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TECHNOLOGY ADVANCES in dentistry, new materials and techniques are becoming
available to produce better-quality dentistry. Graduation from NYU
Dental School changed my way of thinking about various dental procedures.
My main problematic procedure remained root-canal therapy, a technique
that produced numerous complications, such as PAP (periapical pathology),
broken instruments, and numbness. I had taken many courses and spent
a lot of time and money to learn new techniques in endodontics. Nothing
worked well for me.
Then a friend of mine, Dr. Natapov, recommended
that I attend Dr. Musikant’s course. This two-hour meeting changed
my life. I am very appreciative of Dr. Musikant for his simple and
generous technique. It enabled me to run my practice stress-free
and turned my most-feared procedure into my most-loved.
Now, I would like to report about one of the most
stressful complications from RCT, which I experienced in very few cases.
This was numbness and alteration of sensitivity after completion of RCT.
Usually, it is very rare that complications arise
from mandibular blocks or mental foramen anesthesia, but in my cases, it
resulted from RCT itself.
A 43-year-old Caucasian female came to my office
for a second opinion with complaints of alteration of sensitivity in the
LLQ and her lower lip following RCT on #21. The patient stated that
the anesthesia did not go away completely and the next day it had worsened.
One x-ray showed a canal of #21 overfilled by approximately 0.5 mm.
Mental foramen located approximately 1 mm from the apex, and periapical
pathology, possibly a cyst, produced lowered tactile sensitivity in the
whole area plus a completely numb area of 5 mm on the lower lip.
The patient was referred to an oral surgeon. During her consultation,
they discussed redoing RCT on #21. The surgeon explained to the patient
that the treatment would offer a chance to remedy her situation, but if
it didn’t work, she would need to do something else. In other words,
the patient was informed about the possible results of the treatment.
Using the technique of Dr. Musikant, old gutta percha was removed and the
canal was instrumented, irrigated, and refilled with EZ-Fill® cement
and new gutta percha to 0.5 mm prior apex. The patient reported feeling
better the next day, and in the following three days said that she had
gone back to normal. At the six-month checkup, x-rays showed that
PAP had disappeared.
I had two similar cases with teeth #20 and #28 in
which the RCT was performed by me. The situation in those cases was
stressful, not only because of complications, but because RCT was performed
on the teeth so that they could serve as an abutment for future bridges.
In those three cases, I used Dr. Musikant’s techniques, which made it possible
for me to resolve easily problems that might otherwise have led to malpractice
cases.
Always study pre-operative x-rays with concern about
mental foramen. It’s better to underfill the canals of lower premolars
than to overfill them. It seems that filling the canal to radiographic
lengths, as required by most insurance companies, is equal to overfilling.
Dr. Gertsberg originally hails from the USSR and has made his home
and professional practice in Brooklyn.
January - March 2005
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Always study
pre-operative x-rays with concern about mental foramen.
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