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This patient come today with intense and continuos pain in 36 due to a caries and leaky restoration. Vitality
was possitive for cold. Palpation was normal but slighly sensitive to percussion. No mobility and normal periodontal
probing. The diagnosis was irreversible pulpitis.Pulpotomy was done after obturation the distal face with Ketac Cem. It took me a lot of time to obturate the distal face. I would like to know different tecniques and materials that you use to do that???? I left a dry cotton and placed a temporal filling. What do you think about intracanal medicament used in pulpotomies???? After occlusal adjustment and analgesics - Noemí Pascual, Barcelona - Spain read more..... |
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The Apical seal in not important - From: Joseph Dovgan
To: ROOTS Sent: Saturday, March 17, 2007 12:21 AM Subject: Re: [roots] the apical seal is not important You know we try hard to do "qualtiy" endodontics. The problem is, quality does NOT pay well. In fact, the higher the morals, ethics, and qualtiy orientation, typically the lower pay you take home and the higher the fee because it costs more to provide services Faster endo inevitably results in corner cutting, which decreases long term success or increases the chances for other things. As for "Standard of care"...it exists already....and I can show you how endodontist routinely don't abide by it...it's all about corner cutting for most. Here's quick break down of how to measure...and by all means...not trying to be inclusive. 1. Adequate Medical History....now to cut corners, many use 10 or 12 questions...the ADA has a recommended health history with 56 questions on it. I know many use the "short" form...but then miss many medical interactions. Pt's love the short form...less to fill out, takes less time. Dr's love the short form for the same reasons..
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2. Adequate Radiographs. Now to me one PA on a posterior tooth is below the standard of care. We don't get enough information and the probability of additional roots is high. Good quality endodontists take at least 3 PRE op films, and 3 Post op films, understanding that it takes off angles to show all the canals. If your endodontist takes ONLY a single film in the posterior...it's cutting corners, plain and simple. If they are NOT taking proper off angles...it's just corner cutting.
3. Adequate Diagnosis: 90% of endodontists miss the mark. They fail somewhere. I've listed the minimums before, but here it goes: At least one point thermal test, EPT if NON responsive to thermal, percussion, palpation, full perio exam, Eval for swelling, sinus tracts both intra and extra oral. Endodiagnosis requires 2 parts pulp and periradiuclar status 4. Adequate Tx planning: They fail typically to actually document the discussion with the patinet...typically they use the inform consent for this.
5. Adequate endontic Tx: WOW...this is a tough one...and quite broad...but it's easy to gauge when you see it. If your endodontist does ALL tx in a single visit, he's cutting corners...there are plenty of teeth that should be done in a single visit. | ||||
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Treatment of Periodontitis and Endothelial Function Volume 356:911-920 , March 1, 2007 , Number 9 Maurizio S. Tonetti, D.M.D., Ph.D., Francesco D'Aiuto, D.M.D., Ph.D., Luigi Nibali, D.M.D., Ph.D., Ann Donald, Clare Storry, B.Sc., Mohamed Parkar, M.Phil., Jean Suvan, M.Sc., Aroon D. Hingorani, Ph.D., Patrick Vallance, M.D., and John Deanfield, M.B., B.Chir. ABSTRACT
Background Systemic inflammation may impair vascular function, and epidemiologic data suggest a possible link between periodontitis and cardiovascular disease. Methods We randomly assigned 120 patients with severe periodontitis to community-based periodontal care (59 patients) or intensive periodontal treatment (61). Endothelial function, as assessed by measurement of the diameter of the brachial artery during flow (flow- mediated dilatation), and inflammatory biomarkers and markers of coagulation and endothelial activation were evaluated before treatment and 1, 7, 30, 60, and 180 days after treatment. Results Twenty-four hours after treatment, flow-mediated dilatation was significantly lower in the intensive-treatment group than in the control-treatment group (absolute difference, 1.4%; 95% confidence interval [CI], 0.5 to 2.3; P=0.002), and levels of C-reactive protein, interleukin-6, and the endothelial-activation markers soluble E-selectin and von Willebrand factor were significantly higher (P<0.05 for all comparisons). However, flow-mediated dilatation was greater and the plasma levels of soluble E-selectin were lower in the intensive-treatment group than in the control- treatment group 60 days after therapy (absolute difference in flow- mediated dilatation, 0.9%; 95% CI, 0.1 to 1.7; P=0.02) and 180 days after therapy (difference, 2.0%; 95% CI, 1.2 to 2.8; P<0.001). The degree of improvement was associated with improvement in measures of periodontal disease (r=0.29 by Spearman rank correlation, P=0.003). There were no serious adverse effects in either of the two groups, and no cardiovascular events occurred. Conclusions Intensive periodontal treatment resulted in acute, short- term systemic inflammation and endothelial dysfunction. However, 6 months after therapy, the benefits in oral health were associated with improvement in endothelial function | |||||
