An Old Case.

Dentistry April 10th, 2007

It’s a slow day at work today (I’m not complaining) so I was just organising some of my archived cases and ran across this one. I don’t think I’ve posted it before.

It was done years ago and since then I’ve developed some very aggressive techniques to blast through calcified canals and blocks like these. I’m also more careful to not block myself in canals by packing dentinal debris into the apical third like I did here. The case showed some promising signs of healing a few months after obturation though. Working and obturating to a more ideal length would have been purely radiographically aesthetic in this case.

I actually know a number of my peers that would have automatically surgerised this case to present a nicer result to the referring dentist.




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  • Dr. Mommy, D.D.S.

    you obviously did something right if the case is healing.

    my old boss in bolton would have said, “oooh, you’re short…”
    remember that discussion we had a few months ago about ideal length?

    how does apical impaction of debris affect prognosis? like yourself, i have run into this problem once or twice where i managed to get just 1 mm shy of the apex but the canal was not patent because of impaction. doesn’t happen to me much anymore since i started using pathfinders and size 8 files in my initial canal negotiation, and it happens more with vital teeth (dentin mud)

  • Ameloblast

    Thanks, but I think of it more as, “What I did worked.”

    Sometimes we do things that aren’t ideal and they work, and sometimes we do things that are ideal and they don’t. We can’t say we did right or wrong from that.

    I did actually remember your old boss when I posted this post.

    As far as I know, no study has shown a difference in long-term outcome with teeth that have apical dentinal plugs. But then again, not many have really examined the issue. I do vaguely remember reading one when I was a student about deliberately creating an apical dentinal plug to provide an apical stop to obturate against.

    I prefer to not leave dentin packed apically for two reasons: Infected cases will probably leave bacteria packed in with the dentinal plug, and these plugs will trap more and more dentin (this is the reason why recapitulation is important) and your working length will get shorter and shorter as you work the case.

    A crown down technique helps immensely to minimize this apical packing. Vital cases can be more problematic because there are not just dentin chips but also pulp that’s packing down. Some pulps also have calcification within that will hinder things also.

    Hey I was right. Here are a couple of abstracts from Medline:

    Oral Surg Oral Med Oral Pathol. 1980 Apr;49(4):366-9.
    Tissue reactions following apical plugging of the root canal with infected dentin chips. A histologic study in dogs’ teeth.

    * Holland R,
    * De Souza V,
    * Nery MJ,
    * de Mello W,
    * Bernabe PF,
    * Otoboni Filho JA.

    The object of the present work was to observe whether the condensation of a plug of infected dentin in the apical region, before the filling of a root canal, could show results similar to those found in the absence of contamination. The histologic analysis of the periapical tissues of dogs’ teeth containing infected apical plugs showed results that were totally unfavorable, when compared to cases in which the plugs were absent. Such data do not encourage the use of dentin plugs for cases of contaminated root canals, at least until other experiments can better clarify the problem.

    And:

    Oral Surg Oral Med Oral Pathol. 1983 Apr;55(4):398-401.
    The effect of the filling material in the tissue reactions following apical plugging of the root canal with dentin chips. A histologic study in monkeys’ teeth.

    * Holland R,
    * Nery MJ,
    * Souza V,
    * Bernabe PF,
    * Mello W,
    * Otoboni Filho JA.

    The object of the present work was to observe whether the root canal filling material has some influence in the periapical healing process after apical plugging with dentin chips. Monkeys’ teeth were filled with nine different filling materials in use today. Ninety days after the treatment, the histologic data showed no differences in the results with the nine materials studied. This fact suggests that the filling material does not influence the healing process when the plug is present.

    Of course, I haven’t, or don’t remember having, read these articles, so I don’t know what their validity is like.

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