Cases

Advanced Endodontics Newsletter 8

Posted on June 30, 2012 by Dr. Sashi Nallapati

Quite a few colleagues ask me if I do all my treatments in one visit and if I do a case in multiple visits, what are the criteria for multiple appointments? While it’s true that a lot of cases that I do are done in a single visit (which includes a permanent core build up) I still do quite a few cases in 2 or more visits. The reasons for 2-visit endo are:

Cases with necrotic pulp and large lesions, I tend to do them in 2 visits (even if the canals are dry at the end of visit 1)

  1. Canals that cannot be dried at the end of first visit.
  2. Retreatment of cases with lesions.
  3. Vital cases with a lot of pulp tissue in the isthmus that bleed incessantly.
  4. Emergency cases that have to be worked into the busy schedule with not enough time for a complete endodontic treatment.
  5. When the case is anatomically challenging and needs more time than what one appointment can afford us.
  6. Patients that cannot open their mouth for full appt time.
  7. Questionable perio/endo cases that need a two visit approach to see if the perio symptoms disappear after the first visit.
  8. Questionable endo cases (read : cases with treatment, retreatment, surgery done previously) that I dont want to commit the patient to a full fee until I know my treatment is getting the healing response.
  9. Trauma cases where teeth were avulsed/ luxated extruded intruded and teeth with open apices.

These are the general guidelines that I follow. once a while there may be exceptions to the rule and I may decide to do some of the above mentioned cases in one visit.

Here are the last few cases that I treated in my practice past 2 to 3 weeks. Some of them are done in 2 visits and some are in one.

You see the pattern that I followed with these cases. You can also appreciate the complex anatomy of the cases that we have here and the need to address this anatomy in a predictable and consistent basis. My mentor Dr.Gary Carr says “you are only as good as your last root canal”. I like to say, “‘you are only as good as your last 10 root canals”. Consistency is the key to endodontic excellence.