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Calcified upper incisor:buccal sinus tract - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been credited
for the individual posts where they are. - Photos courtesy of Nuria Campo - www.rxroots.com
From: Nuria Campo
To: ROOTS
Sent: Wednesday, April 09, 2008 3:54 AM
Subject: [roots] Calcified Upper Incisor

Male, 46yo . Chief complaint: buccal sinus tract near #8 (or 11) 
3-4 moths evolucion, symptom free. Tooth sufferred trauma 26 y ago 
when the patient fell down due to unconscienceness. Root Canal is 
badly calcified according to X-rays. Discrete apical radiolucency 
is guessed. PVP: negative but not conclusive in this cases

I assume that the tooth maintained its vitality in the moment of 
trauma and as a reparative process
the canal became calcified.

But if the canal is aseptic and no entering of bacteria... How the 
tooth become necrotic and appear the sinus tract?

How succesful are you entering in the original path of the canal 
under the scope in this cases?

Did you consider SRCT if you are not able to have the canal? 
- Nuria Campo



Dear Dr. Campo  The suggested avenues for pulp infection in an 
intact, non-vital tooth are, (in the order plausability):

1.  exposed dentinal tubules without dentin sclerosis from either 
    non-union of cementum and enamel or gingival recession in a 
	tooth thatlooses it's vitality and thus its natural defenses 
	against     bacterial invasion.

2.  cracks that traverse the enamel and expose the dentin to 
    bacterial invasion as above.

3.  anachoresis  (I don't buy this one)

The ability to follow the original path under the scope and with 
transillumination is greatly increased. By the way, turn off the   
scope light.

NSRCT is a last resort and only with precise patient consent.  
I have seen cases where the doctor opened the tooth up surgically, 
was able to find the major canal and was able to pass an instrument 
from the apex to the crown which then allowed them to treat the 
tooth from the orthograde approach with success.

Hope this helps in giving you more choices.  Good luck - Grant

Dear Dr. Merritt, I believe these possibilities are poorly 
understood and appreciated, and why obturation remains an important 
step.  The vital pulp is the best root filling, and the pulpo-dentin 
complex is not vestigial. Thanks for sharing, - Kendel
Toughest root canal

Retricted mouth opening

Deep decay

Upper second molar

Open sinus lift

Implant after extraction

Implant # 20

Implant # 30

Irreversible pulpitis

2 step necrotic case

Fracture

Lesion on MB

Endo perio case

Surgery or implant

Silver point removal

Series of cases

SS reamers and files

Single visit RCT

Ortho resorption

Apico retreatment

Apical perforation

Funky canine

Crown preparation

Two tough molars

Epiphany recall

To squirt or not

Core distal end

MTA miracles

Pain with LR

Instrument removal

3 canals upper Bi

Acute pain

Dental decay

Calcified chamber

Mandibular first molar

Ultrasonic activation

Fluorosis

TF and patency

Interim dressing

Huge lesion

Tough distal canal

Debris in pulp chamber

Access and success

Restricted mouth opening

Broken drill fragment

MB2 or lateral

Gutta percha cases

Another calcified

Big Perf

Canals and exit

Dam abuse

Amalgam replacement

Simple MTA case

MTA barrier

Restoration with simile

Immediate implant

Traumatic accident

Lesion on D root

Extract / Implant

Carious exposure