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4 year recall Weeping Lesion - Courtesy ROOTS

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From: Terry Pannkuk
Sent: Wednesday, June 24, 2009 7:28 AM
Subject: [roots] 4 year recall Weeping Lesion

I changed the CH two times on this case over 4 months in 2005.  One month with a wet mix; it was still weeping so
I then packed with a dry mix of USP mixed with 10% BaSO4.  You can see that quite a bit of it was pushed out into
the lesion and the BaSO4 seems to have collected in a ball in the center of the former lesion area.  I let it go
with this mix for 3 months.  It was still weeping but I packed it anyway.  Basically the 1 month wet, 3 months dry
hard pack is as long as I'll screw around.

It healed and shows osseous regeneration now at 4 years.  I'm convinced that many of these stubborn cases will not
heal until you "pack them off".   I'm an ardent two-stepper and occasional three-stepper, but I won't dick around
being a 4, 5, 6, and 7 stepper.  The cost-benefit becomes ridiculous and if it doesn't heal after a meticulous
series of irrigations and 2 CH changes you are likely to be sucking pus till the cows come home anyway,.....
if you pack it off and it usually heals.

This case is a perfect example of this clinical phenomenon.  I rarely need to surgery on these cases.  The size of
the lesion really doesn't matter except that healing takes longer.

This opinion is one of many that got me kicked off TDO.  If the apical prep had been narrow and the gutta percha
not molded/compressed adequately, I doubt you'ld see the same healing.

Who wants to bet that hydraulically squeegying the puss out of a canal doesn't have anything to do with healing? :):):)

Pack n Whacks are unnecessary unless you do a crap job of apical third shaping and packing.

This was a prospective recalled case. I posted this treatment in 2005 on TDOChat and made the claim that it would
"more than likely" heal even though it was being packed with weeping.  Many doubted it would. This was a very simple
case but certainly highlights one anecdote that suggests obturation might have some importance.

Maybe this will stir the pot - Terry

Terry, I think we all have cases that we continue to med with Ca(OH)2 until the cows come home ( or until the patient finally says "No Mas" after months and months of "we're getting me") and then decide to pack...only to have them heal. This seems to defy the literature and clinical good sense (i.e./ pack em only when they can be totally dried). The real question is " When do you proceed to the pack, rather than continue to med?". Does the level of patient compliance play the major factor? How long do we wait? How many med appointments? If you are the patient and you have the choice of "visiting me" for your 8 or 12 week CaOH2 fix (for Lord knows how long!) would you not rather just pack and whack and get the damned thing over with? I don't know the answer. My patients like me....but most would prefer NOT having to see me too often. I understand that. Stir the pot? Terry, you are the Endo-Osterizer - Rob Kaufmann Nice "endo grafting" with USP of the PA lesion through root canal Terry :-). One more proof of the abilities of human immune system. Deserves mentioning that such approach is biologically sound solution for patients lacking funds for lengthy and more expencive RCT and who are not planning to have implants treatment. Root canal was filled with iRootSP bioceramic paste/sealer by just using a simple Lentulo type paste filler - Valeri Here is the case in which intentionally iRootSP bioceramic was "pushed" out in PA lesion to use its high pH and antimicrobial action. See how it has followed the patterns/ shape of PA lesion. Such approach gives chances to treat the cases in one visit. Canal was filled with bioceramic sealer/paste only. iRootSP remains as non-resorbable HA bioceramic bone-replacement material after hardening. Coverage with Metronidazole per os for 3 - 5 days is done in case of pus presence - Valeri Stefanov

Is there a recall on this case? Why not push out the stuff in every case with a lesion? - Fred
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