Tooth # 20 :Tooth # 30
The opinions within this web page are not ours.Authors have been credited for the individual posts where they are. - www.rxroots.com From: Fred Barnett To: ROOTS Sent: Tuesday, March 01, 2005 2:44 AM Subject: [roots] cases Nothing special...but I am happy to post some cases to show that I am still alive ;-)) The radiographs are photographed off of a view box with my CoolPix 950. Rotary debridement was with K3 VTVT sequence. Irrigants: 2.5% NaOCl alternated with SmearClear; CHX final rinse. Tooth #20; Dx: irrev. pulpitis; MAF: #50; Resilon and PacMac obturation w/post space ;-(( Tooth #30; Dx: irrev. pulpitis w/deep distal caries. The patient was going straight to the referring doc for a build-up, which he would NOT let me do. 4 canals; the distals joined in the apical 1/3. I could get to patency with a #8, 10 and 15 handfiles, not any of the rotaries. I took the K3's to where the crazy curve was and finished by hand. I bent lots of files to follow that curve, but was not very pleased witht he degree of enlargement. Oh well...take what the canal will give you - FredVery nice cases, Fred. Unfortunally, I am not confortable to use Resilon. Maybe I should have try. I am afraid to not have the same results. Is it make sense? I belive there are a lot of people like me - Henrique Bassi Sort of typically great. I think the referring dentist should have removed that decay. Guy who is he, Fred? the patient or the referring doc? just curious - Marcos Arenal The referring doc. I am trying to break in a new referral base to allow me to seal the chamber - Fred Hi Fred, I see the emoticons after the comments re the post, and I assume you feel like me, I just can't see any reason to place a post here. I would have built up the core and made the referring doc cut straight onto that. Heck I might even have cut a rough crown prep for them. I realise there are diplomacy issues, and you don't want an iatrogenic incident in a post prep, but what value is a post going to have here??? Over here people love it when I provide them with something caries free that they can prep straight away. I guess we have less concerns than you with specific codes from insurance companies for particular items. Other than the NHS, where all fees are very low, I guess around $40 for a cast post, we can decide our own fees. All the dentists I work with understand that quality costs, and are very good at explaining that to the patient. So if a dentist wants to charge more for the crown, feeling they've missed out out on a build up fee, they simply tell the patient the crown fee and do so. I have never been asked not to provide a core, my job I figure is to do the endo, apical, and coronal, and prepare that patient as much as possible for the final restoration. I guess the other doc will do the build up under dam and with a scope? Did you seal the canals? See you next week. - Bill Bill, I agree 100% that I should have done the build-up here after total caries removal. I think it is an economic issue for the referring doc; more to charge and bill. Little by little I will be placing build-ups, but in this geographic area, it has never been done by the local endodontists from what I can gather. Keep the beer cold!! - Fred If you need someone to advise them to let you place build ups refer them to this old doc. That is one of the most valuable services an endodontist can offer after the endo. Guy I have found lower bicuspids to be the most susceptible teeth to fracture when crowned. For a period of my long and arduous career, I thought putting a post in the damn things would prevent fracture. All it did was weaken them even more at the neck and they fractured easier. Now I only use cusp cap onlays or nothing on lower bicuspids. Someone may be living under the misguided impression that they are strengthening these obnoxious little teeth by putting in a post. They are sadly mistaken. They are weakening the tooth and that includes bonded fiber posts - Guy
