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From: Roberto Cristescu Sent: Tue 3/29/2005 15:54 To: ROOTS Subject: [roots] PERIAPICAL PATHOLOGY + VITAL PULP Thought this might be interesting...I know it may happend from time to time, that's why it is so important to accurately make all the investigations. This 33 y.old male was reffered to me for chronic apical periodontitis because the other doc saw a big decay, the radiotransparency on the X-ray and the pt told him that it hurts when he eats on this tooth (47 international, 31 USA). The vitality test with pulp tester showed me a value of 48 and the tooth 37 (18 USA) was 45 on electric pulp tester. I saw on the X-ray that on the mesial the pulp might pe open.... Made him one articaine and one mepivacaine and started to remove all the decay, and yes, the pulp was discovered :-))) was vital and not bleeding but..unfortunately still hurting when I gently tocuhed it with the explorer....I had to temporise, which I really hate MOST ! I rescheduled the pt, and I'll go with ibuprofen premedication and who knows what kind of anesthsia so that I'll be able to make the pulpectomy safe and without pain ! The patient have had in 2002 hepatitis B :-))) It's so sad to see on myself that the authors that are writing about the high failure rates of SPix anesthesia for endo on lower molars are damn right :-((((( All the best regards, - ROBERTO

Ledermix paste is great in cases such as this. Settles things down so that the LA works ok for pulp extirpation at the next visit. - Stephen Day. Dear friends: This is a similar case.MY left cetral and lateral incisal. apical lesion was noted over 6 years, no color change almost no symptom , sometimes feel a little sensitive I ask my friend to do the endo ,but when he use the high speed I feel very very sensitive. So I think it is vital. And decide to follow up. What should I do ,keep follow up or endo? please give me some suggestion, thinks. - Shih wu hsien Take more x-rays form different angles. Do thermal and electric pulp testing. - DanS

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