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Carious exposure : Irreversible pulpitis with AAP

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. - Valeri Dear Ahmad, 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

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