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From: "Terry Pannkuk"
To: "ROOTS"
Sent: Thursday, March 12, 2009 9:51 AM
Subject: RE: [roots] Multiple tooth isolation
Here's a case I finished today with multiple tooth isolation. There is
no way I could have controlled the Dycal matrix for the post and core at
the end of treatment without isolating multiple teeth. This patient
weighed well over 400 lbs, had a beard, and isolation otherwise would
have been impossible.
I frequently treat coronally compromised teeth with very compromised
cervical dentin. If these cases are handled properly and restored
properly. The issues of dentin preservation and coronal flaring are
largely eliminated. The only problem with coronal enlargement is it
takes a competent restorative dentist to follow up treatment
appropriately.
That is the message that seems to be lost with the issue of
"conservative access". I'm all for conserving dentin, but I've looked at
so many long term recalls that I know that restorative competence is
more the deciding issue than endodontic access design. We need to
educate restorative dentists to respect the requirement of ideal
endodontics. In this case I instructed the restorative dentist that it
was manditory to create a bevelled finish line on dentin
circumferentially without overprepping the tooth if he expected
treatment to be successful. A shoulder prep is out of the question.
The burden isn't entirely on the endodontist to create success. Dentin
should be conserved but not at the expense of ideal endodontic treatment
resulting in a failure to ideally clean and shape. - Terry
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