From: Terry Pannkuk
To: ROOTS
Sent: Tuesday, January 26, 2010 6:21 AM
Subject: [roots] Pulp Chamber Floor Split

This was a wild one.  The patient really wanted to save the tooth 5 years ago and agreed to be a science experiment.
I left her in calcium hydroxide for a year before feeling confident enough to finish the endo.  The crack extended
through the pulpal floor. The initial plan was to keep CH indefinitely and eventually extract the tooth, but there
was no perio defect and no discomfort/clinical signs so I decided to finish the tooth.  4 canals with 4 separate
POE's and a midroot anastamosis between the MB1-MB2 which is visible on the CT.  She reported some awareness of
the tooth today, but I couldn't probe any defect and palpate any area of swelling.  She noticed at a very low level
on biting pressure.  The tooth has been adjusted to very light occlusion.   The CT was interesting and really didn't
show any osseous breakdown - Terry



I think this is a sort of a miracle:) - Sergiu

Terry, please excuse my semi-ignorant question...

Why did you leave the tooth with calcium hydroxide for a year?  Was it simply that you didn't think the tooth would
make it so why bother finishing, or did you expect the calcium hydroxide left that long would aid in some healing?
Thanks for the post  - Craig Harder

Good question.  I probably wasn't clear.  I expected to eventually extract the tooth and since there were no clinical
signs of perio bone loss, we decided to just place a dry mix of CH, place a simple core and watch it indefinitely.
I had actually recommended extraction but she wouldn't do it and wanted me to keep trying.

I've had a few cases like this.  I can't remember off the top of my head any case that has survived over 10 years,
so I'm not that optimistic about this case.

I have no problem placing CH indefinitely, placing a permanent occlusal filling and riding these as long as the
patient wants.  The patient gets charged 1/2 an endo fee and it seems like a very decent service even though we are
delaying the inevitable.  On the other hand it's a rare patient that is willing to finish the treatment for full fee
knowing the long term prognosis is poor, but it seemed to be of value to this patient.  Not every patient is willing
to be a science experiment, but if I'm not harming them and they want to have their tooth as long as they can, why not?
With the advent of implantology these types of experiments are becoming rarer and less appropriate - Terry

Thanks Terry.  Makes more sense to me now. I'm with you... if the patient is fully informed, then its their choice
to a point.  I'm willing to take those chances if we can get them a few more years with the tooth - Craig Harder

Terry could you please tell me what kind/brand of Ca(OH)2 are you using in your cases? What is exactly dry mix of Ca(OH)2
and how do you place it in the canal? Thank you very much -  Javier.