Dentaltown February 2020 - 50

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dentalben98
Member Since: 07/10/02
Post: 2 of 92

Good round of antibiotics and finish the endo ASAP. Stop thinking about what the insurance restrictions are and start thinking about what's in the best interest of the patient. Let them
decide. If they want to hold off until January because of insurance and end up losing the tooth
or dying from an oral infection, that's their choice. ■
11/25/2019

wkawk2416
Member Since: 09/13/13
Post: 3 of 92

I would bring the patient back, open the access cavity, irrigate a lot and have the access cavity
open for a week or so. You can put a cotton pellet in the access cavity to prevent food going up
there. And also possibly something going on with #8 or #11 tooth as well. My question for you
is, was the tooth vital for sure? ■
11/25/2019

CrosstownDDS
Member Since: 08/16/17
Post: 4 of 92

In my experience, visible lesions respond well to clindamycin, but amoxicillin not so much.
This tooth was in the process of blowing up and your timing just happened to catch it before it
did. If you cleaned the canal thoroughly and placed CaOH, I think you did all you could do.
Now it will just take a little time for the clinda and the CaOH to do their job. ■
11/25/2019

flyfishdr
Member Since: 02/26/04
Post: 5 of 92

I wouldn't panic. You maybe pushed a bit of debris beyond the apex. Patient had a flare-up.
I think your plan is fine. I also think finishing in January is OK as well. My view, anyway. ■
11/25/2019

jgne
Member Since: 03/20/14
Post: 6 of 92

Did you just go from file to CaOH? If no irrigation and CaOH not down, there isn't much
stopping the rest of that debris from taking that breath of air and letting the bacteria go wild. ■
11/25/2019

DoctorEd
Member Since: 09/21/02
Post: 7 of 92

Very odd scenario. Did you irrigate with NaOCl? How long was the NaOCl in the canal?
Unbonded composite is not a good temporary restoration to seal an access cavity midtreatment
because it does not seal. Use Cavit or Tempit. I agree that clindamycin, some thorough irrigation
with NaOCl and another placement of CaOH should turn things around. Isn't this actually the
left central incisor #9? ■

11/25/2019

eeznogood
Member Since: 02/23/06
Post: 8 of 92

u647
Member Since: 10/02/04
Post: 10 of 92

You can try using a Lentulo in order to better fill the canal with CaOH? ■
11/25/2019

From what DoctorEd is saying: By not properly sealing the access midtreatment, did you
just leave the tooth open for contamination? Next visit, try to get the canal patent, irrigate,
activate irrigation to get the hypo in all the nooks and crannies of that apical third. If you get
a dry canal, no exudate, I would obturate it in the same appt. Then prescribe the antibiotics. ■
11/25/2019

glai
Member Since: 08/23/10
Post: 11 of 92

I didn't notice a rubber dam clamp in your WL file shot, did you use a split rubber dam
isolation instead? Without rubber dam isolation, it could also be a way for saliva/bacteria to get
inside the canal if you started with a vital case. ■
11/26/2019

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