Dentaltown February 2018 - 40

message board
HaasEndo
Member Since: 11/28/15
Posts: 35 and 40 of 98

With that apical extrusion, re-treat will very likely not help. I wouldn't refund the patient,
especially if it's explained to them that the ongoing infection might be due to resistant bacteria
outside the root, which a good and routine root canal can't get to. That's why I never quote a
patient a 100 percent success. As in medicine, nothing is 100 percent and unfortunately this
unlucky patient is one of them. That's how I briefly explain it. Refund in this case means you're
guilty of something wrong, as far as many patients see it. And I don't see that with your best
efforts and good intentions. Communication with the patient and explaining things clearly and
firmly and sincerely can go a long way.
What I don't tell such a patient, for obvious reasons, is that the extrusion reduces success rates
and may be a contributing factor. That's why I'd only recommend apicoectomy. Re-treatment
will not remove that extruded sealer/g percha and may also not be able to deal with any possible
resistant apical bacteria. And, who knows what colleague somewhere said the wrong thing to
make the patient question your work and good intentions in a case that we've all faced personally.
Good luck.
[10/23/2017]
I really don't know why Formocresol is still discussed, let alone used, in 2017. There is no
university undergrad/grad program in the Western Hemisphere, no textbook, no article, no
study, no specialist that even speaks of the "F" word when discussing medication.
Those that say it works don't realize that the symptoms may go away because the pulp may
have become necrotic or symptoms chronic or the patient learned to stay away from a symptomatic tooth. But "F" does nothing at all for endo. Period.
As for re-treat, I agree that you need to clean the inside of the root and that bacteria may
still be there. But this real-world scenario with a potential hot potato means that we need more
definitive treatment. In other words, deal with the two issues with only one treatment. The two
issues are canal bacteria and extrusion. And this patient and whoever is coaching her behind the
scenes doesn't need more perceived proof that something was done wrong the first time around.
Re-treat will still require apicoectomy afterwards (very likely.) The success for this apico (if
not fx'd, which I don't think it is) will be very high with an apical filling and with the use of a
microscope. Very high.
As for extrusions, it is never good to have any foreign body in the periodontium. Even porcelain. Radiographically it may seem to disappear but histologically it's been shown years ago,
already, on poor monkeys that were sacrificed, that there is long term apical inflammation that
continues even if radiographically there is no more material seen apically. This case definitely
needs to have that material removed.
P.S. I wish we could just have this friendly discussion over a beer, or two! ■
10/24/2017

rtcnls
Member Since: 06/24/03
Post: 44 of 98

I medicate with either Vitapex or CaOH (I use the Edge brand currently). Vitapex is usually my
first choice except for where I want more flow/easier removal or if there is a very large lesion and I
want some extrusion with quicker resorption. The CaOH will flow better and resorb more quickly.
As for obturation, I am looking for closure of any sinus tract, healing of a perio pocket if
I suspect endo-perio, and resolution of any symptoms. I usually wait anywhere between one
week and two months depending on the case and the decision to give up is highly subjective
depending on the tooth, the situation, and the patient. ■
10/24/2017

flyfishdr
Member Since: 02/26/04
Post: 45 of 98

Manor, guys use Formocresol for both vital, necrotic adult teeth and primary pulpotomy.
You're not going to be able to tell guys who use it that it doesn't work. Especially when a lot

FEBRUARY 2018 // dentaltown.com

http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown February 2018