Second molar access : 22 months recall - Courtesy ROOTS
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From: Terry Pannkuk
Sent: Thursday, November 17, 2005 9:25 AM
Subject: [roots] 22 month recall today
I took the crown off to treat this case. This is a retreatment case I think I posted in January of 2004.
It was a miserable second molar access case due to the occlusal table being submerged below the first molar.
The patient initially presented with mega-pus streaming out of the access. Only two canal systems had been
previously treated. It had borderline restorability but seems to be doing well at 22 months with the apical
LEO healed. I checked her last April and the previous crown was still temporarily cemented. I had placed
an orifice seal:
Maybe this helped even though it was posted through later.
The tooth is now definitively restored with posts in each of the canal systems.
Luckily Itís not cracked (yet). - Terry
You put in all those posts? I hope they draw when the build up comes off. They are hell to get back on
if they don't draw. Guy
No! I didnít put in the posts. Not my job according to the union rules - Terry
Dear Terry, With the beautiful endo that you and Camie do in Santa Barbara, how do you still have restorative
guys doing so many posts? Are you now treating these cases with CHX 2% exclusively or still some NaOCl?
My partner and I have decided to treat necrotic cases with NaOCl the first half of the case for any potential
pulpal remnants and then we use 2% CHX for the second half of the case, we then follow with EDTA/Smear Clear
to remove the smear layer - Matthew Brock
I used NaOCl early and CHX late like you do. I also use the Sterilox Catholyte as an adjunct to NaOCl.
Once thereís more literature on it I may use it instead of NaOCl. I transition the NaOCl irrigant to 2%CHX
with Peridex with is a much more diluted CHX solution (0.2%) so I donítí end up with the precipitate that
occurs when you mix concentrated CHX with NaOCl. I donít use much EDTA because the Catholyte clearly removes
the smear layer much better and does not interfere with the antimicrobial activity of the NaOCl. Iím finding
out that you really have to worry about how these irrigants interact with each other. I really donít like
using EDTA much anymore and figure I donít need it with Catholyte. I used Peridex as my last irrigant before
drying and obturating. I donít like using Alcohol or EDTA as a last rinse and figure Peridex is the last best
irrigant because it doesnít interfere with bonding and it offers some antimicrobial activity if there is any
residual irrigant left in tertiary anatomy that canít be completely dried. I blow the canals dry with the
Stropko after drying with paper points. I donítí believe alcohol (whether absolute or 95%) dries the canals
completely like many think. There is no evidence of this and I believe it is a pointless exercise - Terry