Dentaltown February 2018 - 47

If the gingiva is swollen and the tooth is not painful you can close it and do an incision
and drainage. ■

11/18/2017

I think that the articles you linked need to be put in perspective based on when they were
published. At that time, there were many questions that were sufficiently answered until they
weren't. Many or most dentists wouldn't dare complete endodontic treatment-even vital
cases-in a single visit and maybe not without a negative culture from the canal. Overfills
caused failures. Mechanical instrumentation of the PDL caused cyst formation.
IMO, is it sensible to say that a vital tooth that is left open was not as infected as it will be
after being open for a few days? Conversely, how about an already necrotic infected tooth like
the OP's case? Is it going to get more infected than it already is?
I have found that not leaving teeth open in appropriate situations can lead to unnecessary
patient misery. I'm curious if your comment on most endodontists not leaving teeth open is
based on fact or opinion. Honestly don't know what the general feeling is among the majority
endodontists in the U.S. or anywhere, other than I'm sure most were taught not to leave teeth
open in their residencies by older instructors. ■

rtcnls
Member Since: 06/24/03
Post: 13 of 89

11/18/2017

Just had a case about a month ago ... large abscess, tooth was depressible, opened up the
tooth irrigated, tooth was draining like a volcano. Put him on antibiotics, left the tooth open, he
came back in three days and swelling was gone, finished RCT. Saw him a week ago, everything
has healed well. ■

dalmacija
Member Since: 04/14/15
Post: 29 of 89

11/19/2017

LoveThisJob
The canal is already full of
bacteria with the pus present. Member Since: 05/16/13
Post: 31 of 89
Leaving it open a few days to
drain is not going to harm the success of the endo. You're
actually allowing oxygen into the canal, which IMO would
help destroy the anaerobic bacteria we are battling with.
Your profile says dental student; have you ever seen
a patient with swelling and lots of pus? Try closing that
tooth off early and not leaving it open for a few days and I
guarantee your patient will be back the next day in pain.
I'm speaking of the serious abscesses when patients are in
severe pain, necrotic tooth and the pus is a fountain. Not
the pulpitis types.
While I&Ds may be necessary at times, opening a
tooth and leaving it open is not nearly as traumatic and
much easier to heal accompanied with antibiotics. ■
11/19/2017

flyfishdr
I would have done exactly
Member
Since:
02/26/04
as the OP did here. It's kind
Post: 42 of 89
of a tough spot. This works a
high percentage of time for me. You get a case where the
swelling does not immediately go down and guys start
critiquing the treatment in a perfect hindsight scenario.
If the case just proceeds as expected everyone says yes,
FREE FACTS, circle 27 on card

dentaltown.com \\ FEBRUARY 2018

http://www.psfs.com/townie-upload http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown February 2018