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  Necrotic pulp and extreme percussion sensitivity

The opinions within this web page are not ours. Authors have been credited for the individual posts where they are. - www.rxroots.com photographs courtesy: Mark Dreyer
From: Mark Dreyer
Sent: Tuesday, October 11, 2005 3:48 AM
Subject: [roots] (no subject)

This is a case I started today and decided to document a bit more thoroughly than usual.  If any of you find this
series of photos helpful for teaching purposes (as out of focus as they are),  I thought it was a nice
illustration of how looking at symmetry (or lack thereof) can help you avoid missing a second distal canal.

Necrotic pulp and extreme percussion sensitivity....did emergency start, but I didn't want to push debris out the apex
today while he is in the extreme pain phase, so will see him in 2-3 days to more fully instrument then pack caoh...that
is if we decide to keep the tooth....bad crack, but he's VERY medically compromised (I was actually going through
emergency contingencies in my head while working on him) and the referring dentist (my wife) wants to try to avoid ext
of this tooth if at all possible since she's concerned about the possible involvement of the wisdom tooth, during
surgery to remove this 2nd molar...so we're going to try to save it - Mark Dreyer DMD

Thanks Mark - instructive pix and I will use them, with attribution of course - Simon You donít have to put all the teaching aids on one tooth. Spread them out a little more. Fabulous work and points well taken. Ruddle and another fellow whose name escapes me at the ada this weekend both placed heavy emphasis on proper access design and exposure, both independently calling it the most difficult thing they do. Get the roof off and you can find. If not, no chance. Let us know how the search for the 6th and 7th goes. - Gary Nice documentation........any probings. I dont think the tooth should be a goner if there isnt any probings , and what does the PA look like - Glenn Hi Glenn, There is a 5mm probing on the lingual near that crack. I don't have the PA readily available here on my home machine, but it looks unremarkable - Mark 2 step necrotic case which had some interesting aspects to it. Pretty unusual sinus tract in that it had an appendage like extension at least 10mmís long. I thought about cutting it off, but I didnít, and interestingly enough at visit 2 it was totally gone. I guess that white stuff really does have magical powers. Neat photo of the pulp stone, and also a nice palatal canal branch which I was aware of instrumenting with pre-curved k files.- Mark Dreyer DMD