The legacy of referring a patient for a “root canal” and getting the case back with “cotton and cavit” in the access has led to many unneeded failures over the years and a loss of confidence in endodontic treatment for many patients. Studies have shown that when saliva and bacteria are in contact with gutta percha and the pulp chamber, that it only takes a few days for those bacteria to reach the root apex and cause symptoms. Failure of endodontics due to coronal leakage for whatever reason is unacceptable in our office.
Imagine how depressing it is when after three visits a patient leaves our office completely asymptomatic and two years later he/she shows up with a failed root canal treatment due to some kind of contamination of the pulp chamber!! Ask me how I know!! Root canal treatment in our office involves the complete sealing of all “endodontic orifices” which includes the access. This eliminates the possibility of coronal leakage, between office fractures, iatrogenic perforations, “unmotivated” patients, and contamination of the previously cleaned and disinfected pulp chamber due to a lack of rubber dam usage.
Not only that, but by taking a postoperative radiograph of the core buildup, we can know that the buildup margins are closed and the pulp chamber sealed. This also saves you valuable “chair time” when the patient comes back to your office. All that is needed is to place the finishing touches on the crown prep and take the impression. This significantly decreases the time for a crown appointment. It is another win-win-win situation: I can be sure that there is no leakage into the root canal system; you are saved the time and effort of reisolating the tooth, cleaning the pulp chamber, and placing the core buildup; and the patient wins in that his/her tooth stays asymptomatic. If you desire the tooth be temporized please let us know and we will accommodate your request to the extent possible.
Patient presented to our office with a chief complaint of hot/cold sensitivity and acute biting pain on the right side of her face. We had treated tooth #3 one year earlier and she believed that her pain was coming from that tooth. We were able to localize her pain to tooth #30 which had a fractured buccal composite which was “hiding” deep subgingival caries. A gingivectomy was performed and the old composite and decay were completely removed resulting in frank exposure of a vital pulp. The tooth was isolated with a rubber dam and the buccal cavity prep was restored with composite. The pulp chamber was then accessed, the contents removed, and the canals medicated with calcium hydroxide. Six weeks later she presented to our office asymptomatic. Root canal treatment was completed and the tooth was coronally sealed with a dual-cure resin core. The patient’s general dentist decided that a crown would not “help” the situation in this case as he did not want to place the buccal margin on composite and both marginal ridges were completely intact.