Maxillary second molar: Thermafilth - 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
Sent: Monday, November 30, 2009 10:13 PM
Subject: [roots] More Thermafilth
Here's a maxillary second molar that wasn't treated well, but the symptoms were vague,
no perio defects, no percussion, palpation nor clinical signs of pathosis.
The CBCT was interesting. Thermafilth can also be marketed under the label of
"Hide-A-Perf". More carrier obfuscatioin shenanigans.
Guns don't kill people, Thermafilth does and it's easier to hide the weapon
after the crime. :):):) - Terry
All retx cases should have a CBCT don't you think? - Fred
Fred, I'm used to Forrest Gump boxes of chocolates so this is a bit of an epiphany. We can eliminate
many surprises by routinely using the CBCT for retreatments. I"m interested in running statistics
on how many retreatment consults give me new information that changes the prognosis assessment and
"starting treatment plan".
Ironically, this doesn't help the patient out as much as it helps me. :):):) Look at it from the
patient's perspective: If I go into a case not knowing this is Thermafilth and perfed, I assume
it is a simpler case and present the patient with a routine retreatment fee. Now that I have a CBCT,
I'm going to charge the patient an additional fee for the scan, then present a higher fee knowing
this case is more complicated, requires more time. Before I had a CBCT I would just eat the
additional fee because I didn't like surprising patients with add on expenses during treatment
knowing it created bad will and a potential loss of trust. The patient is now going to get this
information up front with increased fees, 1. The additional CBCT fee and 2. The additional fees
for a complicated case upfront now knowing that we aren't dealing with a Forrest Gump Box of
In the whole philosophical scheme of things, more information should be better; which it clearly is,
BUT looking at it from the patients perspective, they are now being charged more to avoid my having
a surprise complication that I would have historically comped them on later. Aside from the negative
economics from their perspective, it is clearly better for me, more fair, and allows me to discuss
with greater precision the anticipated dental status and give them a chance to decide on complicated
treatment or extract.
This may actually lead to more teeth being extracted due to more complications being seen upfront
then discussed with the patient, then having them decline. It avoids the patient benefiting from
my going to the 1/2 way decision point with a set fee, then being out on a limb to finish.
I've successfully treated many of these types of complicated teeth but may not in the future if the
patient perceives the effort as being too complicated and expensive.
From my perspective, it is what it is. If you are an objective scientist and a fair health
professional, the CBCT information is of clear value. Objective information should be available to all.
If that information makes things more complicated and expensive, someone would have had to discover
and expend the energy to deal with it. The CBCT technology is allowing that burden to be shared more
fairly and not weighted entirely on me.
This seems to be the most profound change it will create for clinical practice. Like Thermafilth it
can now be abused by snake oil salesmen over utilizing it, distorting the information, and pretending
it benefits patients in a different way by changing the "potential" to better treat patients.
Like a microscope, like a handpiece, like every other piece of equipment and instrument we decide
to use; our judgment, knowledge, skill sets, are the determinants of quality and success, not the gadgetry.
I'm just happy, this gizmo will allow me to reveal the slick misdeeds before I have to spend my time
and materials being blindsided, then paying for it.
The CBCT is a great new way to obtain case data; it's not necessary on most routine cases, I might start
using it on most retreatments which might end up being all retreatments. One thing is certain:
my conversation with the patient will change. If the patient presents as a referred case for retreatment,
I will suggest a CBCT and if they elect not to have it, I am going to amp up my retreatment fee to cover
the Forrest Gump Box of Chocolates that always seem to leave a bad taste in my mouth. :):):) - Terry
Terry are you using a Morita machine?
Are you enjoying the CBTC usage on such cases that you have posted? - Carlos Murgel CD, Dr.
Kodak - Terry
Question, poser, interrogative: ALL cases should have a cbct, don't you think?
many of these retreats become treated right the first time. :) - gary
I personally think so!! - Fred