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Fiber Post Drill-Out on an Abscessed Bicuspid with a New Crown

Terry Pannkuk, DDS, MScDRetreatment Strategies, Dismantling, Recall Observations, All by Date

Description

Initial access demarcating the fiber post from the peripheral composite core material

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Nonsurgical Versus Surgical Endodontic Retreatment on Teeth With Posts?

Patient: 65 year-old female with Hashimoto’s Disease and managed hypercholesterolemia

Chief Complaint: swelling on gums

Dental History: The patient reported a past history of root canal treatment (not recent) and a new crown on the maxillary left second bicuspid (less than a year). She started to notice some swelling associated with the area 3 weeks before the endodontic consultation.

Significant Findings (Tooth #13): a fluctuant buccal mass was noted opposite the said tooth which yielded slight discomfort when palpated. A periapical radiograph revealed a large periapical radiolucency and previous root canal treatment. The less radiopaque column of material in the coronal half of the root suggested a bonded fiber post. Clinical tests demonstrated Class 1 mobility, moderate percussion sensitivity, and periodontal findings within normal limits.

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I hate to sound like a broken record, but I can't understand why Cavit is used (with, or without cotton), instead of a bonded composite! What if the patient, or the doctor, had a change in schedule, and the next visit may un-expectantly be several months away. Isn't that of concern? Besides that, how do you make sure the occlusion is correct when using Cavit? Cavit just doesn't fit in to a plan for a predictable outcome.

A deep column of compacted Cavit seals very adequately as a temporary for a month or even two months for an intact crown with good margins. If the margins are questionable and there is fear of loosening, I would generally place a GIC or resin modified GC which seals without the same degree of shrinkage as a composite which poses the C-factor problem pulling away from walls. . If the patient doesn't come back for two months there are bigger problems with neglecting to finish the endo and having the crown weakened without a luted fiber post. It just seems like attempting to etch bond, gain clean surfaces with CH, etc. etc. using an extravagant material instead of a proven well-sealing temp for a routine occlusal access requiring no strength properties is an unnecessary exercise, no? The working cusps are generally not within the occlusal endodontic access outline and there would be no disruption of occlusion. In many instances you want to take the tooth completely out of occlusion while it is being treated to avoid unnecessary discomfort. Why do you want precise occlusion during the interim period of treatment? The occlusion is put back in with the final restoration after the treatment.

Hi John, Please quote some studies showing the inadequacy of Cavit as temp during the routine interim of two step endo treatment. We need them for the references here.

I switched to sponges one year ago. They compact much better.

I agree much better than cotton, even better is no sponge spacer at all! it's very simple to remove deep Cavit with a safe ended bur (eg. Pulp Shaper bur)

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