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14 year recall: retreat the retreat?

From: Terry Pannkuk To: ROOTS Sent: Wednesday, April 28, 2010 10:56 AM Subject: [roots] Ugly-working, Radiographic Fake job-failing- 14 year recall Puzzle: what next? This case is a perfect demonstration of how apical cleanliness, maintaining asepsis during treatment, and understanding sound endodontic principles leads to success. I was referred this patient in 1996 for retreatment of the first molar which had been previously ledged blocked and filled with Sargenti paste. I cleaned and shaped it to the blocks, manicuring a controlled lateral perf under meticulous isolation with a rubber dam, maintaining an aseptic field; I.e. I didnít use an IsoLite. When I recalled this patient in 1998 at two years, I noted that she had seen someone else to have #31 treated. Maybe she was told my radiographic result didnít look appealing so she went to a white line lover radiographic showman. :) I found out later it was treated with Thermafilth. She was referred back yesterday as her crown had fallen off. Her new dentist was dismayed that the cotton pellet I had left in the distal post space in 1996 was still intact and looked as ripe as month old guacamole (another example why I donít leave spacers, either cotton pellet or sponge, when I send them back to their dentist for a core these days ,below is a case I treated today and placed solid Cavit without a space letting the dentist dig out as much as he needs for retention). I took a CT and predictably the Thermafilth case was growing a mesial lesion and my retreated tooth showed no lesions on either root. Sure this is just another single anecdote, but is it really a small wonder that an unclean, poorly shaped apical third filled with a CrapnCone will eventually break down and fail? This radiographically ugly retreatment endo success next to a radiographically pretty Thermafilth failure is a nice side by side contrast of endodontic long-term outcomes. Puzzle Question: What do you do with #30 now that the crown fell off? Retreat the retreat again? Clean out the post space, place a core, have a new crown made and cross your fingers? Extract and implant? What do you think Iím planning on doing? - Terry If you pack the Cavit deep you donít get rotten guacamole like this case today (2nd molar today, I treated the first molar in 2005)
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