Apex Locators in the diagnosis of perforations
Healing on a retreatment case
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From: Jorge Vera
Sent: Tuesday, April 26, 2005 12:32 AM
Subject: [roots] HEALING ON A RETREATMENT CASE ( CORRECTED)
I sent this case earlier but my computer got crazy and attached
another file that wasnīt mine. Hope it goes trough this time
- Jorge Vera
No patency, yet beautiful healing.
So how do we(you) explain these? The biofilm, bioburden, is
significantly reduced such that the balance of disease/healing
is tipped in the favor of the host? The biofilm/infection in
the uninstrumented areas is disrupted by diffusion of Ca(OH)2?
I have a couple cases I'm trying to follow like this ( too recent
for follow-up images as yet) retreats without patency on one or
more canals, yet symptoms resolved and apparent healing underway
Yes Kendel, I would guess the medicaments have a lot to do with
this, but, on the other hand, achieving patency doesnīt guarantee
elimination of Biofilm or bacterial flora like we proved on the
study done with Nair in which every case was kept patent but 88%
of the canals remained infected, on the other hand, thereīs no
study that has proven that patency increases bacterial reduction
and/or success. I do however try to attain it in every case that
I can and I think it should remain a goal - Jorge
Let me play devils advocate. If we have no evidence that patency
increases success or even bacterial colonies, on what are we
basing the principal that attaining patency should be one of our
goals. What then is the justification for doing so? - Gary
The same principal we use when we wash our dishes at home.
Intuitively we know it must be better when we leave things
cleaner - Mark
Isn't this an example of a situation where 'we don't have
evidence' because thea ppropriate test (ie randomised
double-blinded trial) would be impossible to carry out, or
I justify striving for patency on the basis that I want to
give access to thee entire canal system to my irrigants; if
there is a peri apical radiolucency, then presumably the
canal immediately adjacent to the p/a area is contaminated,
so I want to get into it.
An additional factor in my mind is that I cannot be certain
about length control until I have achieved patency - Simon, Oz
I agree completely, but, despite the fact that it hasnīt been
proven to increase bacterial reduction (It probably does),
it has been proven to aid in maintaining working length and
it aids in the cleaning of the apical third when compared to
those canals where patency was not achieved. So, I try to
achieve patency but still can sleep very well at night if
forever reason I canīt on any given case - Jorge
You may be correct simon. But we are an evidenced base
profession. How do we establish a protocol without hard
evidence it makes a difference. I truthfully never did it
until I joined roots. I just finished a max bi two minutes
ago. I instrumented a #20 hand file 2mm beyond the apex,
finished to the apex locator reading, recapitulated in
between with the #20 in the m4, and obturated. Does it make
any difference I took the time to do it. I hope so,
but Im not sure.- Gary
Go to any endodontists office and ask him to show the last...
Oh say 10Billion failures that came in. Two will be "long"
i.e. overextended and underfilled. The remaining 9,999,999,998
will be short.
I do not need a double blind, cohort bound, multi-location,
cross-referenced, time trial controled, interdisclinary study
about dropping a hammer on my foot to know that it will hurt.
What would such a study prove anyway? If it said patency was
not important, us barbarians would say "Methodological problems"
If it said patency was important, the pulp lovers would say....
I trained at Iowa. It was a major abandonment (I chose this
word on purpose) of almost everything I was taught. It took
a few years, and a very embarrassing question from Buchanan,
but the bulb went off.
Again, paradigm effect. The engineers, starring at the molten
debris of Cherynobl knew from their construction of the reactor
core that it simply could not have blown up...
Speaking of Ruskies, why is is there are only defections from
the pulp lovers side?
Ahhh ignorance is bliss. I long for the good old days when I
could be 1-2mm short. Then I could do 10-15 cases/day and get
that e55 and new computer I have lusted after for years
- John A Khademy
LOL..................the real bottom line is that we need to
debride and especially disinfect to the foramen. Patency will
facilitate that as it helps to prevent ledging, blocking and
transportation, all of which may compromise the ability to
properly disinfect - Fred
It obviously does not hurt. We've been doing it accidentally
for years with no ill effects whereas we do know that there are
ill effects from filling short. I can see no down side to
cleaning the entire canal and filling the entire
canal. Can you? - Guy W. Moorman, Jr. DDS
We are evidence based to a point and often scorn the statement,
"it's worked well for years". Truth be, "it's worked well for
years" is evidence based. I remember when I was in the military
they were going to put a warning against using lidocaine in
pregnant women on the package. The basis of that was that
lidocaine had come out since an arbitrary date in the late
thirties so it had to have that warning. Is that evidence
based or simply a crap shoot. The dental profession was able to
stop that warning from going on the package. Lidocaine came
out about 1 year after the arbitrary date set by the FDA.
Evidence based CAN be a crap shoot when we have two or even
three groups studying a material or technique and coming out
with differing positions or answers. Sometimes, "it works
well for me" is all the evidence base we need in some cases.
We were getting patent for years without trying with no ill
effects. Now that we understand disinfection, getting patent
simply makes sense - Guy W. Moorman, Jr. DDS
How do we know that patency would effectively eliminate all
the bugs? But,I agree, that on teeth with AP, patency is
what I try to achieve and maintain. But I have closets full
of cases of AP that never had patency and healed beautifully.
So what do we learn from this?
That patency is NOT the answer for enzootic success. Please
see the Hoskinson et al study and look at their healing rates