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- www.rxroots.com -Photos courtesy Rick Schwartz
From: "Richard Schwartz"
To: "ROOTS"
Sent: Wednesday, June 06, 2001 7:21 AM
Subject: [roots] Re: 6 week apexification (or the miracle of CaOH)
Here is a patient I saw today. She is a 15 year old who presented on April 22 with swelling in her maxillary labial gingiva and upper lip.
She had trauma to her anterior teeth at age 8 and the root canal was done on #9 shortly thereafter. The pulp was necrotic in #8 and the apex
was wide open so my plan was apexification. I prepared the canal to size 120, placed CaOH,
prescribed antibiotics and reappointed her for a week later. She was a no-show for that appointment, and another one 2 weeks
later. Finally we got her back in today. Because of the difficulty in getting her to come in, I decided to place an MTA barrier today and complete the root canal.
However, when I removed the CaOH, there was a solid apical barrier. I poked around with a size 10 file and could find no holes. When I obturated I placed sealer, filled
the canal with the Obtura, downpacked with the System B and then backfilled. No puffs! The first 4 pictures are from April 22 and the last two from today. I didn't
think it was possible to form a solid barrier is so short a time - Rick Schwartz
Rick, Nice case. Yes, that is quite fast to obtain a complete barrier. Open up the
owerpoint slide that is attached for a review of barrier formation times. - Fred
Table courtesy - Fred
Apexification
Hard-tissue formation, Ca(OH)2:
F. Barnett
help the slow people .........can you explain what the slide is telling us/me.....craig
Craig, Sorry...I should have explained this slide.
The slide shows the number of teeth for each study (No.), the percentage of cases that
developed a complete barrier (Barrier), and the average time in months for the barrier
to form (Time). In the Finucane et al paper, the (p) denotes a parallel root apex,
and the (d) signifies a divergent root apex, which should and does take longer for a
barrier to form.
Please let me know if you need more clarification. This slide is taken out of context
from a lecture on trauma that I give.
Fred (BEAT L.A., BEAT L.A., BEAT L.A., sorry, Sixers mania is getting the better of
me).
Once again, a great learning experience. I cant believe how fast that the
apexification occurred. Was there much bleeding on day 1?
How do you pack the MTA in at the apex on a case like this if you want to do it that way.
Dovgan Carrier I guess but how to pack it down there - Glenn
Glenn, After some drainage initially, I was able to dry it pretty well at the first visit. I
was going to try my new Dovgan Carrier for the first time, but didn't need it in the
end. I place the MTA with a carrier as far apically as possible and then use Schilder
pluggers with a stopper to gently maneuver it to the apex. I clean up the excess with
large, wet then dry paper points. I'd be curious to hear how other people do it - Rick
Miracle of CaOH
