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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
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 old...my 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