From: Sashi Nallapati
To: ROOTS
Sent: Friday, June 25, 2010 12:19 PM
Subject: [roots] Fwd: High pulp horn

When this tooth was referred to me for RCT in 4, i was positive that the tooth was cracked. and that's why it got infected.
she had a done a filling in 4  a few years ago.
as you can see from the BW, the restoration is quite far from the pulp.
when i removed the amalgam, i didnt see any cracks which got me wondering why did the pulp become necrotic.
as you can see, right below the amalgam there was a pin point pulp expsoure.
the expsosure came about due to a very high pulp horn just about 3 mm below the occlusal surface.
these sort of exposures go unnoticed to the naked eye since one doesnt expect the pulp horn to be that high up.
any way RCT was completed in one visit.
i was expecting a lot of lateral canals seeing the spread of the lesion around the tooth. You can see a good bit of lateral
anatomy got filled.i did recommend cuspal protection for this tooth. all in all interesting to see the high pulp horn
in this case. that's why BW are important to assess the proximity of the pulp horn to the occlusal surface.
comments are welcome -  Sashi Nallapati



beautiful obturation Sashi! Its very humbling to see the great work posted here on roots.

Could it have been a possible dens evaginatus? The lower second premolar also seems to have the pulp horn
extending high up coronally on the bitewing.-  Imran

Absolutely could be a DE. particularly looking at 29. thanks Imran - Sashi

Beautiful work. Do you expect lasering the pin point exposure followed by GIC could have helped keeping the
pulp alive longer - Henry

if it was an iatrogenic exposure, at the time of the filling, placing MTA and then GIC over it, may have worked.
If it was carious, then very little chance of pulp cap working. pulp capping in general  is an unpredictable
procedure in adults - Sashi

great job ,  by the way , it is 5 not 4 . - Magdel

thanks american system, its 4 - Sashi

Sashi, Sorry for the late reply on this thread.  Just got back from hol in Mallorca.  I wanted to say that
I really enjoyed your talk on complicated premolars in Barcelona.  V inspiring :)

In this case, I'm guessing that it didn't take you too long to shape the canal.  I'd like to know,
typically how long you have irrigant (hypochlorite) flowing through the canal before obturation.

I'd also like to ask you and the other Rooters too which brand of K-Flex files you use to create the glidepath.
I have been taught that K-Flexofiles are good in severely curved canals.- Nik

NIkhil  you are right,  shaping took me little time.
after the shaping and gauging  is complete, i irrigated with hypo at least 10mls  and then used a
fine ultrasonic tip to agitate the hypo while irrigating the canal about 5 mnts. then EDTA and ultrasonics
about 2-3 mts and  final rinse with hypo. then dry and obturate. i like flexo files as well. - Sashi