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Endo Questions for the RWE Faculty:

In this area, users are encouraged to ask questions from the RWE Faculty regarding Endodontics in General and the EndoSequence Technique.

Endo Questions for the RWE Faculty:: Reparative Endodontics

Missing

Joined: March 2018

Rank: Rookie

Posts: 4

#1
"Conventionally, revascularization is believed to be achievable only for the root canal space of an avulsed, reimplanted tooth. [9],[10],[11],[12] However, studies prove that the same can be achieved for an immature or mature permanent tooth with periapical periodontitis or abscess by means of thoroughly disinfecting the canal followed by inducing bleeding and establishing blood clot into the root canal system via over-instrumentation supplemented by a good coronal seal. [13],[14],[15],[16] Theoretically, it was presumed that the formation of a blood clot in the sterile root canal system creates a scaffold of fibrin that entraps stem cells capable of initiating new tissue development." [7]

Do you have any comment on this? One of my front teeth seems to have died from minimal trauma. It was never avulsed or anything severe. Insensitivity to ice and loss of healthy coloration.

Can anything be done to help it revascularize or is root canal therapy my only option?

"Root canal revascularization via blood clotting is a relatively simple and practical approach which can be accomplished with presently available instruments and materials. Moreover, the possibility of immune rejection and contamination can be averted since the root canal system is filled with patient's own blood cells. [7] Case reports have revealed progressive thickening of dentinal walls, continued root development, and positive response to thermal pulp testing. [15] A 24-month follow-up comparative study between revascularization induced maturogenesis and conventional apexification found the former to be advantageous." [33]

Here is the study: Root canal revascularization via blood clotting in regenerative endodontics: Essentials and expectations

http://www.jdrntruhs.org/article.asp?issn=2277-8632;year=2013;volume=2;issue=4;spage=235;epage=238;aulast=Vemuri

PDF link: http://www.jdrntruhs.org/downloadpdf.asp?issn=2277-8632;year=2013;volume=2;issue=4;spage=235;epage=238;aulast=Vemuri;type=2

It looks promising to me. Have you ever done anything like this?

Allen_ali_nasseh

Joined: August 2013

Rank: Faculty General

Posts: 250

#2
Depends on your age and apical diameter of your tooth. Also, the longer the tooth has been infected and the more established the biofilm the more difficult it is to sterilize it. The purpose of obturation is to entomb any potentially remaining bacteria inside the tooth, where it can not cause any immune reaction. 
The main question is what is the advantage of revscularization vs. RCT in an adult tooth with compete root formation. If you have a romantic notion of a vital pulp then you can certainly try and see if you can achieve adequate revascularization in your tooth. If not, RCT is needed. Otherwise, a more definitive approach that is not so dependent on many factors is doing RCT and filling the access. That's the quickest way to address the problem and the tooth should theoretically last a lifetime if done properly and restored adequately. 
Good luck! Al
p.s. you may want to post a radiograph of the tooth here if you want (attach file). 
Missing

Joined: March 2018

Rank: Rookie

Posts: 4

#3
Two questions for now. I've seen a few cases of RCT upper incisors that show discoloration from the root canal procedure itself.

http://rogersdental.ie/gallery/

Two cases are shown here.

Is this because the endodondist is using something in the tooth that is staining the dentin?

Here's an extreme result: "This young man presented with a very discoloured upper left front tooth. This tooth had suffered trauma many years ago and had a root canal treatment carried out at that time. The tooth subsequently discoloured."

Secondly, would it be prudent to drill out and replace the endo access composite resin filling approximately every 10 to ensure any leakage is kept to a minimum?

And when you say the work could last a lifetime, I guess it depends how old the person is. In my case, I still have 60+ years ahead of me unless something unexpected changes that.
Allen_ali_nasseh

Joined: August 2013

Rank: Faculty General

Posts: 250

#4
In reply to James Long This answers your staining question: https://realworldendo.com/videos/do-root-canal-treated-teeth-darken


Also, only replace the access filling if there are signed of leakage, not every 10 years automatically. 
Good luck!
Missing

Joined: March 2018

Rank: Rookie

Posts: 4

#5
But by the time there is evident leakage is it not too late?

This is why I was wondering if I would be better off having the access hole sealed with a better sealing, longer lasting restoration like gold foil.

As my tooth is now, it could benefit from just a bit of whitening. What do you think about leaving some calcium hydroxide combined with some bleach to sit in the tooth for a week before finishing the job? In your experience has calcium hydroxide led to any root fracturing?

Remember that since I'm young I want to make sure the job is done as best possible. This is also why I was inquiring about encouraging whatever pulp structure I have to heal itself. Unfortunately I can't right now share an X-ray with you for a better analysis of the prognosis of that.

Most endodontists seem to prefer what they call root canal therapy which simply extracts the pulp and cleans the internals. That's easiest and best for most people I understand. However since I don't have an infection or pain I have some time to explore all options.
Missing

Joined: March 2018

Rank: Rookie

Posts: 4

#6
Looks like my tooth is dead since it's getting darker.

Also noticed this article:

4 Ways Getting a Root Canal Can Discolor or Stain Your Tooth


http://www.oralanswers.com/discolored-teeth-root-canals/

I guess I need root canal therapy and internal whitening. Some dentists and office people are saying if I get a root canal the tooth is going to be brittle so I need to get it crowned, even when they know it's a front central maxillary incisor that has never before been drilled. Others say the crown will just weaken it further.

"medications that cause staining when used in RCT, such as eugenol, formocresol, root canal sealers, and some antimicrobial pastes."

As for the brittleness of a front RCT tooth, one endo office told me that the access hole can be done in a "micro" way where it is 8X smaller than usual, conserving maximal tooth structure.

Any thoughts? As for gold foil, I've crossed that off.


Allen_ali_nasseh

Joined: August 2013

Rank: Faculty General

Posts: 250

#7
In reply to James Long Just get a root canal and have the access filled. Make sure they don't use a root canal sealer that contains silver. You're over thinking it. If you tooth has never been drilled into you don't need a crown. Just get the endo done by a specialist. A front tooth is not rocket science you have something that millions of other people go through. It's good to be thorough as I see you are; but you're over-thinking it at this point. Find a good specialist and trust what they say. But don't get a crown if the tooth is only a central incisor and is not structurally compromised. That's for sure. 
Cheers. 
p.s. This website is for dentists and not patients. And this section, particularly, is for dentists who are members of our educational platform. Thank you.