Dental Q - Root canal and root amputation

[Melee]

Hi Dr. Stein,

Come to think of it, I vaguely remember the oral surgeon asking if I did scuba diving, and at the time, I said "No", and that I was a rock climber. D'oh! I'm thinking he probably didn't fill in the gap. Gadzooks, what was I thinking? I have an appointment next week (thank goodness) and I'll ask the dentist if she can fill in the gap, if it wasn't filled.

Also, what is the purpose for the cotton in the pulp chamber?

Thanks (numerous times) again.

Mel

 

[Laurence Stein DDS]

Hi Dr. Stein,

Come to think of it, I vaguely remember the oral surgeon asking if I did scuba diving, and at the time, I said "No", and that I was a rock climber. D'oh! I'm thinking he probably didn't fill in the gap. Gadzooks, what was I thinking? I have an appointment next week (thank goodness) and I'll ask the dentist if she can fill in the gap, if it wasn't filled.

Also, what is the purpose for the cotton in the pulp chamber?

Thanks (numerous times) again.

Mel

The cotton in the pulp chamber is there so you can clean your ears from the inside! :54:

Actually, the cotton is usually placed between root canal visits to help medicate the canal. It may be dipped into camphorated monochlorophenol, beechwood creosote or other canal medicament.

It also helps the dentist to identify when he is getting close to the bottom of the pulp chamber when removing the temporary filling. It should never be left behind once the tooth is restored with the final restoration. Since the cotton creates a partial air space, it can become problematic during scuba diving.

If you must dive while in the process of root canal therapy or at the end of therapy, ask the dentist to completely fill the chamber with temporary cement. This reduces to a minimum the potential air space.

Larry Stein, :doctor:

 

[Melee]

Hi Dr. Stein,

I will ask these questions at my visit. This information is enormously helpful. Thank you, thank you, thank you!

Also, thank you, Itziar, for sharing your experiences.

Much regard,

Mel

 

[Melee]

Hi Dr. Stein,

Just wanted to give you an update on my dentist visit. My dentist is going to speak with a periodontist for a consult. My dentist took an X-ray of the tooth and can’t tell if the hemisection was retro-filled. She told me my existing crown and filling below the hemisection are intact. Is it common practice for an oral surgon to not retro-fill the area remaining where the root was amputated (dumb question)? This oral surgeon did a great job on my hemisection (according to my dentist), so I wouldn’t think he’d not retro-fill.

Thanks much,

Mel

 

[Laurence Stein DDS]

Hi Dr. Stein,

Just wanted to give you an update on my dentist visit. My dentist is going to speak with a periodontist for a consult. My dentist took an X-ray of the tooth and can’t tell if the hemisection was retro-filled. She told me my existing crown and filling below the hemisection are intact. Is it common practice for an oral surgon to not retro-fill the area remaining where the root was amputated (dumb question)? This oral surgeon did a great job on my hemisection (according to my dentist), so I wouldn’t think he’d not retro-fill.

Thanks much,

Mel

Hi Mel,
I'm a little confused...Did you have a root amputation or a hemisection?

A hemisection is where the tooth is cut in half...completely through the crown and root in a vertical direction. If there is a periodontal pocket between the halves and the roots are firm, then it is possible that nothing will be extracted. Each part of the sectioned crown and its attached root are restored (usually with a cap) individually. In essence a two rooted tooth become two one rooted teeth.

If there is an abscess at the end of one root or one root is fractured, then the questionable root is extracted and the remaining sectioned root + crown is either restored with a cap or is used to support a bridge (permanent fixed bridge).

In a ROOT Amputation, the tooth is sectioned in a horizontal direction and the offending root is removed, leaving behind the entire crown.

My confusion is that you would only need a retrograde filling in the hemisection scenerio. Sometimes, when the existing root canal appears to be sound, no retrograde filling is necessary. In a root amputation, the root is removed and there is nowhere to insert a retrograde filling into the root tip.

In a root amputation, there is a hole in the orafice that was the entry into the nerve canal of the amputated root. Filling this is not normally referred to as a retrograde filling. A filling here can be done at the time of surgery, at the time of any root canal procedure or at the time the tooth is prepared for the new crown.

Many but not all oral surgeons will remove the root as necessary but will refer you back to your regular dentist or root canal specialist (endodontist) to fill in any hole in the root tip (retrograde filling). This requires special instruments that endodontists usually have.

Before any retrograde filling is inserted, the tooth must have a completed root canal.

I know this is a confusing post but a root amputation and a hemisection are similar BUT different types of treatment. How you manage the remaining hole depends on which procedure was done. Technically, the retrograde filling would only be used in the hemisection procedure.

Man, even I am confused!!! Keep me updated.

Regards,

Larry Stein

 

[Melee]

Hi Dr. Stein,

Sorry for the confusion. I heard both terms (root amputation and hemisection) during the treatment and thought they were the same thing.

I had a root canal therapy done on the tooth before I had the root amputation. The root amputation was done because I noticed an absess on my gumline a year after the root canal therapy. The oral surgeon removed one of the roots and left the crown intact. So filling the “entry into the nerve canal of the amputated root” is what I’m wondering if the surgeon filled at the time of surgery. Hopefully, this makes sense?

Thanks for your patience.

Mel

 

[Laurence Stein DDS]

I really doubt that your oral surgeon plugged the hole if it is present. If the root canaled tooth was restored, there may be a core within the chamber and no plug is necessary.

Most oral surgeons don't have the instruments to place an alloy or a composite filling. In most cases they will inform the patient to see their regular dentist to fill it.

I don't know whether there was nothing to plug, he forgot to tell you or he actually told you but it was not understood...perhaps if you were sedated.

You should ask him or have your dentist check the tooth.

Regards,

Larry Stein

 

[Melee]

Hi Dr. Stein,

Thanks for the info. I will be speaking to my dentist today. Sorry for all the confusion.

Regards,

Mel

 

[sbbi]

In a root amputation, the root is removed and there is nowhere to insert a retrograde filling into the root tip.

In a root amputation, there is a hole in the orafice that was the entry into the nerve canal of the amputated root. Filling this is not normally referred to as a retrograde filling. A filling here can be done at the time of surgery, at the time of any root canal procedure or at the time the tooth is prepared for the new crown.

Hi Dr. Stein,

I am also a little confused.. Are you saying that there is no filling needed in the place of amputated root, except filling the hole on the orifice? But i read here says: "I have sometimes seen root amputations performed without doing a retropreparation and retrofill. That would be the same as doing a root canal without placing a permanent restoration. Bacteria will leak in and contaminate the root canal."
theendoblog.com/2007/12/root-amputation.html

Thanks.

 

[DocVikingo]

Hi sbbi,

You do realize that the last post in this thread is dated February 25, 2004?

In any event, I will email Dr. Stein and ask him to respond.

Regards,

DocVikingo