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From: Abdul Parmar
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
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?
- 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
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