From: Siju Jacob To: ROOTS Sent: Monday, January 21, 2008 12:33 PM Subject: [roots] importance of recalls Here is a case I did in september 2006. Restorative prognosis was poor but both patient and referral were keen on giving it a shot. I had a tough time getting patency in the mesials. The tooth had a lesion in the distal root. 15 month recall shows the distal lesion totally healed. A new lesion has cropped up on the mesial root! I've suggested surgery. SijuYou see what can happen when you have patency on non-lesion roots ? :-)))))) Learn the lesson ! :-) very nice treatment...keep us posted after the next step ! - Roberto nice siju, at the moment pt symptomatic/asymptomatic? I would still wait for some more time. - Raghu Hi Raghu, Patient is asymptomatic. Why would you wait for some more time? - Siju Dear Dr Siju, Well, what can I say, a dificult case and it looks good at the pos op X-ray. I´d retreat the mesial root, maybe trying to seek for a canal between MB and ML!!! Perhaps that´s the cause of the failure - Rodrigo Cunha Hi Rodrigo, Thanks for the input. No. There wasn't a middle mesial canal. This was a re-curvature case. I probably didn't clean the apical portion well enough. - Siju A. Mesial apical shaping and fill is weak. This is the reason for the lesion B. Recall films of crowns should always include BWs, How can you evaluate the margins w/o Bws? C. The distal margin appears short and open. Mesial looks similar though it’s hard to tell without a BW residual cement visible on M margin. D. Margins on 2nd molar speak for themselves open and unacceptable E. Why the space between the post and the GP? F. I find it difficult understanding how one could restore the first molar without dealing with the bombed out premolar adjacent to it. (Possible bridge? Mesial crown contours?)Tx planning? You can’t make a silk purse out of a sow’s ear. When you work hard on an endo treatment, you should expect that a similar effort should be made for the restoration. In this case the restoration is deficient. Surgery is entirely the wrong approach. Better coronal dentistry is the solution. Retreat the case conventionally, treatment plan the quadrant properly and close the margins. Then you will have success. - Rob K
Hi Rob, I agree with all the points mentioned. The bombed out premolar was supposed to be extracted and an implant placed. The second molar crown needs to be re-done. A treatment plan was made for this case. The fact that it hasn't been carried out is a different matter altogether. You are right. Surgery alone may not be the right approach. However, i would not re-do the apical portion because I know it is impossible to enlarge the apex anymore without causing iatrogenic errors. The right approach here would be to re-do the coronal restoration along with surgery. The other option would be extraction (which probably should have been the right thing to do in the first place) - Siju NICE comments Dr. Rob but i want to stop by one of them Why the space between the post and the GP? how dose the space between post and gp affect RCT and when in which type of post, cements and teeth? any evidance? Thank's - Dr Mohammed
