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 intrument 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