The opinions and photographs within this web page are not ours.
Authors have been credited for the individual posts where they are.
- www.rxroots.com
We tend to only show our spectacular cases, but we all have mishaps.Here is one of mine
with self-criticism it is intended for the less experienced Rooters. It shows that even
after 35 years of cleaning canals you can still screw up. It is a strip perforation case,
which I have not had in years, because- before NiTi rotaries.
I would have been careful not to use GG’s bigger than #2 in the orifice and done the
mesial canals by hand. I stripped the mesio-lingual canal with a .08/25 Flare used
aggressively. It now has Ca(OH)2 and will have to put another two hours to repair
the perforation with MTA.
Error #1: It is a DMO case – I accept some (about 25% percent of my practice) because
in Petaluma, many Latino patients that have such insurance, and I enjoy treating them.
For this case I will be payed 75% of my UCR fee, in addition, If I like the patient we
usually allow them payments for their portion (co-payment). So when you do not get paid
well you tend to cut corners---albeit unconsciously. So if you accept to cut your fees
voluntarily you should take a deep breath and still do the case right right right regardless.
Error #2: No pretreatment. If it was a dental student in the clinic floor, we would
have demanded caries control and a build-up or a cemented band or aluminum crown before
putting therubber dam on. I did not; the caulking paste from Ultradent usually lets me get
away without pretreatment…..wrong…wrong….wrong.
Error #3: Let the RDA dismiss the patient (because you’re checking your Outlook express
for Roots wisdom) without checking the Ca(OH)2 X-ray. I will have to see him today again to
replace the temporary filling, since despite the so-called high alkalinity of the calcium
hydroxide and its antibacterial (???) properties you still want a pulp chamber that is
semi-secured from leakage by a decent temporary restoration.
Error #4: Not insist that the 3rd molar gets extracted.
I appreciate your patience by reading this mea culpa. As you know I have Jewish/Eastern
European/Spanish,/Aztec heritage and OH boy!!!! do we experience guilt. To top it off
the patient is 24 years old (the age of my son), he is sweet and nice and happy to be in
America and works as a janitor. He takes a bus to come to my office, I felt like giving
him the keys to my Volvo. I’ll settle by doing the best MTA repair possible, under the scope,
thank God or Gary+John for the repair instruments, Mahmoud for the MTA, Joey D for his
carriers, Stropdude for the Stropko and everybody else in our wonderful field of endo.
If I keep thinking about it I will pay the patient's way to Scottsdale and let my
Hero(Stropdude) patch it …..I’ll pay his outrageous fee.
Photos courtesy of Ben - www.rxroots.com
From: Fred Barnett
Sent: Saturday, April 14, 2001 05 39
BRAVO BEN....finally, someone besides me does an occasional screw up.
Please tell us how you diagnosed the strip: bleeding, apex locator, visual inspection.
Also, the Ultradent Ultracal product with the 30 gauge bendable polypropylene needle lets
you get the white stuff far down the canal. It is also very important to remove all Ca(OH)2
from the walls of the chamber, otherwise you will have coronal leakage once that Ca(OH)2
washes out.
Do you really think that the Ca(OH)2 is not antimicrobial????? Do I need to send you more
Scandinavian studies? ;-) - Fred Barnett
From: Uziel Blumenkranz
Sent: Saturday, April 14, 2001 06 16
Dear Benjamin: Congratulations on your post. This far have not bought the tachles.
What is the story about tha panic clinic you mentioned the other day?
Best regards. - Uzi
Mishaps - Resorption
