From: Ahmad Tehrani
Sent: Wednesday, May 06, 2009 11:05 PM
Subject: [roots] Ricardo 5509
Gotta love a "carious exposure" practice - ahmad
Ahmad, What was the reason you've chosen "total" RCT instead of
trying MTA/ BioAggregate capping at orifices level ?
Patient seems to be young enough and such approach would be more
biologically sound to me since reparation potential of such
patients is high - Valeri Stefanov
The diagnosis of this case was: Irreversible pulpitis with AAP.
Patient is 18 with IRM temporary being 6 months old.
He was told he needed a root canal and waited until he was in so much
pain, he sought treatment
I wouldn't even consider doing a MTA pulp cap in a "mature " patient
like him. If the apices weren't closed and pulp wasn't violated
previosly, perhaps.. MTA is a great product and I use it frequently....
but as a panacea for ALL endodontic cases? no way - ahmad
Valerie, With mature roots, what's the downside to doing rct?
possible failure? ok, pretty unlikely, especially a case done with
the skill of a doctor like Ahmad. The only other downside is a life
lived without pulp in that tooth? ok, the patient will cope. :-)
What's the downside of doing vital pulp therapy on a tooth like this?
Lose track of pt, pulp goes necrotic, leading to abscess/facial swelling
on the pt's wedding night? Oh boy, that would be a bit harder to cope
with than a tooth relegated to a lifetime with no pulp. :-)
How about the tooth becomes symptomatic in 10 yrs but now there are
no patent canals til the apical third? Unless your name is Marga Ree,
that might not be a doable rct. Now the patient has to ante up $4k
for ext/implant supported crown.
Bottom line, I think Ahmad made the right choice. If the roots weren't
mature, I'd do the vital pulp therapy as you suggest - Mark
Mark, If dentist prefers to stay 100 % on the safe side, he will do what
Ahmad has done and what you as it seems from your comments will do,
if case is yours.
I am not familiar with this case in details, but from what I see on RXs,
I will definetly do direct pulp capping with MTA/BioAggregate and I will
follow the patient. There is a big chance scenario you have described
not to develop in great number of such cases with young patients.
Been there, done that :-). Of course that is only my personal opinion.
A nice case, as usual. I have a problem with the diagnosis. Irreversible
pulpitis is in vital teeth and AAP in non vital teeth. Was this a partial
necrotic case ?
I also don't do MTA pulp caps in irreversible pulpitis and mature roots (not
just closed apexes, I also I check the width of the canals, but they were
thin here already) as I don't think there is a need - Thomas
hmmm...never seen a red bleeding pulp tissue in a tooth that was sensitive
to percussion?? - ahmad
Yes, you are right. I have it still stuck somewhere that AAP is usually
associated with a non vital tooth - Thomas
Thomas, You've never encountered a patient with IP/AAP? - Mark
Mark, I have re-read the new AAE terms and I see that today they don't
associate the AAP with a necrotic teeth which was done 6-8 years ago.
So every tooth that responds to percussion has AAP now I guess, right ?
If so I have seen many - Thomas
Thomas, I think most of the time an AAP is associated with a necrotic pulp,
however I seep plenty of percussion sensitive teeth with irreversible
pulpitis - Mark
Mark, I have seen a lot of those as well. I just never thought of them
as having AAP that's all - Thomas