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The opinions within this web page are not ours. Authors have been credited for the individual posts and photographs where they are. - www.rxroots.com

Today's long term recall cluster

From: Terry Pannkuk To: roots Sent: Saturday, March 03, 2012 1:59 AM Subject: [roots] today's long term recall cluster I treated 4 teeth for this woman starting in 2003: Thereís obviously a lot of discussion points possible here which may be very interesting. My observations The endo that looks good on PA radiographs wasnít necessarily good when looked at on CBCT. I have CBCT views of all the mandibular anterior endos. Accepting a chronic lesion which isnít visible on the 2-D PA is still accepting recurrent disease. Would you want a mouth full of endo treatments performed on yourself or a family member where at least a diligent attempt at cleaning out the entire root canal system was not performed? Look at the #27 PA below and if you want more CBCT views of that periapex or any of the other teeth in the area, Iíll provide them. This is just one collection of anecdotes that Iíve seen in mounds over the years. My general opinion: Adhering to Schilderian principles of clinical endodontic treatment leads to more predictable success and less recurrent endodontic disease than not adhering to them. Thermafilth is one of the worst products ever introduced to the specialty of endodontics because it is one of the most abused and poorly perfomed techniques with terrible retreatability in the most common instances it is used (narrow, inadequately prepared, curved roots). She had endoís previously done (#ís2, 3, ( 4 failed and replaced with implant), 21, 22, 25, 26, 28, 29, 30, 31, and maybe one or two other sextants that were not the focus of examination/concern. Preop radiographs: long term recall cluster

long term recall cluster I retreated- 1. #25, 26: 3/6/2003 (one shotís which I wouldnít do these days even though it worked out well for these teeth) 2. #3: 6/18/2003 (one shot also, metal Thermafilth retreatment) 3. #30: 3/16/2005 (My Hail Mary Thermafilth retreatment escapade; tooth presenting with a mesial root fracture, near pulpal floor perf, and a near lateral strip perf which I finished off as a direct perf, never getting the apical Thermafilth segment of the ML out; patient thought I was a miracle worker and wanted me to try; couldnít pull it off; we observed for a year after backfilling the ML with MTA, she was still having symptoms and the tooth was extracted and replaced with an implant, no regrets by anyone; nothing ventured nothing gained mentality by all including the gp who went along with this) #25/26 (not the small chronic lesion on #27 (Yep, itís not just a radiolucency and represents a lesion as far as Iím concerned): long term recall cluster #3 pics: long term recall cluster

long term recall cluster #30 (which was extracted): long term recall cluster Well, Here is what I see. The three ways violated upper second is gone. The three ways violated lower first is gone. Pannkuk's retreatment of the upper first has condemned it to the same fate. The lower second will probably be fine unless Pannkuk retreats that. Calling a finding on a CBCT a "lesion" and saying "recurrent disease" speaks to an exceptionally poor understanding. Actually...no understanding. The only thing I see here is adhering to these principles is great for an implant practice - John A Khademi So 6 out of 8 teeth showing path by nonSchilderian, or an unknown philosophy of treatment versus 3 out of 4 showing no path on CBCT with the one failure being a heroic attempt at treatment, not good enough for you? The radiolucencies on the CBCTís of #27 and 28 do represent a virtual certainty of recurrent pathosis. So letís add up the observations on this case: 1. I retreated #ís 25, 26, 3, and 30, all had been treated with Thermafilth and were failing. (#30 I could save due to a fracture, perf, furcation defect, etc.) 2. Tooth #2 is an unknown previously treated with Thermafilth by previous guy (good bet there are lesion/lesions at the periapical areas indicated by periapical radiolucencies on a CBCT but I didnít take one so canít state that as fact, only a good guess based upon the fact that 6 of 8 Thermafilth treated teeth on this patient clearly show a history or current evidence of path. 3. The teeth I treated that were treatable show no path on the CBCTís and have no clinical symtpoms/signs of disease since 2003-2005. Just for your edification hereís the CBCTís of the teeth I didnítí treat that I happen to have CBCT imaging of: #21: long term recall cluster #22: long term recall cluster #27: long term recall cluster #28: long term recall cluster

Occlusal trauma
Premolar and RCT
Resistant lesion
Screw job
Geristore resorption
Curved MB canal
Tectraciclin in surgery
Root resorption
Endo perio lesion
Crack resorption
Mandibular molar
External resorption
Rubber dam limits
Middle mesial
3D obturation
Inflammatory resorption
Hess anatomy 3
Wierd upper 2nd molar
Implants and/or teeth
Cracked tooth syndrom
Crown root fracture
Open Sinus lift
Mandibular nerve
Missed DL canal
Apical Periodontitis
Endodontic autopsy
MM Canal
3 visit retreatment
Deep bifurcation
Dangerous curve
Lower wisdom
Coronal lateral
Hess anatomy
VC Obturation
Diagnostic trivia
Sinus tract
Extraction & Clearing
Tooth #2
Implant placement
tooth clearing "technology"