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