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Buccal swelling and radiolucency - Courtesy ROOTS
From: Rob Kaufmann
To: ROOTS
Sent: Tuesday, May 25, 2010 12:39 PM
Subject: [roots] Diss Dilemma
Here’s 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 prep’d 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 I’m 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).
Here’s 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 don’t think the case failed because of anything I did, but I’m really not happy charging the patient.
It’s not their fault the guy didn’t 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)
