From: Daniel Shalkey
To: ROOTS
Cc: Fred Barnett
Sent: Friday, April 25, 2008 1:53 AM
Subject: [roots] Attempted pulpal regeneration

I cleaned this out and placed a triple paste of Clindamycin, Augmentin, and Doxycycline on 3/28/06.
I realize this is not what the literature advises but I used what I had in the office.  I recleaned
it and stimulated bleeding at the apex and filled the root with a blood clot on 4/11/06.
I restored it with a Cavit plug and flowable resin.

Two years later the lesion has healed and the tooth is assymptomatic.  It does not respond to cold.
It does not appear to me that there has been any signifigant maturation of the root.
Time to give up and fill this case?  - Dan Shalkey



Time to give up and fill this case?
I would think the time is now to give that root some rubber Dan.  :-)) - Mark

For some reason I just broke out into song that ant can, move that rubber tree plant cause he’s got
high hopes,  I don’t have much of a life - Gary



Wow!  Not only has the lesion disappeared but a normal apical
morphology with constriction appears to have formed.  It also appears
that the dentin width in the apical 1/3 has increased.  Lastly, I
wonder if you would be so kind as to post an immediate post-op of the
treatment.  If the area of increased radiopacity I've indicated is
what it appears to be, (a dentin bridge), then there is, as you know,
only one way it could have formed; a successful pulpal regeneration,
with odontoblast-like cells producing reactionary dentin. If this is
true, I think you have filled the tooth with the best of all possible
materials; a living pulp substitute.  With that much reactionary
dentin formation it would be doubtful that you would ever get a
positive cold response.  Have you tried electric?

Eager to hear more about this fabulous service you have provided - Grant

Grant, Actually, I thought I saw a dentin bridge as well.  I will try an electric test.
Are you saying it may be possible for me to leave this alone? - Dan Shalkey

Dan, What do you have to gain by doing anything other than close followup?  I'm not among those who think the
only good pulp is on the end of a barbed broach and I certainly have not yet seen a root filling material that
has the benefits of a vital tissue.  I'm suggesting electric because there may be enough hydration in the dentinal
tubules and reactionary dentin to carry the current to the pulp-like tissue. I would test as close to the
gingival line as possible.  Regardless of nerve response however, if a dentin bridge and circumpulpal dentin
has formed, you need look no further for pulpal vitality in the truest sense; vascularity.  Yes, I'm saying
that it is not only possible but probable that you only need to make sure the coronal seal remains intact
for this tooth to survive as well as its neighboring teeth.  Of course, that is just the opinion of an
interested party on the basis of a couple of xrays - Grant

Dan,  If I were you I won't do anything, I will just follow it up... that's it ..
you did an amazing job in getting rid of the lesion and gaining some dentin deposition - Emad

Grant, what is Triple Paste? - Guy W. Moorman

Guy, Triple Paste?  If you're asking Grandpa Merritt, having 11
grandchildren, I have a little experience with this: - Grant