Pulp horns, deep finish lines

By JK

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In a different thread, CB commented on his concerns about a pulp horn.  I have not seen a case fail from an "undebrided pulp horn."  If we think about it just a little bit, we don't debride the apical portion well, and cases still work.  So conversations about the coronal pulp chamber are pretty pointless.

With more careful evaluation of the surviving stream of cases, what's clear is that the things endodontists and endodontics things are predictors of long-term outcome, things stemming from the Kochian, planktonic world based on The Endodontic Triad are not required for long-term outcome.
Treatment objectives designed to satisfy The Endodontic Triad may are thus certainly not required/necessary, nor are the sufficient for long-term outcome, and may actually reduce it.
This patient was in yesterday for a different tooth, and we can see the pulp horn to the mesial along with drawings showing traditional SLA and how much tooth structure might have been left.  
This was also a deep finish line case where my advice (to a new clinician in town) to leave the distal finish line on amalgam was not heeded.  Ferrule only counts if the crown fits.  Here…it doesn't seem to have mattered although I don't think anyone would be happy about that process outcome.  I don't think it should be revised either, as there isn't any evidence that even the process outcome would be improved by such a revision.
10 year followup from yesterday.

JK

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I doubt a single person can show a case where any possible cause of failure could be attributed to “an un-instrumented pulp horn”…..

gbc

Usman Fazli

Leaving necrotic pulp horns causes discolorations in anterior teeth, more often necessiating retreatment prior to internal bleaching. These micro organisms and their biproducts endotoxins traverse the dentinal tubules for a considerable length.Leaving truss intact does not adequately address the issue of furcal canals either. I lean to the vast majority of cases I retreat in my practice which show inadequate shaping of the canal system and more often missed second canals . Its evidence enough from a common sense point of view to be able to clean and shape adequately and maximize debris removal

Hi JK, totally unrelated question to the RCT, what matrix is that, just a regular tofflemire? Nice to see you at IAE, hopefully you remember beyond the tequila lol!

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