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From: Svetlana Berman
To: ROOTS
Sent: Friday, June 06, 2008 9:15 AM
Subject: [roots] calcific metamorphosis
Please help: is there any reason for #9 RCT? 30 year old, lateral
luxation 14 years ago of #8 & #9, #9 slightly yellowish, completely
asymptomatic. Pt's dentist send her to an endodontist because of
something suspicious on the image; endodontist said that #9 needs a RCT
to use the window of opportunity until there is still a canal there;
came to me for a second opinion. I can see intact PDL and incisive
foramen, but no reason for a RCT. Should I miss my
"window of opportunity"? - Lana
Dear Svetlana,
This type of a problem is one of endo contraversies. Those teeth are
usually vital. The color is the result of the calcification of the
crown by the traumatised pulp. Only in small percentiges the tooth
will become non vital and a lesion will form. Here the pdl is still
intact. The vitality tests may be hard to make as those teeth are not
so sensitive to cold even when vital.
If the tooth becomes non vital then we have to make a RCT.
If the patient wants to bleach the tooth then a RCT is indicated, or
opening without exposure is even possible (Marga showed a case like this).
If the tooth is vital and no bleaching is wanted then my usual
recommendation is not to touch the tooth. I discuss this with the patient
of course - Thomas
Hi there is a review article on Quintessence international, I wrote,
Amir, Witherspoon & Gutmann 2001;32:447-455. titled Calcific
Metamorphosis a challenge in Endodontic Diagnosis & Treatment. read it
pls and tell me what u think. I may have it on desktop I will send if
I can.
I personally dont recommend Tx unless radiographic evidence of PA
changes or Symptoms. tests some time are irrelevant. you will not
loose your window of opportunity. Always remain a canal space even
though smaller. - Faisal
I absolutely agree with the complementary given advices about Diagnosis
and Treatment Decision Making. BTW, in my experience the discoloration
of this calcified teeth is usually only one yellow tone andd stable
along time.
What is your experience or what says the scientist evidence about that?
If the discoloration is the chief complain of the patient, no his dentist
chief complain, the tooth should be treated as all of you agreed even w/o
symptoms or clear periapical lesion.
What do you think about the opcion of external bleaching of the affected
tooth only at the dental chair or at home ?
Thomas, I remembered the Margaīs case sent 2 y ago. She opened the tooth
and advanced througt the calcified pulp chamber some mm under LAC I suppose
and she sealed with GIG and make internal bleaching w/o previous RCT. She
held his decision on the basis that studies said that only 9 -10 % of this
calcified teeth suffered pulp necrosis like we are discussing With Grant
some days ago. I wonder if the studies results are referred to intact teeth
(w/o chamber opening) or include opened and bleached teeth.Obviously I
assume that Marga did the access under rubber dam and aseptic conditions,
and we should hope that the rate of pulp necrosis didnīt increase in
comparision with the untouched teeth. Really she showed a 5 year follow up
for his case report.
Then the Q is: Shoud be the Margaīs protocol the first option vs RCT try
(usually sucessful due to the partial calcificacion of the canal and the
help of MO) before internal bleaching?
Svelana, thanks for engage this interesting discussion sharing this case.
- Nuria Campo
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