From: Terry Pannkuk
To: ROOTS
Sent: Thursday, September 17, 2009 1:16 AM
Subject: [roots] Nuclear Testing

This mushroom cloud of CH represents the condensation that occurred after 4 years.  It is suspected to be healing,
no symptoms or clinical signs related to this tooth, although #9 recently flared up. My partner just finished #9.
The patient is a local heart surgeon.  He got sick of my bugging him to come back for recalls (which he didn't
until my partner got him in for needed treatment on the adjacent tooth).

I spent 4 months treating the tooth, changing the CH several times.  The lesion never would dry so when I got it
relatively dry to pack with MTA in October of 2005, I just did it. I don't really do pack n whacks, maybe one in
the last 10 years. I've never done a decompression or found a reason to. If a lesion is suspected to be of
nonendodontic origin I refer the patient to the oral surgeon and they may have to do decompressions for certain
exotic nondental lesion presentations.  When I treated this tooth in 2005 I was having a debate with Gary Carr
who said you should never pack a symptomatic tooth.  I completely disagree; it depends entirely on the particular
case and I never say never.  Since Carr booted me off of TDO I won't have the opportunity to show him he's wrong
(again).  :):):)

Maybe I was a bit fortunate on this particular case.  It's agreed that no one cleans/seals these types of cases
perfectly, but we usually accomplish excellent clinical efficacy if we are meticulous and work at it with the
necessary effort and skill.  My suspicion is that the multiple appointments irrigating, flushing, and churning
irrigant then changing the CH resulted in bringing the microbial titer down to a level conducive to clinical
success without the need for decompression or apical surgery.  I nuked the periapex with CH ! - Terry



Geez, it actually looks like upside down heart on the last pic :-)) So good for the Ivy King ... ;-) - Dmitri