From: Terry Pannkuk
To: ROOTS
Sent: Wednesday, June 17, 2009 8:15 AM
Subject: [roots] 9 year surgical recall

I was referred this case from an oral surgeon in 2000.  He had been decompressing a large lesion with no resolution
for about 6 months and the patient had lost confidence with him and wanted a second opinion. Frankly, I feel that
decompression is rarely necessary especially not for pure lesions of endodontic origin. I simply flapped the two
involved teeth (#'s 11 and 12), resected the roots and reverse-filled them with MTA.  There is still residual
(but shrinking) through and through defect).  Many times these eventually fill in but it takes years. It's basically
a race between the osteoblasts and the epithelial cells.  The greater the thickness and distance between the labial
and palatal plates of bone the better the chance the osteoblasts will win the race.

Interestingly, I dont' mind leaving teeth open for drainage for a couple of days,  but dont' like leaving a drain
that creates a communication between the PA tissues and the oral flora.  It's equally interesting that those people
who fear leaving teeth open for drainage tend to have no fear decompressing sites like this for months.

I don't get it. This case was open for months before I got my hands on it - Terry



Dear Terry, Very interesting analysis and well done as always.
Do you feel that decompression is ever necessary for a lesion of endodontic origin? -  Patrick Wahl

Imho, there is no big "danger" of leaving a tooth open for couple of days when one needs "things to calm down" in
complicated cases. Risk of flairing compared to tooth filled straight with CaOH is reduced significantly. After
acute phase is gone and tooth is calmed you can fill it with CaOH or directly with iRootSP :-).

Based on my surgical experience I am also a believer in decompression of large cystic bone deffects  of endo origin.
- Valeri

I haven’t left a tooth open in fifteen years. - Guy