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Endo tips    Better Endo    Endo abstracts    Endo discussions

 Nice retrofil
The opinions within this web page are not ours.Authors have been credited for the individual posts where they are. - photographs courtesy:Marga Ree

From: Marga Ree
Sent: Friday, September 12, 2008 11:08 PM
Subject: [roots] Nice retrofil....

This patient was treated by an OS some years ago, but the sinus tract never went away.....
Look at this retro"fill" and the root canal system in the mesial root...:-) Suprised it didn't work??

Recently, a survey amongst Dutch oral surgeons was published in a Dutch dental journal.
The aim was to inventory which materials are being used for root-end fillings.
The most popular material was IRM, used by 47% of all respondents. Amalgam was second popular,
35% still uses this obsolete material.  2% used MTA and 3% used a scoop.

I just finished an article to comment on this, needless to say that the tone of
my piece was pretty critical. - Marga

retrofil Dear Marga, Nice documentation to illustrate this topic. I would be grateful if you could send to me the article when you will finish (english version if its posible). Also I recently downloaded your article Decompressie. Een niet-chirurgische behandeling van een grote peri-apicale cysteuze laesie from your webpage. I would be very pleased if I could have in english. IMHO periapical surgery should be performed for trained endodontists when indicated, not this case on first term. OS aren´t usually trained on endo diagnostic, then they "treat" the lesion without understanding nothing about the origin. Understand RC anatomy and bugs involvement is mandatory. On the other hand, microsurgey and the use of appropiate retrofill has revolutioned SRCT. And most OS have no idea about that. I would like to known your criteria in cases with large lesions (cyst-like) no endo origin but placed near the apexs of 1 or 2 vital teeth and then the OS referrs for endo previous exeresis of the lesion, in case the nerve-vessels complex would be cut and then the healing of the area could be compromised. Perhaps its a very general question and it depends on the case - Nuria Dear Nuria, Unfortunately these articles are in Dutch, so I cannot send you an English version. We do run a HOC on microsurgery in English, so if you are interested, please let me know, I can send you some info. Concerning your question, it's hard to give you a general answer. Ít's all about establishing a proper diagnosis. If there is a lesion of endodontic origin, you might consider a decompression, to have the lesion decrease in size - Marga Hi Marga, You trigger an interesting point for us in Holland . I agree with you but IMO it is not only the OS who are to blame . What about the bad an ugly rct from the GP we see . What about the insurance company who are paying for the mess of the OS . And to finish what about the time given to the OS to learn about endodontics microsurgery etc It is a complex problem .Some of the OS send the patient with a bad RCT back to the dentist but the rest cut for the money .It has also to do with integrity and compassion for the patient. I don’t think that Holland is the only country with this situation - Paul NOYER Paul, I totally agree with you and I'm afraid this point is universal ... Our ego keeps us from accepting the scientific facts about failure My lecture at the ESMD on saturday is going to address these issues - Jan Well the recurring lesion was obviously due to missed out anatomy in the Mesio-buccal root, probably an MB2, Also see how nicely the canal interconnections are filled with in the last film after a retreatment. Obviously the referring GP has done a poor endo to begin with, I am surprised every one is blaming the Oral surgeons. They only carry forward from where we left the tooth. Surely we can't expect the OMFS to correct our poor endo along with the apicoectomy and retrofils. If canals have been missed the endo can fail inspite of a good retrograde fill. - Dr Sanjay Jamdade
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