DentaltownUK August 2017 - 44

message board
Continued from p. 42

Craig Smith
Member Since: 07/26/06
Post: 4 of 32

#18 and #30 for sure. Do some follow-up X-rays for the others when the patient comes in
for the crowns. ■
1/27/2017

jourdo
Member Since: 01/16/03
Post: 5 of 32

Asymptomatic lesions are the worst. They most likely need re-treatment, but many patients
don't worry about it if it's not causing pain. You can inform them of the issue and keep retaking
X-rays for changes, refer them to endo for evaluation, or jump into the re-treat yourself. I have
seen some of these stay that way forever and never cause an issue. Others blow up when you look
at the tooth wrong. Probably not the most helpful post in the world, just my two cents' worth.
(Canadian ... so not worth that much.) ■
1/27/2017

SFain
Member Since: 05/16/05
Post: 8 of 32

Send them to the endodontist for a second opinion and if they refuse to go, document it.
That way you're covered in case something goes wrong. ■
1/27/2017

ERC
Member Since: 10/15/11
Post: 9 of 32

Just out of curiosity: Why extract #9, and how can you tell that #25 has a second canal (or
what do you look for)? Don't you want to take 6-month postop to compare size of PARL? Just
trying to learn like OP. Thanks! ■
1/27/2017

mattcosta
Member Since: 07/02/09
Post: 10 of 32

I didn't say anything about extraction; I said #9 might not need to be re-treated. The fill
looks good and you can still see sealer or CaOH extruded into the lesion, so it was probably
recently done. I would monitor that one. On #25 you can see a distinct ligament, indicating
either a midroot constriction or two fused roots. You can also see a deep split in the apical 3mm
that has no sealer or GP thanks to the short fill. When in doubt, serial radiographs every three
months for a year to evaluate healing or lack thereof. ■
1/27/2017

flyfishdr
Member Since: 02/26/04
Post: 12 of 32

Pretty much the same as Matt (except not sure on the two canals on lower incisor). But they
all need re-treatment except #9 in my view as well. One could do this over time or based on
symptoms. However, I would be sure the treatment would be justified but maybe not urgently. ■
1/30/2017

v0g3L
Member Since: 11/24/14
Post: 13 of 32

I come across this all the time. I look for intact PDL space around the root tips. #9 and #25
look like it is still continuous; the others don't. The conversation I have with the patient is as
follows: "OK, Mr. Smith, there are a few things on your X-rays that I am concerned about. See
the space we see around these other teeth and how it is continuous with the tooth? You have a
few teeth where this isn't the case. When we see this, it means the tooth may need a root canal.
This is the first time that I've seen you so I don't have previous records of these teeth, but when
there's an infection sometimes it can lie dormant ... but other times they can blow up on you and
cause a lot of pain and infection to other parts of the body. We can do one of two things: We can
either continue to monitor them by taking new X-rays at your follow-up visits, or I can send you
to a specialist to have these evaluated to get their opinion on whether they need to be re-treated."
They then go on to say just watch it and I tell them to let me know if they ever have any
symptoms with either of these teeth and I will let them know if I see any changes at their followup visits. This is just for teeth that have been previously treated; if I see these lesions on teeth
without root canals, I do vitality tests and treat accordingly. Hope that helps. ■
1/30/2017

44

AUGUST 2017 // dentaltownuk.com


http://www.dentaltownuk.com

Table of Contents for the Digital Edition of DentaltownUK August 2017

Cover
On Dentaltown.com
Editorial with Mike Gow
Meet the Team
Howard Speaks: Drive-Thrus and Dentistry
Endodontic Reboot: Part One
Classified Listings
Brand Advertising
A United Voice
Adhesion in Primary Dentition Restorative Dentistry
Additive Dentistry
Zero Moment of Truth
Through the Keyhole
Message Boards: Re-treats question
Due Diligence—A Vendor's Perspective
Message Boards: Antibiotics after Surgical Extraction
Adding Value to the Patient Experience
Lifestyle
Poll: General Dentistry
CE Update
Students Section
Wishlist
DentaltownUK August 2017 - Cover
DentaltownUK August 2017 - Cover2
DentaltownUK August 2017 - 3
DentaltownUK August 2017 - 4
DentaltownUK August 2017 - On Dentaltown.com
DentaltownUK August 2017 - Editorial with Mike Gow
DentaltownUK August 2017 - 7
DentaltownUK August 2017 - Meet the Team
DentaltownUK August 2017 - 9
DentaltownUK August 2017 - Howard Speaks: Drive-Thrus and Dentistry
DentaltownUK August 2017 - 11
DentaltownUK August 2017 - Endodontic Reboot: Part One
DentaltownUK August 2017 - 13
DentaltownUK August 2017 - 14
DentaltownUK August 2017 - Classified Listings
DentaltownUK August 2017 - 16
DentaltownUK August 2017 - 17
DentaltownUK August 2017 - 18
DentaltownUK August 2017 - 19
DentaltownUK August 2017 - 20
DentaltownUK August 2017 - 21
DentaltownUK August 2017 - 22
DentaltownUK August 2017 - Brand Advertising
DentaltownUK August 2017 - 24
DentaltownUK August 2017 - A United Voice
DentaltownUK August 2017 - Adhesion in Primary Dentition Restorative Dentistry
DentaltownUK August 2017 - 27
DentaltownUK August 2017 - 28
DentaltownUK August 2017 - 29
DentaltownUK August 2017 - 30
DentaltownUK August 2017 - 31
DentaltownUK August 2017 - Additive Dentistry
DentaltownUK August 2017 - 33
DentaltownUK August 2017 - Zero Moment of Truth
DentaltownUK August 2017 - 35
DentaltownUK August 2017 - 36
DentaltownUK August 2017 - Through the Keyhole
DentaltownUK August 2017 - 38
DentaltownUK August 2017 - 39
DentaltownUK August 2017 - 40
DentaltownUK August 2017 - 41
DentaltownUK August 2017 - Message Boards: Re-treats question
DentaltownUK August 2017 - 43
DentaltownUK August 2017 - 44
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DentaltownUK August 2017 - 46
DentaltownUK August 2017 - 47
DentaltownUK August 2017 - 48
DentaltownUK August 2017 - 49
DentaltownUK August 2017 - 50
DentaltownUK August 2017 - 51
DentaltownUK August 2017 - Due Diligence—A Vendor's Perspective
DentaltownUK August 2017 - 53
DentaltownUK August 2017 - 54
DentaltownUK August 2017 - 55
DentaltownUK August 2017 - Message Boards: Antibiotics after Surgical Extraction
DentaltownUK August 2017 - 57
DentaltownUK August 2017 - 58
DentaltownUK August 2017 - 59
DentaltownUK August 2017 - Adding Value to the Patient Experience
DentaltownUK August 2017 - 61
DentaltownUK August 2017 - Lifestyle
DentaltownUK August 2017 - 63
DentaltownUK August 2017 - 64
DentaltownUK August 2017 - 65
DentaltownUK August 2017 - 66
DentaltownUK August 2017 - 67
DentaltownUK August 2017 - 68
DentaltownUK August 2017 - 69
DentaltownUK August 2017 - 70
DentaltownUK August 2017 - 71
DentaltownUK August 2017 - 72
DentaltownUK August 2017 - 73
DentaltownUK August 2017 - Poll: General Dentistry
DentaltownUK August 2017 - 75
DentaltownUK August 2017 - CE Update
DentaltownUK August 2017 - 77
DentaltownUK August 2017 - Students Section
DentaltownUK August 2017 - 79
DentaltownUK August 2017 - 80
DentaltownUK August 2017 - 81
DentaltownUK August 2017 - 82
DentaltownUK August 2017 - 83
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