The first xray is a duplicate which accounts for the poor quality. The case was referred to me by the patient’s new dentist. When I saw the patient, a parulis existed in the buccal furcation area. Apparently the endo was done in the 80′s and retreated by the previous dentist 1-2 years ago. That was when obturation material was pushed out the apex and the carbon fibre posts were placed and the bridge with the open distal margin was glued on.

I’m posting this case to show that extruded gutta-percha generally doesn’t cause problems.

The canals were cleared and medicated with calcium hydroxide paste for 6 weeks. The parulis disappeared. I obturated the canals.

Carbon fibre posts are a real pain to get out because I have to pretty much drill or ultrasonically destroy them to get them out; unlike metal posts which I can usually get out in one piece.

The extruded material had no impact on healing. The open margin on the distal will have an affect on healing if it isn’t addressed.

Ignorance is bliss isn’t it. I feel sorry for this commenter’s patients. This is an answer to this question at Yahoo Answers.

HeatherS, you I suppose you are expecting an answer from me.I don’t how how long ago you graduated from dental school, so perhaps you’ve been in practice so long that you’ve just learned to accept the status-quo.

There is a horrendous problem in the dental profession, both at the educational level and the pratical level. There are ten different kinds of dental doctors, 9 of whom deal with problems almost exclusively within the confines of the mouth–a hole in the head the size of a tennis ball. Obviously, there’s not much turf to go around, so what happens? 1. you get a lot of overlap between the jobs of specialists, and 2. you get specialists who isolate their practices to very few types of problems and procedures.

Take endodontists for example. There is absolutely no justification for their existence. None whatsoever. How do I know this? Because the scope of their work is exceedingly limited (root canals, endo retreatments, post spaces, apexification procedures, and apicoectomies), . So limited in fact, that it could easily be incorporated into a dental school curriculum for general dentists to learn. Certainly, any general dentist (with a little bit of practice) can learn to do all of these procedures. I did.

The fact of the matter is that there are general dentists who don’t know how to do it and don’t want to learn, Why? Because they don’t want to bother with it and because they know they can make more money performing crown and bridge. And of course, there are plenty of endodontists who are just happy to feed off these lazy, greedy dentists, doing root canals day in and day out at literally 150% or more the cost of a root canal performed by a general dentist.

This approach does not serve the dental profession well. It makes us look absolutely ridiculous! The fact that a patient who comes in with an endodontic tooth problem and cannot be treated by his dentist sounds preposterous. Moreover, it doesn’t serve the patient well.

If you’re too incompetent to do your own molar endo with similar speed and quality as an endodontist, you shouldn’t have a license to practice dentistry.

I am also a firm believer that periodontics and orthodontics should not exist either. These are services that general dentists should be able to perform as well. How do I know this? Because there are many general dentists who perform all of their own perio surgeries and general dentists who handle all of their own ortho!

Same with prosthodontics and pedodontics.

With the exception of oral and maxillofacial surgery and oral path, none of the dental specialties are sciences that are diverse enough to warrant doctors who study them exclusively (the way a cardiologist studies cardiology, or a plastic surgeon studies plastic surgery, or an ENT studies the head and neck). Endodontics, ortho, pedo, prosth are all tiny disciplines that can easily be incorporated into the scope of a general dentists practice.

But they’re not. Why? Because everyone with a DDS or DMD is interested in making money…especially the specialists. And the schools are more interested in preserving the work-load for the specialists by keeping their students ignorant of anything but the most basic endo, pedo, prosth, and teaching them absolutely nothing about ortho.

Think about it this way, Heather: what type of work is unique to the general dentist? Fillings. That’s it. That is the only kind of work we do for which there isn’t a specialist.

This doesn’t strike you as absolutely ridiculous?

DR. SAM & DR. ALBERT:

Dr. Sam, you said it yourself: you don’t do molar endo because it “disrputs your schedule” and because the endodontist can do it faster. Ask yourself this: what if endodontists didn’t exist? General dentists would become more competent at molar endo! And, patients wouldn’t be charged the specialist premium for a procedure that a general dentist OUGHT to be able to do!

Dentistry should consist of three types of doctors: general dentists, oral pathologists, and oral surgeons. Why do I say this? Because there are general dentists who treat kids, perform ortho, perform all their molar endo, perform their own perio surgery, their own prosthodontic work, etc. Oral pathologists cover the diseases of the oral cavity and maxillofacial region, and oral surgeons are there to handle the more involved surgeries (i.e. orthognathics, vestibuloplasties, pathology, etc.). Between these three doctors (if general dentists were trained PROPERLY in dental school), everything within the dental profession would be covered. Everything. But that will never happen because there are too many general dentists who are perfectly content sticking with the money-making routine work and too many specialists perfectly content doing root canals and sedating kids day in/day out for obscenely high fees.

I perform the majority of my third molar extractions, virtually all of my preprosthetic surgeries, and 99.999 percent of my extractions of surgically-erupted teeth. I also treat many children, and when I get training to sedate patients, I will treat all of my pediatric cases. I also perform virtually all of my own endo, referring to endodontists the cases that are borderline hopeless (and often turn out to be untreatable).

I am am under 5 years in private practice, mind you. I have a long way to go in my career and thus plenty of time to learn to do the things we general dentists SHOULD have been taught in school.

The poster tried to suck me into a pointless argument here.

Adrian and Kelly, my brother and sister-in-law, are expecting their first child in May and just had their baby shower. From our family to theirs, we got them this playard off their baby registry at Babies “R” Us.