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Emergency patient
From: "ahmad tehrani"
To: "ROOTS"
Sent: Tuesday, April 01, 2008 8:28 AM
Subject: [roots] Emergency patient
RCT is 10 years old......it has nice white lines.
so what is the problem? - ahmad
Thermafill? - Vincent
As an educator, I think yours is the best and truest answer. It's not
the obturation material. It's the lack of understand of the disease
process and the willingness to apply principles that would reverse and
prevent that process. To date there is no evidence in the literature
that any obturation method, improperly used, will result in a better
result than Thermafil used improperly.
When I was a practicing endodontist I swore with the same words,
(under my breath of course), when re-treating schlock dentist's
attempts at thermafilth AND guttapuke. I'd probably use the same
words today as oaths against those who expect resilousy to perform to
the level of properly used Resilon.
Thermafil is a good obturation material if properly used. Those who
say not, don't know how or don't care to use it. That's fine...they
shouldn't. In my opinion, those who use it improperly doom their
patient's dental health and are thieves on two counts, trust in the
dental profession and money. The same can be said for those who
consistently perform any other instrumentation and obturation
technique with disregard to the principles of disease control and
tooth preservation. There is nothing inherently disaster prone about
the material itself. That distinction can't be said for the ignorant
or careless dentist.
Just as in flying an airplane, the great majority of problems are due
to pilot error whether you are flying a J3 Cub or a Gulfstream 650.
Each has an elegance. Both make scars in the ground and spread
destruction with inattention to detail.
Gee, what a sanctimonious grouch! - Grant
bacteria - Marcos
Dear Ahmad, There is coronal leakage (open margin on mesial ?).
Also overfill can be a sign of bad seal - Thomas
THE APICAL R.L IS EVIDENT...AT FIRST SIGHT LOOKS LIKE A NICE RCT...
BUT TAKE A LOOK CLOSELY; ....SEEMS LIKE..... DISTAL OBTURATION IS
PASSED
1 1/4 mm, ML CANAL HAS A SEPARATED INSTRUMENT... AND THERE IS
ANOTHER ONE PULLED OUT OF THE CANAL.... BY THE WAY CROWN IS NOT
WORKING PROPERLY.... I WOULD GO FOR EXPLORATORY CX AND APICO.
- DR. ALEXANDER GARCIA J.
Ahmad,
1. Coronal microleakage with, (Has the crown been off recently?)
2. Overextension, underfilled canals
3. Surely a missed distal canal
4. Possible missed mesial canal etc.
But then, if the radiolucencies were larger a few years ago and the
patient is without symptoms, some literature would say give it another
20 to 30 years, it may show radiographic healing.
By the way say hello to my patient. I told them NEVER to let anyone
xray this area again or something bad might happen. - Grant
From: "ahmad tehrani"
To: "ROOTS"
Sent: Tuesday, April 01, 2008 10:03 AM
Subject: [roots] Emergency patient Part II
the dreaded TF...probably canals were prepared to size 25 in
less than 15 minutes, irrigated with saliva ( since her eyes got as
big as saucer when she saw the rubber dam) and shoved a over heated
size 30 TF to the apex...of course pushing all the bacteria out of the
canals!.. these carriers were all stripped off the gutta percha
apically providing no apical seal what so ever.
Gary is right about "biofilms".
when accessed the chamber, this tooth stunk so badly that we had to
double mask, turn the fan on and reach for lemon scented bleach to get
rid of the stench.
No wonder Terry calls it Thermafith!
on the bright side, it only took only about an hour to remove and
clear the crime scene!
I know it should take less according to the Hollywood video that
removes these from an extracted tooth is less than 30 seconds, but
that seldom holds true when teeth are still attached to some one's
jaw...at least in Texas....)))
after 20 minutes of NaOCl, EDTA, CHX irrigation , packed it with CH,
thick layer of cavit and composite to close the access for a while.
then I got to thinking that some where, some one thinks s/he never has
any failures....and they are probably right in their own
mind....patient moves away, switch dentists , or simply gets the tooth
extracted and implant placed...so "technically" they never have any
failure...or when they become aware of it, they send it to Levin and
instruct him to:
"Just Fix It!"
"clinical reality" is a subjective and loose term...no?? - ahmad
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