Calcified upper incisor:buccal sinus tract - Courtesy ROOTS
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From: Nuria Campo
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
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