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Endo tips    Better Endo    Endo abstracts    Endo discussions

CaOH alone is not working - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are - www.rxroots.com
From: craig
To: ROOTS
Sent: Saturday, January 21, 2006 6:02 AM
Subject: [roots] because caoh alone is not working....

This is what I am trying here

Bug killer or not, my clinical experience and observation with my 
cases in my practice over the past 4 years or so has shown that 
caoh doesnít seem to have the effect I initially thought it did..

So today, I faced reality rather than pretending..rather than doing 
the same thing over yet expecting a different result.

I am not saying this is going to work..dont know if it will even 
make a difference.

BUT

My 3 observations with caoh have been:

if it is a bad infection.draining and all that BS..then it just 
washes the stuff out and therefore..no effect so we are just going 
through the motions.  if the case has a chronic lesion most of the 
time no notable changes can be noted in any reasonable amount of 
clinical or functional time.ie: only and probable realistic truth 
is that I am just going through the motions based somewhat on 
observation 1 the case has no lesion and most assuredly, I am going 
through the motions based on observations 1 and 2

now my one thought was to start planning in a scheduled retreat of
my own case with the idea that at least I would have an attempt at 
seal between visits but then the question is: how long do you wait 
to schedule the retreat?..........2 weeks?.....2 months?     And  
now  you have used permanent stuff?.the idea would be to let
some healing occur before the apical seal is broken down first by 
the lesion/bugs/what-have-you..

conclusion: too much trouble at this point in the game based on 
something that ranks as less than a hypothesis on the continuum scale.

So my next thought was to put caoh in with a sealer or use a caoh 
based sealer and seal the canals with that mixture and then come 
back and retreat that.

Conclusion: same BS as before and then you have to drag out
chloroform or what ever plus caoh sealers are not
necessarily bacteria killers...

SOOOOOOOOOOOOOOOO

Hereís what I did today.and I think this is based on the Siguera 
paper where he promoted the use of a fit GP cone in the prescence 
of caoh .i may be wrong because it was posted here on Roots years 
ago and I am only going from vague memory..regardless seems like 
it makes sense in coordination with my clinical experience.

THE CASE:

This guy was swollen with a major infection associated with this 
tooth sure to be a wash out case with caoh alone ..which means
we do nothing and/or go in circles

What I did:.

Pre endo build up, access .brief and dangerous lack of orifice 
shaping to hopefully get to working length with first rotary to
allow some amount of tug back at length for each canal..located 
the MB2 but too damn wicked to concentrate on today in a state of
emergency..

Looks  like a 15 min endo case but what it is are GP cones fit to 
length but mainly with the focus on getting some type of  tugback 
at or around the tip of the cone...filled canals with coah and 
placed gp cones and seared at orifice..cavit and ketac 
interappointment restoration

The canals are severly under prepared but at least I have a shot 
at maintaining some type of seal to prevent
the washout that I know will happen.

Anyway .brainstormers and criticizers is what I am looking for.. 
- Craig

PS..the MB cone  is to full length.. the cone (MB)  is so small 
and the canal so curved that it didnít show up well on the xray

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