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From: Abdul Parmar
To: ROOTS
Sent: Tuesday, June 17, 2008 11:17 PM
Subject: [roots] Another trauma case!

This little boy came in today, Cvek's pulpotomy 21, have arranged to see
him again in 6 weeks, we dont have MTA (which I guess would have been
the material of choice for the pulp cap) - Abdul

Very nice!! Ca(OH)2 has a success rate of 95%.....so have no worries!! - Fred thanks Fred! Really hope it stays vital - Abdul Dear Dr. Parmar, From my reading of the literature, it's not so much the capping material as it is the preparation of the wound site and care in placement of the covering. Remove the bugs and avoid pushing capping material below the wound surface and it has been demonstrated that you could use amalgam. Certainly, Calcium hydroxide and white MTA offer better esthetics though. We tend to forget Kakehasi's research when faced with marketing efforts. "It's the bugs, Doc." Questions: How long post trauma before you saw the patient? How deeply did you have to go into the pulp to debride? What did you use for the restoration? Is that a pin on the facial of the exposure site? - Grant Hi Grant - The patient was seen 1hr post trauma - I went to a depth of about 3mm - The final restoration was non setting Ca(OH)2 over the exposure, followed by a light cured resin modified glass ionomer called Vitre Bond (3M Espe), the tooth was then etched and bonded and the tooth restored with composite shade A1 Charisma (Heraeaus Kulzer) - There was never any pin, if its what I think you are talking about then what you can see is the end of a floss ligature - abdul ps i'm just a GP with a love for endo. Dear Abdul, That was really fast getting to the patient. Bacteria travel very slowly through vital pulp. You've done a wonderful service for the patient. Hopefully they will be compliant so you can watch the progression of the reparative dentin formation. I'm really happy to hear that was floss. Endodontists should be very happy there are competent, committed GP's like you. Endodontics would not survive were it not for GP's who try to attain excellence in treatment - Grant Very nicely handled Abdul. Nice documentation also! Grant, thanks for the reminder that it's the bugs (or lack thereof) rather than the miracle material that spells success in cases like this.However, if I were to look for an altnernative to MTA, rather than amalgam I might just go shopping at Home Depot. :-)))) - Mark Can you imagine the headlines in the tabloids "Rogue dentist used cement to fix tooth!" lol - abdul Me too. However, I keep a photomicrograph of odontoblast-like cells on the periphery of non-inflammed pulp, forming reparative dentin, just under an amalgam as a reminder that it's not the material - Grant Any particular reason for using non setting Ca(OH)2 before using Vitre Bond - Anantpal hi anantpal, well firstly I was taught that the pH of products such as dycal wasn't high enough and we never had dycal as undergrads and secondly we dont have any setting Ca(OH)2 in practice in any case. maybe someone more learned can give an opinion? - abdul

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