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Endo tips    Better Endo    Endo abstracts    Endo discussions

The opinions within this web page are not ours. Authors have been credited
for the individual posts and photographs where they are. - www.rxroots.com

Buccal swelling and radiolucency - Courtesy ROOTS

From: Rob Kaufmann
To: ROOTS
Sent: Tuesday, May 25, 2010 12:39 PM
Subject: [roots] Diss Dilemma

Hereís the story.

I finished the endo on this upper right first bicuspid in 2002. 
The RD requested a buccal post space and I complied filled with Ca(OH)2. 
I noted the buccal lateral canal ( going distal) and prepíd above that 
level ( I thought.) I saw the patient for a 6 month recall. The post 
had been placed short, and the rest of the buccal canal was unfilled.
I sent a note to the RD on the recall report suggesting that  this be 
corrected and that in future he try to fill the entire space. 
Patient wants to wait to next calendar year to place post.

The 1 year recall shows a disappointing result no alteration of the 
post placement and now the  crown has placed without any change in 
the buccal canal space.

Fast  forward to 2010. Patient arrives with buccal swelling and 
radiolucency right next to the Bu lateral canal which now shows no 
evidence of any obturation sealer gone.  Crown has decent margins 
and patient is happy with aesthetics. She wonders why my endo failed 
and is NOT happy with the prospect of an endo retreat. We discuss
possible SRCT as an option Iím not happy about where the discussion 
is going.

My unappetizing options:

(1)    Phone RD (an A- referral) that we need to disassemble retreat. 
       He may have to eat the cost of the crown. Who pays for the 
	   disassembly/retx  ? The patent? Him? I do it for free?

(2)    Do the SRCT

The little voice in my head knows exactly what I should do disassemble, 
retreat the case, place the post and core myself and then tell the RD 
to restore.   Or explain AGAIN, that he needs to place the post properly 
( without a space).

Hereís a good example of how we Endodontists sweat the little things 
because we know they make a big impact in the long run. It is so 
difficult to try  explain this to  RDs

Now for the big question: Who should be paying for this? Should I do 
the retreat for free?

I donít think the case failed because of anything I did, but Iím really 
not happy charging the patient.

Itís not their fault the guy didnít seal the post space.  
But I certainly can't bill the RD.

Grad students! its been 24 years and I still wrestle with ( and hate)  
these kind of RD interactions. -  Rob Kaufmann DMD MS(Endo)


Protaper flaring

6 yr old Empress

Cvek pulpotomy

Middle mesial

Endo misdiagnosis

MTA retrofill

Resin core

BW importance

Bicuspid tooth

Necrotic #8 treatment

Finding MB2 / MB3

Deep in a canal

Broken file retrieval

Molar cases

Pushed over apex

MB2 and palatal canal

Long lower third

Veneer cases

CT Implant surgury

Weird Anatomy

Apical trifurcation

Canal and Ultrasonics

Cotton stuffed chamber

Pulp floor sandblasting

Silver point removal

Difficult acute curve

Marked swelling

5 canaled premolar

Sealer overextension

Complex anatomy

Secondary caries

Zygomatic arch

Confluent mesials

LL 1st molar (#19)

Shaping vs Cleaning

First bicuspid

In Vivo mesial view

Inaccesible canals

Premolar 45

Ortho and implant

Radioluscency

Lateral incisor

Obturation

Churning irrigant

Cold lateral

Tipped to lingual

Acute pulpitis images

Middle distal canal

Silver point

Crown preparation

Epiphany healing

Weird anatomy

Dual Xenon

Looking for MB2

Upper molar resorption

Acute apical abcess

Finding MB2

Gingival inflammation

Irreversible pulpitis

AG BU ortho band

TF Files

using TF files

Broken bur

Warm technique

Restorative prognosis

Tooth # 20 and #30

Apical third

3 canal premolar

Severe curvature

Interesting anatomy

Chamber floor

Zirconia crown

Dycal matrix

Cracked tooth

Tooth structure loss

Multiplanar curves