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for the individual posts and photographs where they are. - www.rxroots.com

Stopping bleeding

From: Rachna
Sent: Wednesday, November 30, 2005 4:42 PM
To: ROOTS
Subject: [roots] Bleeding

Any suggestions on causes of bleeding in 35 which has already 
been opened and cleaned and shaped to size 40. ??
The tooth was diagnosed with irreversible pulpitis and was 
vital . It was very hard to achieve anesthesia .
The bleeding just continues , might stop for  a few 
seconds and each time the canal is filed to the working length
it starts and keeps going. I have used Na hypochlorite and no 
perforation is noted on the x ray.
Any advice on how to proceed??  - Rachna

Closely evaluate and re-evaluate your working length
Use paper points and the EAL many many times
Place caoh in the canal to wl and then see patient back in a 
few days/weeks or so Maybe you are long..
Maybe you have a huge lateral canal
Or
Both..
Most likely you are long on the WL. - Craig

Show us the x ray. pre op and operative. pack CaOh and wait 
for few weeks. may be you are over preparing also. take a
WL xray with a file - Vipin

Bleeding is caused by 3 things:

WL Too long over- instrumented.  Confirm WL again using EAL, 
Radiographs and paper point ( if you can dry it enough)
WL Too short Pulp stump remnants are bleeding Confirm WL 
again as above. Donít be short. Big lateral canal Use paper 
point and try to determine location (which side of the root).
Use sharply precurved file to try to drop in to the lateral. 
Removing the tissue in this area often stops the bleeding.

In 95 % of the cases, the reason is #1 or # 2.  
and NaOCL woní't help that.

In very tough cases cases, you can try hemostatic agents 
(I prefer H2O2 and paper point apical pressure). Some clinicians
use an intrapulpal LA injection with Epi or other hemostatic 
agent applied with a paper point.

Obviously, you can also close the case with CaOH and have 
that work on the remaining tissues until the next appointment - Rob

Lots of possibilities, some of which are over instrumentation, 
perforation, over 'extension' of files and on -  Alan

Hi, Rachna! There was a thread on this IN DT. Mark Dreyer 
suggested there might be some vital pulp tissue ar the apical 
2mm. so taking a larger file 45 or 50 , and cleaning and shaping 
the area might be prudent  - Vimal

Here is my idea how to stop bleeding
Regards - Michal, Poland

Great idea McGiver! - Terry Intermediate dressing in the canals with a mixture of ledermix paste and calcium hydroxide will help as well. At the next appointment it will be normal working conditions - Stephen Day

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