4 year old open endo

[gpg]

Thats exactly how the tooth is. The patient went to another dentist for Endo of #9. But she never got beyond the access opening stage.Said it hurt like hell.

Any way,so the tooth has been open for the last 4 years.No pain,swelling nothing. Mild discolouration.HUGE periapical.So the #8 has also been screwed up.

I put her on anti-biotics and anti-inflammatory and called her for Endo on the 3rd day. Opened up #8 and cleaned and shaped both with Rotary(Profile). Used lots and lots of NaOCl (5.2%).

The #8 is fine,ready to be filled next time.

But the #9 is not. 3 times I have changed the dressing and yet,everytime,I remove the temp cement and cotton pellet,the canal is full of pus. I take a PA and the periapical is not so prominent any more.

Any advice people?

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[groundhog]

Maybe what happened to me after letting an upper molar that needed root canal treatment go too long after the nerve had died and the infection continued to drain...so no pain. End result was that one root tip was getting absorbed (revealed on exploratory flap peel back) which left me hosed for root canal treatment on that root. The other two roots were sound and were filled ok. The bad root was amputated.

 

[gumgardener2009]

I'm starting to sound like a broken record, but this ought to be posted somewhere else, like dentaltown.com. If you insist to post it here, you also ought to provide us with more info so we can dx and tx plan. What is the condition of the roots and crowns? How's the crown:root ratio? Xrays would be nice. And so on...

 

[gumgardener2009]

Thats exactly how the tooth is. The patient went to another dentist for Endo of #9. But she never got beyond the access opening stage.Said it hurt like hell.

Any way,so the tooth has been open for the last 4 years.No pain,swelling nothing. Mild discolouration.HUGE periapical.So the #8 has also been screwed up.

I put her on anti-biotics and anti-inflammatory and called her for Endo on the 3rd day. Opened up #8 and cleaned and shaped both with Rotary(Profile). Used lots and lots of NaOCl (5.2%).

The #8 is fine,ready to be filled next time.

But the #9 is not. 3 times I have changed the dressing and yet,everytime,I remove the temp cement and cotton pellet,the canal is full of pus. I take a PA and the periapical is not so prominent any more.

Any advice people?

IMHO,
the antibiotics and antiinflammatory were unnecessary. No pain, no swelling, no systemic signs or symptoms and the tooth is open to drain.

 

[toofache32]

What's wrong with a good ol' #150 forceps? I know, I know..."but it's a front tooth!" If the patient really cared, they wouldn't have waited for 4 years. I'm sure the dentist that started the procedure 4 years ago gave her a follow-up apointment for after the tooth cooled off, so it's the patient's fault for neglecting appropriate follow-up, assuming this case is like 99% of the similar ones I see daily.

I know this sounds harsh, but at some point you have to remember that the patients must accept the responsibility for their health conditions, which includes accepting the indicated treatment.

I never feel bad for extracting #9 when a patient did it to himself.

Or you could leave it open and let the patient irrigate it daily at home to speed the drainage, then try endo.

 

[omfsres]

What's wrong with a good ol' #150 forceps? I know, I know..."but it's a front tooth!" If the patient really cared, they wouldn't have waited for 4 years. I'm sure the dentist that started the procedure 4 years ago gave her a follow-up apointment for after the tooth cooled off, so it's the patient's fault for neglecting appropriate follow-up, assuming this case is like 99% of the similar ones I see daily.

I know this sounds harsh, but at some point you have to remember that the patients must accept the responsibility for their health conditions, which includes accepting the indicated treatment.

I never feel bad for extracting #9 when a patient did it to himself.

Or you could leave it open and let the patient irrigate it daily at home to speed the drainage, then try endo.

Apicoectomy and currettage of residual abcess cavity. Give the endo something to do besides twidle their thumbs. They can even call it surgery if they want to.

 

[gumgardener2009]

Apicoectomy and currettage of residual abcess cavity. Give the endo something to do besides twidle their thumbs. They can even call it surgery if they want to.

You seem to be on a kick that only OMS does surgery. If you lay a flap to access the abscess cavity and do an apicoectomy, it's surgery. If an endodontist does it, it's something else?

 

[omfsres]

You seem to be on a kick that only OMS does surgery. If you lay a flap to access the abscess cavity and do an apicoectomy, it's surgery. If an endodontist does it, it's something else?

Have you ever seen a surgery in the OR? Calling elevating a flap surgery is like filling up a hole in your yard and calling it a man-made lake. I agree that it is technically surgery but surgery done by oral surgeons is on a completely different level than those done by other dental specialists.

 

[toofache32]

and so it begins...

 

[gpg]

Guys please take your issue as to who does the surgery elsewhere.
Right now,please post here only if you are commenting on the case.

 

[gumgardener2009]

Guys please take your issue as to who does the surgery elsewhere.
Right now,please post here only if you are commenting on the case.

If you want help with your case you've come to the wrong place. If you want to hop into the morass of oms residents' egos, you've come to the right place.

 

[Mr. So-So]

my style is not to waste time on something like this..

refer.
..and then ask your endo friend what they did.

you aren't doing a service to the patient...nor yourself.

Thats exactly how the tooth is. The patient went to another dentist for Endo of #9. But she never got beyond the access opening stage.Said it hurt like hell.

Any way,so the tooth has been open for the last 4 years.No pain,swelling nothing. Mild discolouration.HUGE periapical.So the #8 has also been screwed up.

I put her on anti-biotics and anti-inflammatory and called her for Endo on the 3rd day. Opened up #8 and cleaned and shaped both with Rotary(Profile). Used lots and lots of NaOCl (5.2%).

The #8 is fine,ready to be filled next time.

But the #9 is not. 3 times I have changed the dressing and yet,everytime,I remove the temp cement and cotton pellet,the canal is full of pus. I take a PA and the periapical is not so prominent any more.

Any advice people?

 

[gpg]

Metronidiazole has done the trick...no pus at all today.........will fill it next time

 

[gumgardener2009]

Metronidiazole has done the trick...no pus at all today.........will fill it next time

You never gave us very good info on this case, but what I can tell I don't believe you're doing the right thing on prescribing antibiotics. From no lesser of an expert source than Walton and Torabinejad's "Principles and Practice of Endodontics":

...Optimal management includes both definitive treatment (e.g., canal debridement and , often, incision for drainage) and pharmacologic adjuncts (e.g., antibiotics) when indicated. Systemic antibiotics are not a substitiute for proper local treatment. Indeed, the vast majority of endodontic infections can be treated without anitbiotics. Pain and swelling are managed by debridement of the pulp space and drainage of the soft and hard tissues. Healthy patients without systemic signs and symptoms of infection but with symptomatic pulpitis, symptomatic apical periodontitis, a draining sinus tract or localized swelling do not require antibiotics.
Likewise, the use of "prophylactic antibiotics" to prevent post-treatment pain or flare-ups after root canal treatment is neither effective, rational nor justified. Even if antibiotics were helpful, because only a small percentage of endodontic patients experience a flare-up, the risk-benefit ratio would not support their routine use. The use of prophylactic antibiotics places patients at risk for side effects. In addition, these patients are subjected to the possibility of selection of resistant microorganisms and "superinfections." Also antibiotics may be very costly.​