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High Pulp Horn - Courtesy ROOTS

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From: Sashi Nallapati
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
Protaper flaring

6 yr old Empress

Cvek pulpotomy

Middle mesial

Endo misdiagnosis

MTA retrofill

Resin core

BW importance

Bicuspid tooth

Necrotic #8 treatment

Finding MB2 / MB3

Deep in a canal

Broken file retrieval

Molar cases

Pushed over apex

MB2 and palatal canal

Long lower third

Veneer cases

CT Implant surgury

Weird Anatomy

Apical trifurcation

Canal and Ultrasonics

Cotton stuffed chamber

Pulp floor sandblasting

Silver point removal

Difficult acute curve

Marked swelling

5 canaled premolar

Sealer overextension

Complex anatomy

Secondary caries

Zygomatic arch

Confluent mesials

LL 1st molar (#19)

Shaping vs Cleaning

First bicuspid

In Vivo mesial view

Inaccesible canals

Premolar 45

Ortho and implant


Lateral incisor


Churning irrigant

Cold lateral

Tipped to lingual

Acute pulpitis images

Middle distal canal

Silver point

Crown preparation

Epiphany healing

Weird anatomy

Dual Xenon

Looking for MB2

Upper molar resorption

Acute apical abcess

Finding MB2

Gingival inflammation

Irreversible pulpitis

AG BU ortho band

TF Files

using TF files

Broken bur

Warm technique

Restorative prognosis

Tooth # 20 and #30

Apical third

3 canal premolar

Severe curvature

Interesting anatomy

Chamber floor

Zirconia crown

Dycal matrix

Cracked tooth

Tooth structure loss

Multiplanar curves