Help with stepwise excavation and calcium hydroxide

[lilo]

Dear everyone.

Today i had a patient where i had to do a stepwise excavation. It was more like an intermediate restorative material because of lack of time, and so i thought it could as well work as stepwise excavation.

However i ended up forgetting using dycal which is a calcium hydroxide, and i also obviously forgot vitrebond (glas ionomer liner) too since i forgot the dycal. Patient is now home. I am wondering how big of a problem it is to forget these 2 if the patient is going to get a permanant filling made in about 1 to 2 months from now?

I guess i will not have any tertiary dentin developement and hence it will be non effective, but will it make the caries worse? Should i call in the patient to fix it with a new IRM?

Please answer me thank you in advance.

 

[Janet Two Hawks]

Dude. Do the right thing and call that patient to correct it. A patient is much more understanding of a mistake than knowing you didn’t do your best but deciding to withhold the information. Everyone makes mistakes. Do you want to be an outstanding dentist? Or one who cuts corners?

 

[KVMCruces]

I COMPLETELY agree with Janet Two Hawks.
You need to do whats best for the patient, even if that means admitting to your mistake.

Keep in mind that MANY patients are on this website reading these posts. Many of them already have anxiety/fear of going to see a dentist so when they come on here and see that a dentist made a mistake and is questioning whether or not he/she should do the right thing and inform the patient... well it doesn't take a genius to figure it out

 

[TallPoppy]

I am not a dentist hence my moniker.

Are you confident of a good debridement? if so move on, anyway avg RCT life is 10 to 12 years. In RCT putting things is of less importance than taking things out, having said that if you have not used advanced toys (since I am not a dentist I will refrain from 'armamentarium') like ultrasonics then calcium hydroxide bleaching might help a bit with lateral canals, residue carries, etc.

But I am surprised you didn't use a sealer? were you doing silver point obduration? or cold lateral gp points? any way if you are gonna call him back you might want to check with a MTA based sealer... kinda doubles up against infection as well me thinks.

Psst - I don't think you are a veteran otherwise you would not be asking let alone in internet. If you are gonna practices for 3 to 4 decades there will be a few irate or disappointed patients who move to other dentists so don't fret. I mean even if a procedure is done well things need not turn out well.

BTW - if you still keep forgetting you might want to refer to a friendly endodontist near by, I think most are decent enough to offer a referral fee. Any way crown is where money is he he.

 

[MattKW]

Not sure why Dycal would be used anyway, as it offers no released CaOH (bound up in methylcellulose); it acts more as a simple lining. Would have been slightly better to use Vitrebond alone as liner, then close up with GIC or RMGIC. In fact, why use Vitrebond at all? What advantages does it offer over plain GIC or RMGIC? No matter, if you have sealed it well with IRM, then that should be fine. All that said, iIt would be best to be honest with patient, and bring them in for face-to-face talk and admit error, and apologise. Test the tooth for sensitivity, tenderness to percussion, take a free Xray, look happy with the results, and If they are having no symptoms, then you can offer to leave it alone. You "just wanted to make sure".