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Root tip extraction : Rubber dam - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are - www.rxroots.com
From: Terry Pannkuk
To: ROOTS
Sent: Thursday, April 13, 2006 11:24 AM
Subject: [roots] Another 98 Percenter Retreat

This one is from yesterday.  Two posts, nonexistent obturation, large lateral lesion,
retained root tips thought possibly to be contributory since a fistula traced to the tips.
Another complete screw up by a 98 percenter.  Attached are some pics of the root tip
extraction with a flap aided with a rubber dam.

Probably another graduate from ROOT CAMP, and maybe he took some extra training at
ROOT TIP CAMP.

Maybe some one can tell me if this case represented a lack of commitment or a lack of skill.
I couldn’t really tell which predominated. - Terry

Dear Dr. Pankuk, Please enlighten me on how to sterilize the rubberdam for such surgical procedure. I could see salive seepin in through the area. In such cases what is the big role of rubber dam and clamps. I think it will just add to the discomfort during the operation IMHHO - vipin Vipin, I soak the tooth and dam periphery with Peridex after placing it. On a case like this where I place caries indicator dye and remove a wall of caries, I don't worry about ripping the dam and replace it after I'm done with the post removal and caries control. It's futile to attempt pristine isolation during the initial phase of access and clean up of a severely compromised case that is already contaminated, requires post and extensive caries removal. Afterward when the dam is ripped I remove it and replace it with a new one. If a gap is seeping saliva and leaking I inject Dycal to affect a seal. During the root tip removal I punched two holes and cut a slit in a new (third) dam. It's extremely handy to use a dam for extraction when you can. If you don't have a distal tooth to clamp it's not practical unless you can manage to clamp the ridge (which I've actually done on some cases). The benefits of a dam extraction: 1. Retraction of the cheek and tongue 2. Helps retract a flap (as in this case) 3. Prevents aspiration of a root tip or small instrument 4. Improves visibility and access. Terry Prognosis of perf repair? - Vincent No perf evident on this case . - Terry Very close then, it seem. What build-up material would you choose when the furcation area is so close from the pulp chamber, as in this case? - Vincent I have to go on record as agreeing with terry on this one. (as long as no one says anything, could affect my reputation :)) he told me about this at amed, I cam back and tried it, and have also used it for isolated (1,2, or 3) implant fixture placement. Not universal in application, but the primary benefit during surgery is retraction without a set of hands involved. And it does help keep saliva out of the hole, so hopefully initial clot formation provides less contamination of the socket when you pull it off. - gary
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