and his number is 212-732-2200. I know nothing about him nor anyone who has gone to him so I have trepidations about giving out his information. He uses Biocalex instead of gutta percha if that's what you're looking for. I googled Biocalex, sounds questionable. What's wrong with gutta percha? > Robert, there are holistic health newspapers and magazines that I pick > up at our local bookstore. For years I have seen the name Lewis Gross. [quoted text clipped - 3 lines] > percha if that's what you're looking for. I googled Biocalex, sounds > questionable. What's wrong with gutta percha? I don't know that there is anything wrong with gutta percha (although I have seen a couple of articles that suggest that it loses its barrier properties over time.) It is mainly that it is ancient technology and with all the new developments in nanotechnology and medicine I would have thought they would come up with something better. Yes, there do seem to be some questions about Biocalex, but is that the only alternative? Understandably there is a huge amount of inertia behind gutta percha, and I doubt there is much motivation on the part of endos to explore alternatives. >> Robert, there are holistic health newspapers and magazines that I pick >> up at our local bookstore. For years I have seen the name Lewis Gross. [quoted text clipped - 16 lines] > doubt there is much motivation on the part of endos to explore > alternatives. Gutta percha has a long history of safe use. It has shown itself to be biocompatible in terms of not provoking an inflammatory or cellular response. You are correct that its biggest failure is that it simply does not seal very well. This is mitigated to a certain extent by various sealers that are used, but all root canal filling materials leak to a certain extent. Of course the same is true of tooth filling materials. It is a matter of degree. Thermal methods of gutta percha sealing make a really beautiful-looking x-ray. However, because of the significant coefficient of thermal expansion, these have potential to leak as well due to thermal shrinkage. All of these methods on the clinical level seem to work well. Resin fillings seem to seal somewhat better, but I'm not sure what is done when retreatment is necessary. Actually, most dentists are tech geeks, and many will try any new thing out there. I'd rather see clinical results over time rather than jumping on the latest technical bandwagon. This has put me personally behind the curve in some areas; a tradeoff I'm willing to accept to avoid experimenting on my patients. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Gutta percha has a long history of safe use. It has shown itself to be > biocompatible in terms of not provoking an inflammatory or cellular [quoted text clipped - 9 lines] > fillings seem to seal somewhat better, but I'm not sure what is done when > retreatment is necessary. Thanks for the comprehensive response, as usual. What kind of sealer do I want my endodontist to use, if I am interviewing endodontists for my root canal? Wouldn't resin sealer make retreatment less likely? Speaking of which, how long should a well done root canal last? Five years, ten years, 20, 50? > Thanks for the comprehensive response, as usual. What kind of sealer do I > want my endodontist to use, if I am interviewing endodontists for my root > canal? Wouldn't resin sealer make retreatment less likely? > > Speaking of which, how long should a well done root canal last? Five years, > ten years, 20, 50? Let me quote (to the best of my rusty memory) what Dr. Kedeshian, the chief of the endodontic service at my residency over 30 years ago said: "It is not as important what you put into the canal as what you take out". That's a bit of an oversimplification--it assumes a good restoration on the tooth, and there is some evidence that tissue fluid that seeps back into the root canal system and its breakdown products may cause some inflammation. But basically the procedure is intended to remove clinical infection. As far as filling material, a good endodontist is good because the whole package works. Some endodontists no doubt try every filling material they can get their hands on; others may use only one. A good operator will use the material which works well in their hands, and gives a good clinical result. I think the jury is out on resins; they're too new to evaluate long-term success. Steve > I think the jury is out on resins; they're too new to evaluate >long-term success. > >Steve That's what my endo mentor says. Yep he's still using GP and Grossman's <Roth brand>. Until research bears out the indication for a switch, it's best (especially for GP's IMO) to stick with what the majority of endodontic specialists endorse. >> Gutta percha has a long history of safe use. It has shown itself to be >> biocompatible in terms of not provoking an inflammatory or cellular [quoted text clipped - 16 lines] > Speaking of which, how long should a well done root canal last? Five years, > ten years, 20, 50? There is no "should". If a root canal works, it has worked. Unless something enters the root canal system (say, a crown on the tooth has fallen off and the tooth is not promptly repared, leading to leakage from the mouth--it has been shown that the tip of the root can eventually be re-infected this way), the root canal should work indefinitely. When a tooth that has had successful root canal treatment is lost, it is usually for another reason--decay, fracture, periodontal disease. Steve Robert, just my two cents...I had a root canal done 45 years ago. I was a teenager eating a piece of cherry pie with a pit and broke a lower molar. I had it done by my general dentist with silver points and have never had a problem, only changed the crown once or twice. I also have 2 silver point RC's that are 35 years old, no problems (I better knock on wood though, I do worry because docs give different opinions on redoing them if they're not giving me trouble). > Robert, just my two cents...I had a root canal done 45 years ago. I was > a teenager eating a piece of cherry pie with a pit and broke a lower [quoted text clipped - 3 lines] > wood though, I do worry because docs give different opinions on redoing > them if they're not giving me trouble). Interesting: silver points, instead of gutta percha? You mean the amalgam? Can any of the Pros here comment on why silver points are no longer used? (Since you had them done 45 years ago and you are obviously in good enough health to use the computer, they are obviously not the death sentence some here would like to claim :) Robert, I don't know why they used silver points but it was common in the 60's. I don't know when gutta percha became popular. As far as the death sentence, I probably don't want to know the negative stuff. I know they can corrode and I just make sure to get x-rays on schedule and do the best home care I can. I would like to see the article you posted...thanks for that... but my antiquated system can't read PDF files. If you could copy and paste the text, that would be great. > Robert, I don't know why they used silver points but it was common in > the 60's. I don't know when gutta percha became popular. As far as the [quoted text clipped - 6 lines] > --------------------------------------------------------------------- > <html><font s=10></html> Reply probably off-topic. ... By saying "antiquated system", are you referring to WebTV? Do you also have a computer online? I've never seen WebTV except to read posts such as yours. Webby Webby, yes, I was referring to webtv. I got this in 1999 and now the browser is so old that it can't access many things. The good thing and the reason people are reluctant to give it up is that it's comfortable, on my tv screen but I can't do nearly what I could do on a computer. Even ebay has become a hassle. I'm getting an Apple soon though..tired of this piece of junk! > Webby, yes, I was referring to webtv. I got this in 1999 and now the > browser is so old that it can't access many things. The good thing and > the reason people are reluctant to give it up is that it's comfortable, > on my tv screen but I can't do nearly what I could do on a computer. > Even ebay has become a hassle. I'm getting an Apple soon though..tired > of this piece of junk! Good plan! Enjoy. > Robert, I don't know why they used silver points but it was common in > the 60's. I don't know when gutta percha became popular. As far as the [quoted text clipped - 3 lines] > posted...thanks for that... but my antiquated system can't read PDF > files. If you could copy and paste the text, that would be great. Fran, it is not a "death sentence". I was being tongue in cheek (tooth in gum?). Many of the "new agers" subscribe to the butterfly effect that the tiny amount of amalgam in your mouth will make you grow a third arm or something like that. > Interesting: silver points, instead of gutta percha? You mean the amalgam? > > Can any of the Pros here comment on why silver points are no longer used? Gutta percha works a lot better based on percentage of long term success. Doesn't mean that a silver point endo can't work. 'Course like someone mentioned, what is taken out of a tooth with endodontic treatment is more important than what is put back in. I retreated a lower molar last year with a failed silver point endo that was only 2-3 years old! The silver points pulled out easily and were blackened by corrosion. Why someone is still using them, I don't know. Steve >> Interesting: silver points, instead of gutta percha? You mean the amalgam? >> >> Can any of the Pros here comment on why silver points are no longer used? > >Gutta percha works a lot better based on percentage of long term >success. Doesn't mean that a silver point endo can't work. True, but the concept is entirely different. GP fills the space cleaned and shaped. For Ag point endo the objective is to shape/machine the space to accept the prefabbed shape of the Ag point. >'Course like someone mentioned, what is taken out of a tooth with >endodontic treatment is more important than what is put back in. Heard that old saw too, but now totally reject that notion. Sure you have to clean it, but without a good hermetic seal the RCT is ultimately doomed to failure. Once did a retreat on an immigrant. The canal was "obturated" with tightly wound cotton. It was a pain to get out, but retreatment with GP+G's was successful. It really does matter what you put into the canal, but more important is the integrity of the "seal". >I retreated a lower molar last year with a failed silver point endo >that was only 2-3 years old! The silver points pulled out easily and >were blackened by corrosion. Why someone is still using them, I >don't know. Some guys are too lazy to update their technic. >Steve > It really does matter what you put into the canal, but more important > is the integrity of the "seal". What do you use as the seal? Can you explain in layman terms? Here is an interesting article, quite a few decades old, that compares silver tips favorably to gutta percha: http://jdr.iadrjournals.org/cgi/reprint/20/4/355.pdf > Here is an interesting article, quite a few decades old, that compares > silver tips favorably to gutta percha: > http://jdr.iadrjournals.org/cgi/reprint/20/4/355.pdf My understanding is that silver points were used primarily for narrow canals. I assume that with older instruments, it may not have been thought a good idea to enlarge the canals too much; in curved canals it was easy to not follow the curve of these canals and this could damage the foramen at the end of the canal. Newer instruments are more flexible and are less apt to "zip" the apical portion of the canal. Still, I've seen plenty of curved canals instrumented successfully even with old-style stainless steel hand instruments. Sometimes silver points worked fine. I have some patients with apparently successful silver wire endos that are very old and with no sign of any problems. I have also seen silver wire endos that fail, and my experience is the same as Newbie's--corrosion and leakage. If they're working I leave them alone. If they're failing they get retreated. I would not use silver wires myself. They depend too much on the sealer, many of which have significant solubility. Steve > All of these methods on the clinical level seem to work well. Resin > fillings seem to seal somewhat better, but I'm not sure what is done when > retreatment is necessary. Speaking of which, I came across this article. I'm sure it makes a lot more sense to you than to me: http://www.jendodon.com/article/PIIS0099239905609879/abstract > Speaking of which, I came across this article. I'm sure it makes a lot more > sense to you than to me: > http://www.jendodon.com/article/PIIS0099239905609879/abstract This is a comparative study of sealers. Gutta percha is the filling. I don't know what Roth 801 is--probably an old proprietary name--Roth apparently didn't like the first 800 he tried. Glass ionomer is an interesting material--it chemically bonds to tooth structure. It leaks too, as do all the sealers I've seen tested. This paper seems to measure inflammation rather than leakage. Steve >> Speaking of which, I came across this article. I'm sure it makes a lot more >> sense to you than to me: [quoted text clipped - 3 lines] >I don't know what Roth 801 is--probably an old proprietary name--Roth >apparently didn't like the first 800 he tried. Roth is a manufacturer of Grossman's. My endo buddy says that it is more radio-opaque than other Grossman's formulations. > Glass ionomer is an interesting material--it chemically bonds to tooth >structure. It leaks too, as do all the sealers I've seen tested. This >paper seems to measure inflammation rather than leakage. > >Steve I googled Biocalex, sounds > questionable. What's wrong with gutta percha? Not much that I can see. There are new composite based filling materials for root canals, but without a long history of success, it's a little early for some of us to make the change. D > I googled Biocalex, sounds >> questionable. What's wrong with gutta percha? [quoted text clipped - 4 lines] > but without a long history of success, it's a little early for > some of us to make the change. Of course, the big question is, who is going to do the research? Its a Catch-22. >>There are new composite based filling materials for root canals, >>but without a long history of success, it's a little early for >>some of us to make the change. > > Of course, the big question is, who is going to do the research? Its a > Catch-22. Why the manufacturers, of course. ;-O D >> I googled Biocalex, sounds >>> questionable. What's wrong with gutta percha? [quoted text clipped - 6 lines] > Of course, the big question is, who is going to do the research? Its a > Catch-22. As Dartos says, the manufacturers do "research". Some may be university based, some done by the companies themselves. On a smaller scale it's like the pharma companies, but the FDA approval for "devices" is more lenient than for phamaceuticals. There's some good stuff out there, and a lot of crap. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 |
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