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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 didn’t 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 didn’t 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 don’t 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 I’m planning on doing?  - Terry

If you pack the Cavit deep you don’t get rotten guacamole like this case today (2nd molar today,
I treated the first molar in 2005)