From: Terry Pannkuk
To: ROOTS
Sent: Tuesday, December 29, 2009 6:38 AM
Subject: [roots] Done now?

Here's the surgery on the perforating internal resorption case I treated today.  Originally treated in 2006.
- Terry





What kind of endodontic filling technic was used in this case? I suppose, that used material is MTA, didn't it?
- Deyan

Infiltrated with Lido 1/50 Thanks - Terry

Wow! Not too easy on a lower second molar. Nicely performed and documented, as usual.
How did you control bleeding from the PDL? Thx for sharing - Maarten

Actually the access was pretty easy with this guy.  He was about 6' 8" with a minimal buccal shelf.
Case selection is everything.   If there had been poor attached gingiva, poor access, involvement of the
furcation/interproximals, I would have extracted the tooth.

Knowing what you can and cannot do is more important than actual clinical expertise.  You wouldn't believe the
number of cases I don't treat simply because I have a "bad feeling" about how it's going to turn out. :)
Back in 2006, I remember thinking to myself, "Jeez, this guy is tall with a great big mouth and wonderful
anatomy for a potential failure".  You wouldn't have seen that delicate little Tedvek suture at the tip of
the mesial papilla if I had been fighting a pudgy wide cheek the size of Jaaba the Hut. :):):) - Terry

"Knowing what you can and cannot do is more important than actual clinical expertise".

Isn't 'knowing what you can and cannot do' exactly the definition of clinical expertise?
Before you know what you can and cannot however, you need to try these things. A lot of stuff isn't thaught at
dental school or postgraduate programme, and you learn just by doing it. The first time might not result in a
satisfactory outcome, the second time will be better, until you reach an acceptable level and are comfortable
in offering it to your patients and execute it.

Attached is a similar case I treated recently. Haven't done a lot of them. Young lady with a  couple of strange
carious lesions (all class V lesions) in an otherwise healthy dention. In order to save tooth 46, I started
removing the (vital) pulp, then reflected a small flap and restored with Fuji II (resin modified GIC).
Calcium hydroxide and a temporary sealing were placed. Two weeks later, the orthograde RCT was finished.

Not as perfect as yours, but not as easy as yours, at least from the perspective of the size of the defect...
- Maarten