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The opinions within this web page are not ours. Authors have been credited for the individual posts and photographs where they are. - www.rxroots.com

Lower left first molar retreatment

From: Raf Michiels To: roots Sent: Thursday, April 19, 2012 3:40 AM Subject: Re: [roots] A case for Terry, what would you do? So to my surprise it seems there are not so much pulp lovers here on ROOTS. I posted the radiograph to provoke some discussion. Here is the full history and treatment. The patient came in 5 months ago for a retreatment of the lower left first molar. I decided to take additional radiographs of the second and third molar too. I then retreated the first molar. I advised the third molar to be extracted and I advised the following for the second molar: 1) Removal of the old restoration and cleaning out the caries. 2) Evalutation if there would be some pulp exposure and if we could get hemostasis or not, that would determine the eventual treatment. 3) So 6 months ago was the consult, 4 months ago the retreatment of the first molar, 3 months ago the 3rd molar was extracted and yesterday I performed the following treatment on the second molar: 1) New clinical testing: everything still responded the same as 6 months ago, no complaints present. So we have pluriradicular tooth with no symptoms and a vital pulp. Downside is possible caries exposure of the pulp and closed apices. 2) Anesthetize the tooth with a n. alveolaris inferior block with Artica´ne 4% 1/100000 epi. And an additional halve cartridge for the n.buccalis 3) Removal of the old restoration 4) Since the old filling was rather deep, I had to first build up the sides again with some composite so I could easily place a rubberdam afterwards. So I applied an automatrix (which explains the straight side on the mesial of the permanent filling) and build up the walls first (after I had removed the caries ofcourse, but only on the outside) with some composite (Herculite XRV Ultra A2 enamel) 5) After this I applied the rubberdam and some Oraseal for isolation. 6) I further removed the caries in the middle now and also the cement which acted as base layer. The old cement was actually into the pulp on the disto-buccal side, so when I removed it, I exposed the pulp. 7) Hemostasis could be achieved after I flooded the cavity with CHX and I put pressure on the pulp with cotton pellets soaked in CHX 8) The pulp exposure was then capped with MTA white from Angelus, I let it set for 10 minutes. 9) I covered the MTA with a small layer of glass ionomer 10) I built up the tooth with direct composite (Herculite XRV Ultra A2 dentin for the core, A2 enamel for the outer layers, Micerium Brown2 stain for the grooves) 11) Polishing with Rubbers, and Diamondpaste A&B from Micerium and finally polishing with Aluminiumoxide paste C from Micerium. Today I phoned the patient to see if there were any complaints. There were none. First follow-up will be performed after six months. When you have a minor pulp exposure in a tooth which responds normally, pulp capping is in my opinion the best option. If it fails, you can still go back and do the root canal treatment. I always inform the patients first and let them choose. If it fails, I also detract a portion of my normal fee for a RCT on a molar so that in the end IF they would need a RCT, they only pay about 1/5 more than they would have normally paid when we did the RCT right away. Overall I am happy with the result, the only thing that bothers me is the straight side on the mesial, due to the automatrix, but I had to use that to build up the walls in the beginning. - Raf lower left molar retreatment

lower left molar retreatment

lower left molar retreatment

lower left molar retreatment

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Instrumenting MB2
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