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Upper second molar: pulpitis
From: DKGarretson
To: ROOTS
Sent: Wednesday, May 13, 2009 3:57 AM
Subject: [roots] in progress
One week ago: This patient presented for treatment of
the upper second molar. That tooth developed a pulpitis
subsequent to the crown prep.
We treated this second molar in a single visit, and
diagnosed recurrence of periradicular disease on the
first molar (visible buccal swelling over mesial root,
some tenderness to palpation and percussion)
Today: We removed silver points in the first molar,
found missed MB2, got past blockages in P and DB---
(likely dentin mud type blockage with some ledging
in the P), and placed CaOH.
In two weeks we will obturate the first molar - KendelG
Hi Kendel, How did you get them out? H-files?
Was there something left to grasp? - Siju
Nothing to grasp.
I expose them first and make sure they have a path of
draw coronally. Under the scope you can usually see an
area alongside the point that will allow placement of
a small file, or small u.s. tip.
I first use an u.s. tip on the lowest power just to
gently break adhesion. While watching under the scope,
you may see movement coronally and they "jump" out---
-easy, and lucky. If that was unsuccessful, I next will
try to thread a hedstrom alongside, and use a solid
coronal pull (fulcrum if necessary). This method is
usually quite effective. The key is to have the hedstrom
deep enough alongside, and to make the motion directly
coronal, and have that clear path of draw for the point
to exit.
In this case, the MB did not allow for placement of the
hedstrom to any significant depth, so I used a 10k file
to bypass and enlarge the space, then I was able to get
a 25 hedstom deep enough to dislodge the point.
If this is not working, return to the u.s., back and
forth. In this case, I checked my time, and the points
were out 20 minutes after administering anesthesia.
The good thing about this technique is that it does not
require anything to grasp, so you don't have to hog out
the canal, or worry if the u.s. should knick the point,
or even break a bit off, or try to fit any kind of
grasping device.
I much prefer taking the build-up and remnant of the
silver point down to floor level, so I can visualize
the postion of the point in the canal, and plan my
"attack". I'm rambling--hope that made sense - Kendel
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