Dentaltown February 2018 - 38

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MetalDoc
Member Since: 05/20/13
Post: 8 of 98

Thank you all for your replies.
Update: I spoke with the other dentist.
1. He's a GP.
2. He never said the RCT was done wrong.
3. He isn't doing it.
4. He recommended an endo consult.
How hard is it to just go to the endo person I work with? ■
10/23/2017

dentist_ne
Member Since: 10/19/14
Post: 9 of 98

What do you fill the tooth with if you do the endo as two-step-calcium hydroxide or
something else? How long do you wait for signs of healing? (rads? clinical?)
10/23/2017

eeznogood
Member Since: 02/23/06
Post: 11 of 98

I use Formocresol and close the access with anything that you'd like. I use Tempit. It is a
white paste. It is very easy to remove. I wait two weeks usually. If there is a draining tract you
can inspect it visually. If not, you open the tooth and smell the insides for a bad rotting smell
and/or for fluids. You then rinse it and dry it.
If you can get it dry and the patient's symptoms went away, then you can close it. If the
patient's symptoms improve but did not go away, no sealing. Just rerinse it and redress it and
again wait two weeks. Same if you cannot get it dry. ■
10/23/2017

BreakingFree
Member Since: 09/03/09
Post: 15 of 98

I will kindly disagree with eeznogood's tx plan of two-stepping with Formo. I think
that's really opening up a can of worms. By the way, I really respect eeznogood's advice
most of the time!
I would have two-stepped this with CaOH. I think one of the things I would do in the
beginning is not instrument enough the first visit before I put CaOH into the canal. Now I
fully instrument and then place CaOH into the canal, cotton pellet and temp filling. I bring the
patient back in about two weeks and take a PA. If the area is resolving and I can keep the canal
dry, I will pack that day. If it isn't dry and I am getting some "weeping" from the apex, I will use
NaOCl to irrigate, followed by sterile saline and then dry. Pack CaOH again and bring back. ■
10/23/2017

boringholes
Member Since: 08/09/01
Post: 16 of 98

When you guys say two-step, you are talking about full shaping and disinfection at the first
visit, fill with CaOH paste, let sit for some number of weeks, then bring back for obturation visit?
What is the criteria for needing to do that? Every necrotic case? PARL above a certain
diameter? One observation about that: The profit margin falls to approaching zero at PPO fees
if you have to do it that way. ■
10/23/2017

eeznogood
Member Since: 02/23/06
Post: 18 of 98

All of the work is done at the first visit except the obturation. I now do this on almost all
necrotic and or symptomatic cases, even if vital. ■

10/23/2017

dentist_ne
Member Since: 10/19/14
Post: 32 of 98

Is anyone having good success with single-visit RCTs? The endodontist at my residency
almost never did multiple visits unless he couldn't get the canal dry. I don't know what his
success rate was though. He did it because according to him the literature does not show a clear
benefit of two visits. ■
10/23/2017

FEBRUARY 2018 // dentaltown.com

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