Hair of Bat and Oil of Cloves.

Dentistry October 29th, 2006

So a young woman came for a consult last week. The old filling on this tooth had fractured a couple of months ago and her dentist built the tooth back up. Shortly after she started noticing bite and thermal sensitivity. A few weeks of that and she was sent here.

That’s the tooth as I saw it at the consult. The xray showed a moderately deep filling and no apical pathosis. After some discussion I decided to try an IRM temp in the tooth to see if we could reverse the pulpitis. The existing filling is obviously deficient so I figured that based on the quality of the existing work, we might be dealing with a reversible pulpitis.

Removal of most of the resin showed a ton of caries that were left behind before.

That’s after caries excavation and placement of some Dycal.

And that’s the IRM temp.

So far the patient has been feeling good on the tooth. I’ll give her another week or so to make sure. What to do after that though? Do I send her back to her dentist for another resin that might look like the last one did? Even if I do the resin myself (I don’t have any unexpired composite resin in the office), she still needs a dentist for her other stuff. And her Mom is this dentist’s receptionist…

Oh well. At least we’ve avoided a root canal for now. Hopefully.


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  • Dr. Mommy, D.D.S.

    looks like caries worked its way under some microleakage in the resin. how long ago was the filling placed? there has to be some sort of explanation about that.

    i’ll spend the rest of my life trying to combat microleakage, but it seems to be a problem with resin fillings. could be a glitch in the bonding process, trouble with good isolation, etc. i’ve started using rubber dams more when doing resto, esp composite resin and i immediately noticed an improvement, esp on lower teeth. i also completely ditched the flowable and the one-step bonding agents, a wicked combination which guarantees failure. a friend of mine who is also an endodontist thinks posterior composites are the worst thing ever, given their history of post-of sensitivity and microleakage. what’s your take on them?

  • Ameloblast

    The filling was placed about 2 months ago…The tooth is a 1.7 and is very far back. The cheek gets in the way, saliva is a problem, etc. Not with the rubber dam though.

    I’ve seen lots of resins last. They are, however, technique sensitive and very unforgiving if a step isn’t done properly.

    Endodontists find a good portion of their business is treating pulpidities caused by resins, so we poo-poo them. However our view is skewed. We see lots of failing resins, but we hardly need to see the good ones.

    All of that being said, I’d still rather see a large amalgam placed to build a tooth up than a large resin. I was reading somewhere recently that there’s some evidence that resin bond strength might actually decrease over time…and as you know, they aren’t bacteriostatic like amalgam.

  • Dr. Mommy, D.D.S.

    quick question for you – what is the minimially clinically acceptable length for a root canal fill, i.e., what is the absolute shortest you can be from the apex and what is the ideal? i got into a scrap with my boss about it, so i’m curious to see what you (a specialist) has to say.

  • Ameloblast

    Had to think about this for a bit, because I usually eval this on a case by case basis (based on root curvature, complexity of the endo, degree of infection, etc).

    The short answer is that almost every outcome study that I’m aware of agrees that the most successful endos are found where obturation is within 0-2mm of the radiographic apex. This is partly because of stuff that I’ve discussed here.

    On the other hand, there are cases that need to be obturated short (see here). And cases that worked out ok even though they weren’t meant to be finished short (here).

    Hope this helps.

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