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Irrigating, flushing, and churning irrigant, changing the CH - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been credited
for the individual posts where they are -
From: Terry Pannkuk
Sent: Thursday, September 17, 2009 1:16 AM
Subject: [roots] Nuclear Testing

This mushroom cloud of CH represents the condensation that occurred 
after 4 years.  It is suspected to be healing, no symptoms or clinical 
signs related to this tooth, although #9 recently flared up. My partner 
just finished #9. The patient is a local heart surgeon.  He got sick of 
my bugging him to come back for recalls (which he didn't
until my partner got him in for needed treatment on the adjacent tooth).

I spent 4 months treating the tooth, changing the CH several times.  
The lesion never would dry so when I got it relatively dry to pack with 
MTA in October of 2005, I just did it. I don't really do pack n whacks, 
maybe one in the last 10 years. I've never done a decompression or found 
a reason to. If a lesion is suspected to be of nonendodontic origin I refer 
the patient to the oral surgeon and they may have to do decompressions for 
certain exotic nondental lesion presentations.  When I treated this tooth 
in 2005 I was having a debate with Gary Carr who said you should never
pack a symptomatic tooth.  I completely disagree; it depends entirely on 
the particular case and I never say never.  Since Carr booted me off of 
TDO I won't have the opportunity to show him he's wrong
(again).  :):):)

Maybe I was a bit fortunate on this particular case.  It's agreed that 
no one cleans/seals these types of cases perfectly, but we usually accomplish 
excellent clinical efficacy if we are meticulous and work at it with the
necessary effort and skill.  My suspicion is that the multiple appointments 
irrigating, flushing, and churning irrigant then changing the CH resulted 
in bringing the microbial titer down to a level conducive to clinical
success without the need for decompression or apical surgery.  I nuked the
 periapex with CH ! - Terry

Geez, it actually looks like upside down heart on the last pic :-)) 
So good for the Ivy King ... ;-) - Dmitri
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