Monday, June 30, 2014

Internal Bleaching of VITAL Teeth

With the recent advances in regenerative endodontics, we have come to see the pulpal tissue in a new light.  This has encouraged us to treat healthy pulpal tissue in ways that would seem counter-intuitive.  For example, in the treatment of a decayed tooth, with immature roots - when the pulpal tissue is completely healthy, we may try an MTA pulpotomy on a permanent tooth, and give the tooth a chance to finish its development. We are finding new ways to perform apexogenesis procedures. The apexification procedure is becoming a thing of the past. In fact, I haven't performed an apexification in several years.

This new approach to the pulpal tissue has brought up a new questions.  In a mature tooth, with calcific metamorphosis causing discoloration, is it really necessary to perform a root canal before internal bleaching?  Conventional wisdom would say yes.  But our understanding and respect for the pulpal tissue and its capacity to repair itself has changed my view on this procedure.

First off, teeth with calcific metamorphosis are often misdiagnosed as necrotic because they do not respond to thermal pulp testing.  Electric pulp testing (EPT) is required to determine vitality on these teeth.  If these discolored teeth are determined to have vital, normal pulps and periapices - why not perform internal bleaching without RCT?

The following case is an example of this procedure.

History of trauma to #8 with gradual discoloration
Close up of the color difference
Radiograph shows pulpal obliteration - complete calcification
Normal endo access with stain removal under microscope without entering canal.  Glass ionomer barrier placed at the CEJ and Opalescence Endo placed in pulp chamber. Access closed with Cavit and bleach left for 1 week. Fresh bleach reapplied for a second week.

Access filling placed.
Before & After
With no exposure of the canal system on a vital tooth, internal bleaching can be performed WITHOUT prior endodontic therapy.

Friday, June 13, 2014

Insurance Companies Respond to Delta Dental of AZ's Recent Changes

The dental insurance world in AZ is a buzz with the recent changes regarding Delta Dental of AZ.  These changes will force providers into the PPO network, to become exclusive Delta providers or terminate their relationship with Delta Dental of AZ.

There has been contact made with the AZ Attorney General's office regarding these concerns by other dental insurance providers.

Here are a few of the recent letters we have seen regarding their response to Delta. While being an exclusive provider for Delta is not a new concept, it is obvious that other insurance companies see that as anticompetitive and questioning it's legality.