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Calcified maxillary central incisor

From: Terry Pannkuk To: ROOTS Sent: Wednesday, May 26, 2010 2:13 AM Subject: [roots] More of the story The lower anterior is one I treated along with a very calcified maxillary central incisor that required deep dissection to find the canal. The labial and lingual canal systems were widely separated and the tooth was in severe linguoversion as you would suspect looking at the patientís facial profile. The referring dentist insisted on doing the bleaching and core, uses an Isolite, and I canít help wonder about the etiology of the gingival inflammation which is the chief complaint. I doubt there is a periapical endo failure on #24 but could imagine some pulp chamber sepsis given the large void which is present in both maxillary and mandibular incisors I treated. The etiology presumptions are certainly speculative. In my opinion worrying about a new veneer versus extracting the tooth seems secondary to finding out why this tooth is uniquely inflamed with no mobility or apparent root-crown fracture. My first step would be removing the core, exploring the pulp chamber, disinfecting it, and placing the core with a rubber dam, no voids under a scope like it should have been performed in the first place; then maybe worrying about a veneer later. This is a typical focus by this cosmetic dentist if the esthetics are not perfect, extract and screw. Is it my place and obligation to ram my decision and perspective down a referring dentistís throat. There are no symptoms with this tooth, no apparent resorption and simple gingival inflammation. Doesnít extracting and screwing seem a bit aggressive for this problem? - Terry

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