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Fracture exploration and dissection of a pulp stone - Courtesy ROOTS

I spent quite a bit of time on this case today. It was either an endo or an extraction setting up for a two-stage implant. I took multiple pictures for a routine access lecture series. I needed something basic for maxillary molar demonstration. I spend quite a bit of time dissecting the entire pulp stone out of the chamber. I rarely if ever have seen that a previous clinician would perform a complete access and stone removal when I retreat molars of this type. It takes quite a bit of extra time, but itís inconceivable to me that someone can make an appropriate assessment of crack extension without doing this and composite finishing burs are the only way I know that one can polish the floor smooth enough to completely see the extent of the cracks. - Terry

Terry, Nice case and nice pics. You've been using the scope longer than I have so maybe you have already tried this and can give me some feedback. I have been using an acid etch of either liquid EDTA or a gel etchant on the pulp chamber to remove the smear layer created by using burs and have found that isthmuses, cracks and canal orifices seem to be more obvious. I use the little fuzzy, plastic micro-brush applicators to scrub around the chamber with etchant for about 20-30s and rinse with a Stropko. What has been your experience? - Randy Hedrick

Randy, I do the same, but also have a chairside microetcher and sandblast it before the chemical etch. Iím extremely paranoid of dentin-debonding; the reason Iím so skeptical of hype of Resilon. - Terry