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Endo tips    Better Endo    Endo abstracts    Endo discussions

Coronal decay

The opinions and photographs within this web page are not ours. Authors have been credited
for the individual posts where they are. - Photos courtesy of Dr Barden -
From: Dr Barden
Sent: Friday, August 18, 2006 10:42 AM
Subject: [roots] calcified

Ok,  this is my first post of a case.

A couple of weeks ago someone asked about the state of endodontics as a 
specialty.  I've been thinking for a while that endo is in trouble.  
i think so because there seems to be a lack of respect for the specialty 
and a lack of accountability when subpar endodontics is performed.  
Unfortunately, I've heard lots of dentist comment,  "I already told the 
patient that root canals don't always work, so if it fails then I'll 
take the tooth out and replace it."  these same practitioners
neglect to use rubber dams or good endodontic techniques.  of course 
the patient, who trusts the judgement of their dentist accepts the fact 
that their tooth is going to have to be removed and they are forever 
leery of root canals.

Anyway, I digress.  this is one of those cases.  patient had dentist 
attempt root canal four year ago - they couldn't find the canal.  
another dentist tried two years later - of course they couldn't find 
the canal either, so they decided to do apical surgery.  she then had 
a six unit bridge placed.  the tooth has been symptomatic since.  
in addition, the bridge came off.  the patient was told that there was 
nothing that could be done because the tooth was calcified and it would
need to be extracted.  luckily, a friend referred her and we were able 
to locate the canal and treat it.  as for the bridge.........i don't 
know what will happen with it.  there was coronal decay that had to be 
removed.  maybe a new one can be constructed and it can be double 
abutted (???)

a little magnification can solve a lot of "problems" - Dr Barden

Nice case Dr. Barden. Sounds like not all C&B works either, do they tell the patients that also? I suppose all implants don't work either. I think an appropriate response would be ,"Yes, root canals don't always work but they seem to do better than a lot of implants." Each procedure has value when used in the proper circumstance and I wish we could get away from the viewpoint of the procedures as being polar opposites. They are complementary procedures used for the benefit of our patients - Randy Hedrick Nicely done Dr.Barden. Is the restoration on the tooth leaking?? If yes then you should be replacing the temp/ permanent restoration immediately - Sachin OK, I'm on a roll about GP's. They never considered referring this patient? I think that is malpractice. The crap about endo not working anyway was a CYA statement and total BS. My young partner got his first taste of my temper. He totally destroyed a upper first bi Thursday looking for the buccal canal and cut a much bigger cavern than you have on this tooth with a mesial perf. Then he sent it to me. The canals were clearly visible under the scope, which he has total access to. I finished the endo, which in deference to him I will not post, and repaired the perf with MTA. It may or may not work. The defect was so large that we placed two bonded FiberKleer tapered posts to fill it. I thought composite would be too damn brittle. The guts of my conversation with him was NEVER go this far without bailing. It is malpractice. He'll get by on this one but I could drop dead and the next endodontist might not be so kind to him. These two guys obviously don't have a damned clue and that irritates the hell out of me. People on other forums tell me that I shouldn't get to upset over crap like this but damn it somebody has to. They have a "never look past your own back door" attitude. You guys are over a barrel. Other GP's are not. I've taken two here to the state board and I'm constantly being told that I'm crazy to get involved. The entire profession needs to get involved or dentistry is going to be back as barbers. Already this cosmetic crap has turned us into high priced whores who will sell our souls for a big case. People don't want take care of sick people any longer. They want the glitz of cosmetics but 75% don't have the skill to do a class I alloy right. Man, I hate this for you guys and it is mostly the GP community's fault. You guys have to take a tiny bit of the blame and maybe when some of you get screw you money, you'll start busting some of these incompetent yo yo's asses. Got bless an age...endodontist who was asked by an attorney to defend one of the idiots here butchering endo on patients. He told the attorney, "hell, I've turned them in on this case myself". He's got screw you money and can limit his practice to just the good referrers. He helped me with endo because he could not do all that was being referred to him years ago. He helped several of us who showed some skills. Now, if he sees rat crap restorative he will tell the patient and tell them then need to get another opinion and often give names of who they should see. Maybe that is unethical but it is for the good of the patient and that can't be unethical. You guys are getting the crap kicked out of you and it just ain't fair damn it. Endodontists take the biggest beating because every jackleg one of us getting out of dental school think we can do it. Then when the walls fall in we expect you to cheerfully drag our asses out of the dumper. Don't work that way or shouldn't. God bless you guys. Guy Guy W. Moorman, Jr. DDS

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