From: Bill Watson
Sent: Wednesday, May 23, 2001 5:32 PM

Glenn

Very nice photography and a very well done case.  If I may make one suggestion that could
improve the case, at least from an aesthetic point of view.  If I interpret the radiograph
correctly, there appears to be GP incisal to the crestal bone.  IF this is the case, there
is potential for future discoloration of the clinical crown from the sealer/GP mass.

Suggestion:

When aesthetics is a concern, always remove GP and scrupulously clean out the remaining
sealer remaining incisal/coronal to the GP which should be 1-2 mm below the level of
crestal bone.

Again, nice case.

bill

From: Glenn van As
Sent: Wednesday, May 23, 2001 7:58 PM

Point as always taken!!

Thanks for the kind words and yes I looked at it too and realized it might be a little
high but that was after the final radiograph.

Patient wants full crowns on the lowers now to prevent this happening so I figure this
might not be the last endo I do......

I will go back and remove GP......

Glenn

From: Harvey
Sent: Wednesday, May 23, 2001 8:06 PM

Hey Glenn,

Freddie forgives...He's a real nice guy. Not to worry.

Now to the issue of 2 canals in lower anteriors. I always assume there are 2 of them
until I can positively prove I am wrong. I know it's hard to believe but lower anteriors
are not easy teeth to treat. They have a myriad of anatomical variants and anomolies....
so my approach is to always prepare for the worst scenario and then I'm covered. Stropko
has the numbers on the variants.

Don't lose any sleep over that "puff" because your patient won't either. When it heals
and most of it resorbs you can put it back on the web for further dissection by
los "rooters".

B.Harvey Wiener, DDS, MScD, FRCD(C)

From: Jerry
Sent: Wednesday, May 23, 2001 8:27 PM

I agree with you Bill, but I get alot of crap from referring docs because they don't
want to have to place the resin down that far.

Jerry Avillion

From: Jerry
Sent: Wednesday, May 23, 2001 8:42 PM

Glenn, I can't believe you are worried about that sealer.   How many times have you
personally seen (or seen someone post) cases like this that have failed?
If it happened, one would think the pulp lover camp would be showing these things in
seminars all over the earth.

On the other hand, any one of us could post a zillion cases of root canals treated 1mm
short that have failed.  Gary Carr probably has a bunch that were done by endodontists.

Jerry Avillion


From: Joseph
Sent: Wednesday, May 23, 2001 9:27 PM

I always bring the obturation down to the CEJ--- and then use self curing resin instead of light-curing ;)
jab


From: Thomas
Sent: Wednesday, May 23, 2001 9:49 PM

Hi Jerry !

Agree 100%. Your docs are lazy. I am a GP too and I have no problems what so ever placing
resin 2-3 mm under CEJ. I even use the Machtou pluggers to make it sit well :)
About the puff, I don't like it but in a tooth like this I think it's unavoidible.
Nice treatment !

Thomas

From: Thomas
Sent: Wednesday, May 23, 2001 10:12 PM

Hi !

I have seen a presentation, I think by Prof' Friedman showing a big puff
(err well, huge ;) ) that failed quite nicely.

Thomas

Did he re-treat it short and get it to heal?

Jerry Avillion


As Fred has repeatedly said, the puffs are not bone magnets.  Typically the failure
would not result from the puff but because of inattention to detail in another area.
There are many more things in endodontics to be leery of other than a puff.

Just my two cents

Blake McKinley, Jr., DDS

From: Jerry
Sent: Thursday, May 24, 2001 12:06 AM

Has there EVER been any research to show that 'puffs' somehow adversely influence healing?

As far as I can tell from my own cases (which is all anecdotal), the ones with the
BIG puffs seem to heal as well as the ones with the little puffs.
It's the ones with NO puffs that are the ones that seem to fail.

Jerry Avillion