Hello sir, i hope that you could answer my question Sir, i am abit confused, is root canal treatment necessary after apexogenesis? I have done a case, after 3 year recall Radiography shows signs of calcification but the tooth is asymptomatic and pulp is vital when tested. Why do we have to do RCT after apexogenesis?
At the 2 year recall, it seems that the lower left 5 may be impacted. If this was able to be diagnosed prior to the initial treatment for the molar, would this have changed the treatment plan?
+everest 312 No. It would not have made a difference. You still have to treat the molar as you would not extract the first molar either way. Space management and orthodontic therapy will be required for this patient as per orthodontic consolation.
If MTA is not available, what other materials are recommended for use? Also, is it advisable to place a permanent restoration / build-up at that same visit?
So I think Dr. Nasseh is correct in deeming the patient to have reversible pulpitis. Dr. Short said he did a cold test for vitality and typically irreversible pulpitis cases would be tolerant to cold. Reversible pulpitis would lead to cold INtolerance which is what it sounds like the patient had. Correct me if i'm wrong of course. Very nice result, Dr. Short. Cheers.
+Scott Kennedy My understanding was that the difference between reversible and irreversible pulpitis was the degree of abnormal response. Like if the patient rated pain on the cold test to be 3/10, I would deem that reversible. But a score of 8 or 9/10 I thought was irreversible. I would also like to know what the correct answer is!
+Jin Song Totally agree that severity of pain would distinguish the two. However, pain is such a subjective thing.....especially in a young child that I'm not sure a pain scale would help in this situation. Looking forward to see if Dr. Nasseh has some input. Good thought!
+Jin Song Typically reversible and irreversible pulpits are clinical diagnostic terms and are distinguished clinically based on two specific symptoms: 1. A lingering reaction to cold, and 2. Spontaneous pain. One would not attempt to do pulpal preservation in irreversible pulpits as by definition, it will not reverse back to normal and will deterministically leads to necrosis. This is why, by definition, a pulp cap would only be indicated in reversible pulpitis cases. Cheers!
My two cents: If the patient arrives to the office symptomatic (pulpal hyperalgesia), then clinically you can diagnose symptomatic irreversible pulpitis, nevertheless histologically this pulp will have focal points of necrosis coronally but apically the pulp is healthy, so by removing the pulp horns, evaluating bleeding and the remanent pulp tissue under magnification you can leave healthy pulp ready to cap with a bioactive material.
I totally agree. This is a big frustration for every endodontist seeing the patients back and then see destructive restorstion by the destructive, pardon restorative dentist
it's easy to throw stones about a particular case when you don't know the original circumstances. I'd be careful with judging others treatment outcomes, especially when they are treating very anxious children. I used to criticize others work too, until I realized that all failure isn't the practitioners fault and that I'm definitely not perfect either. the same measure that you use to judge, will be used to judge you
+marcus moss you are absolutely right and we should judge something when we know all facts. Unfortunately way too often I have seen overtreatment done by collegues, usually with good intentions
+miraamshah Unfortunately, the endodontist does not make those decisions. That's up to the restorative dentist. But in general. I agree with you regarding crowns in teeth without marginal ridge damage. However, it's possible that the restoration was very wide in this tooth. It's difficult to say.
everything depends on how the original restoration failed. if large parts of the buccal or lingual wall have fractured a stainless steel crown is indicated in a young child. that crown can always be replaced when the patient is older once eruption is complete and oral hygiene is sufficient. That was a ton of recurrent decay on a permanent 1st molar for a 7 year old patient.
+marcus moss +RealWorld Endo thats why we should try to prevent that by covering the cusps and you can do that by a nice composite restoration. It is sad to see such a progress of caries especially in young patients. Don't want to point fingers but the society and public should wake up and people should realize it is not normal to give a child a soda coke fruit juice etc on daily base. Children and parents are conditioned by the companies and parents brushing the teeth ocassionally. Neglecting a child like this and not brushing the teeth are in my eyes in most cases child abuse.
I would love to learn how to adequately cover the cusps with composite on the young child. Do you have any videos/case presentations that you are willing to share?
+marcus moss I don't see how it should be different than in adults. Since you can do an endo then the restoration shouldn't be a problem the next session. I always lower the cusps between 2-2,5mm when the margins are missing or very thin walls present. I don't have clinical videos but I can tell you since I have been doing this in last 5 year, I have no single fracture or failing restorstion. There are a lot of in vitro and ex vivo studies which show you need between 2-2,5mm cusp reduction before cuspal coverage for optimal result. And also there is 1 clinical study which shows composite restorstion perform as good as full crowns. Btw in case of crown I perfer inlays or onlays
