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From: Phillip Tomson
Sent: Wednesday, January 18, 2006 12:49 AM
Subject: [roots] First Case on ROOTS - retreat lower incisors
This is the first case i have posted. 36 year old lady, complained of persistent discomfort and occasional abscess's
associated with her lower incisors. Primary treatment as a child following trauma, surg aged 21, surg again aged
25! As you can see the root ends have not been completely resected.
Conventional orthograde re-treat. Prepared with Profile 06 and obturated with Sys B and Obtura. Found untreated
lingual canal in all teeth. Symptoms resolved. Conventional non-vital bleaching with carbamide peroxide (Endoperox).
Pt happy. Any comments /criticisms welcome. - Phil Tomson, Birmingham UK
Phillip........now this is like it. WONDERFUL STUFF>
This is what Roots is all about , showing cases for discussion and being bold enough to put out your stuff.
Could you tell me a little bit aobut you bleaching technique. People here are using sodium perborate for walking
bleaches because of fear of internal resorption.
I really like the result though and your endos are wonderful stuff. Could you tell me a little bit about yourself as
Thank you for your kind comments. The bleaching technique used here was a conventional non vital bleaching. The GP
obturation was finished 2mm subgingival, followed by 2mm flowable composite. The bleaching product that was used was
endoperox http://www.septodontinc.com/Endodontics/endoperox.html . It is carbamide peroxide which is presented in
granules. It is mixed with glycerin, approx 50:50 by volume. This was placed in the access cavity followed by a thin
layer of Kalzinol. It was replaced on two further occasions with a week interval. The shade was off the Vita guide
pre bleaching and it is now an A3.5.
We used to use sodium perborate but can no longer get a supply for dental use and this was the alternative we
sourced. I have done another case with a similar technique producing a good result. I have not tried the inside out
technique with the customised home bleaching trays but wish to give it a try on my next suitable case. Any experience
Just to let you know, I am a Clinical Lecturer at Birmingham School of Dentistry (UK), mentored by Phil Lumley, who
you may know. I am doing my specialist training in Restorative Dentistry and majoring in endo. I am also doing a PhD
in pulp biology. Have looked at roots for about 18 months now and it is an inspiration!!!! - Phil
Dear Phil: your information is awesome to read about on the case. Thanks and again great result. I came onto roots
and showes a case many years ago with heating hydrogen peroxide.........YIKES did Peter Cancelier give me heck!!
Your result is wonderful. Kudos to you and continued success in the lecturing, and specialist training while taking
the PhD in pulp biology, hopefully your plate wont be too full to post the odd case or two. These are the kinds of
cases we all learn from. Glenn
I have attached a review covering most of the research on this topic. Basically the theory is that high [ ] of H2O2
and heat cause increased dentin permeability in the cervical area leading to an inflammatory reaction which results
in external cervical resorption. There are different theories out there. Some suggest that the material directly
causes inflammation in the periodontal tissue; others suggest a foreign body reaction in the area occurs because of
denatured dentin; it is also suggested that bacterial colonization of open tubules leads to inflammatory resorption..
A mixture of sodium perborate with water has not been associated with such resorptions. It is also suggested that it
happens in teeth with previous trauma and damage to the cementum in the cervical region. Sodium perborate requires
probably around 3-4 sessions to achieve good results with minimal risk of future resorption. Ash
Dr Phillip, excellent documentation and procedure , please tell some thing about the bleaching part , how did u
manage to correct the greyish blue in the cevical of the 42 , thanks keep sharing - Gurpreet
Dear Gurpreet, The bleaching technique used here was a conventional non vital bleaching. The GP obturation was
finished 2mm subgingival, followed by 2mm flowable composite. The bleaching product that was used was endoperox
It is carbamide peroxide which is presented in granules. It is mixed with glycerin, approx 50:50 by volume. This was
placed in the access cavity followed by a thin layer of Kalzinol. It was replaced on two further occasions with a
week interval. The shade was off the Vita guide pre bleaching and it is now an A3.5.
You are right, the area of greying has reponded very well.- Phil
Excellent case selection, diagnosis and treatment outcome.
Can you talk a bit about you, your tec, microscope, documentation etc.- Carlos
Dear Carlos, I am a Clinical Lecturer at Birmingham School of Dentistry (UK), mentored by Phil Lumley, who you may
know. I am doing my specialist training in Restorative Dentistry and majoring in endo. I am also doing a PhD in pulp
biology. I am very lucky to be mentored by Prof Philip Lumley who has developed an excellent surgery set up. We use a
Global scope with a 950 Nikon coolpix. Most cases i will use a hybrid technique of hand, protaper (coronal) and
profile 06 (apical). Obturation is done with System B and Obtura and Pulp canal sealer. I document all my cases with
photo's for my log books and lectures, i have nothing fancy like TDO, just good old Bill Gates Microsoft folders to
file everything. I very much enjoy doing surg, however i was pleased with this case not to have to do it and achieve
a good orthograde result, fingers crossed it will stay that way and i won't have to get the scalpel out! - Phil