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Upper second molar: pulpitis

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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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