Endo Perio- Courtesy ROOTS
Here's one of the cases which came as a referral from a Periodontist. He wanted me to do a wire splinting and endo on tooth #23, 24 and 25. I wonder why his dentist couldn't (wouldn't)do it. May be it was grade 3 Mobile and as Marc said he did know when to fold it..:) well I heard that phrase liitle bit later :)
Lesion was purely perio in origin. trauma from occlusion was apparent.
Relieved the traumatic occlusoin. Splinted the teeth with heavy orthdontic wire with grooves for retention and flowable composite. #23 was non vital and 24 was partially vital and the 25 vital.
hand instrumentation initially and then Profile. didn't want to enlarge the canal as the tooth in question was splinted.
Ah Plus and 2% GP with warm vertical condesation. Tooth # 23 seemed to have multiple lateral canals and 25 didn't have any. may be I was soft with the 25?? :)
Patient is scheduled for a flap and Bone graft this week. I am sceptical about the prognosis . But let's see.. He who heels....
You mention that 23 was necrotic. What makes you think this lesion is perio and not from 23? IMO, don't give up on this yet. It could be an endo etiology after all. I don't understand why you did endo strictly as directed by a periodontist and not as directed by your own vitality testing - Mark
Glad someone noted that………the lesion Vipin is primarily endo given the history of trauma, absence of restorations et al………..look at the myriad of portals of exit on the lateral…….follow the outline of the lesion………there is no generalized appearance of periodontitis
This will heal in its entirety, should be bathed in Hibitane daily and ensure that whatever plaque or calculus has formed is debrided and my bet would be that in time……..osseous regeneration………..as to reducing the shaping ………..hmmmmmmm…………..why, you might have missed the isthmus section, second canals et al……….a tooth is a tooth, god make the canal, man made the crowns……….you can remove crowns, futz with restorations, but a canal is religious, biblical, you treat it as a child of god………..you don’t preplan it’s shape based on your tools, or your concept, you return it to its original spatial state, sterilize and seal it and nature looks after its own.- Kendo
Thanx for seeing the case. The periodontist who referred the case told me that those 3 teeth might be going in for a complete root planing and he meant it through and through and packing of bone graft. The roots of these tooth were in the area of lesion. Any procedure can contaminate the other vital tooth also may be it will then act like a foci.
I don't strictly rely on anyone else's diagnosis. I did my own pulp testing and noted what I found. I was told to do such endos before by my assocaite periodontist, but most of them were nonvital retro infected cases.
If I do otherwise I know whom he will refer his next cases to. He is not that open to suggestions especially from and orthodontist or Genereal dentist like me.
Thank you - Vipin Thanks Kendo, For inspiring me.
I didn't know that the endo is the etiology in a case like that with trauma. I was thinking the trauma caused the perio widening and the tear and periodontitist which gives infection through the anal portal.:) May be it's time I read my basics.
I was sure that I didn't miss any of those god made canals. As you said. I just filled the emptiness I made by taking the GODs creation. Let him heal....
And by the way we have no Hibitine available in India, we may have Perioguard and like. but all are of 2%. Nothing with 5%. will they work??? - Vipin