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Skateboard accident:Pulpal digestion:MTA condensation - Courtesy ROOTS

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From: Mark Dreyer
Sent: Thursday, August 14, 2008 3:30 AM
Subject: [roots] Skateboard accident

10 yr old kid had a skateboard accident. Pedo doc referred him to me.  Exposure of pulp was evident.
I prepped a bit into the chamber, placed white MTA and then bonded the tooth back together.
Dad and son were ecstatic with the result - Mark

the result is very good,congratulation - Ricardo Pina Hi Mark, thanks for sharing. How long was the interval between the accident and their visit to you? Do you anticipate the possibility of pulpal necrosis within the next year or so? This is interesting... I would have thought the SOP would be to do an endo! Talk about paradigm shift... :) - Debbie Occeņa-Sablada Debbie, There was a couple hours between trauma and seeing me. I don't anticipate pulpal necrosis, but of course that's possible. Young pulps commonly do quite well with this approach - Mark Mark: Nice job. Would love to see 6 month followup - gary Gary, I'd love to see it also. I hope we can get the kid back. If we do, I'll share it on Roots - Mark Please tell us how you did it we all get cases like this - Sanjay Jamdade Sanjay, I prep away the exposed pulp deep enough to controll any bleeding plus allow a smal reservoir for the MTA. I then pack the white MTA into the reservoir over the pulp stump then etch and bond both the exposed fx'd portion of the tooth plus the separate piece which the Dad brought. Then I used a dual cure resin cement injected over the MTA, and the remaining surface of the fx'd tooth. I then carefully placed the fx'd portion back on the tooth, aligned it as carefully as possible then hit it with the light curing unit. The hardest part was getting the fx'd piece aligned as perfectly as possible before curing it - Mark Mark, congratulations on a nice case.Please can I ask what you used to control the bleeding? - Stephen Day Stephen, there wasn't much bleeding, probably because there was no underlying inflammation. What little bleeding there was I controlled with a sponge soaked in sterilox water (anolyte) - Mark Hi Mark, Didnīt you have any problem to control bleeding? No inflammation, but during reservoir prep I guess with a little round bur or a manual spoon, you might break blood vessels. Has anolyte antiaggregant capability? and what about during the condensation of MTA, didnīt you provoke new bleeding? Did you use shelf-etch? and if not is not difficult to mantain MTA at place during the etch rinse step? - Nuria Nuria, You'd be surprised how little bleeding there is when dealing with a non-inflamed pulp. It really wasn't any challenge at all to control the little bleeding that occurred. The anolyte doesn't have any antiaggregant properties to my knowledge. I chose it rather than bleach since I didn't want any pulpal digestion while disinfecting the site. The MTA condensation didn't provoke bleeding either. I used self etch, but have also used non-self etch in the past and if your MTA is compacted well it won't rinse out - Mark Thanks for the interesting informations - Nuria
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