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Pulp-capping
LETTERS TO THE EDITOR T H E JO U RN A L devotes th is s e c tio n to co m m en t by readers on to p ics o f cu rre n t in terest to d e n tistry. T h e ed itor reserves th e rig h t to ed it all co m m u n ica tio n s to fit av ailab le sp a ce and requ ires th at all letters be sig ned . P rin ted co m m u n ica tio n s do n ot n ecessa rily re fle c t th e o p in io n or o fficia l p o lic y o f th e A sso ciatio n . Y o u r p articip atio n in th is sec tio n is in vited.
P ulp-capping
unsuccessful were advanced well beyond the reversible stage of in flammatory pulpal involvement by the time treatment was instituted. If this speculation is true, it is highly unlikely that antibiotic therapy would have accomplished anything but a possible masking of symp toms.
□ Jordan, Suzuki, and Skinner (The Jou rn al, July) indicate the apparent
resolution of “periapical lesions” in molars treated with indirect pulpcapping. The technique appears valid, but the interpretation of periapical lesions should be ques tioned. The authors imply that a le sion involves pathosis. Long clini cal experience and observation, however, indicate that true periapi cal lesions or radiolucent areas are associated with pulpal disease and necrosis, and these are not amena ble to indirect pulp-capping proce dures. The periapical lesions described may often be noted in normal mo lars if the radiographic angulation is altered and if exposures are made with superimposition of anatomical structures. The mandibular nerve canal, bone depressions, sinuses, and tori can simulate radiolucency and hyperostosis. In addition, re cently erupted molars with normal pulps can show apical variations. Intact apical lamina dura is not ap parent radiographically in many normal teeth. R O B E R T J. M A T U SO W , DMD CONCORD, M A S S
□ I would like to hear the com ments of other practicing dentists and those in the academic dental community on “Indirect pulpcapping of carious teeth with periapical lesions.” I believe two points could be clarified. No men
R. E. JO RD A N , D D S, M SD D. H. SK IN N ER , DDS M . S U Z U K I, M S , DMD LONDON, O N T A R IO , CAN A D A
tion is made of a medical history of these patients, and there is no refer ence to indicate that they were given prophylactic antibiotic ther apy. I mention this because of what appears to be a rather high unsuc cessful treatment result, higher than 50%. Thirteen of 24 teeth were un successfully treated.
The article and research involved are very interesting. . . . Additional academic and clinical input on this subject can be most helpful to our patients. E R N E S T B. JOH N SO N , JR ., DDS T R EN TO N , NJ
A u th ors’ com m en t: The medical histories of patients treated in our research project were, for the most part, noncontributory. Inasmuch as the apparent inflammation was en tirely localized in the periapical re gion, and systemic manifestations of any kind were entirely absent, prophylactic antibiotic therapy was not indicated.
In the absence of histological findings, we believe that the cases in which conservative therapy was
Broken diam onds □ I would like to call T h e Jou rn al readers’ attention to two errors in “Status report on rotary diamond instruments” which appeared in the August issue. Dr. Nuckles incorrectly stated that our study tested diamonds when run “continuously,” whereas in fact we stated repeatedly that we used them interm ittently. Also, he based his reference to our work on an IADR paper given in 1976 and a phone conversation early in 1977. Thus the quotations he used were from the first half of the study and not from the final published study which made the whole effort more meaningful and more accurate. Five of the ten manufacturers of diamonds that we first reported were not too happy because their instruments broke at 5 oz. On the basis of complaints from a manufac turer, we then repeated the whole study and used a much lighter load (1.8 ozj. We simulated the “heavyJADA, Vol. 97, November 1978 ■ 781
P ulp-capping
unsuccessful were advanced well beyond the reversible stage of in flammatory pulpal involvement by the time treatment was instituted. If this speculation is true, it is highly unlikely that antibiotic therapy would have accomplished anything but a possible masking of symp toms.
□ Jordan, Suzuki, and Skinner (The Jou rn al, July) indicate the apparent
resolution of “periapical lesions” in molars treated with indirect pulpcapping. The technique appears valid, but the interpretation of periapical lesions should be ques tioned. The authors imply that a le sion involves pathosis. Long clini cal experience and observation, however, indicate that true periapi cal lesions or radiolucent areas are associated with pulpal disease and necrosis, and these are not amena ble to indirect pulp-capping proce dures. The periapical lesions described may often be noted in normal mo lars if the radiographic angulation is altered and if exposures are made with superimposition of anatomical structures. The mandibular nerve canal, bone depressions, sinuses, and tori can simulate radiolucency and hyperostosis. In addition, re cently erupted molars with normal pulps can show apical variations. Intact apical lamina dura is not ap parent radiographically in many normal teeth. R O B E R T J. M A T U SO W , DMD CONCORD, M A S S
□ I would like to hear the com ments of other practicing dentists and those in the academic dental community on “Indirect pulpcapping of carious teeth with periapical lesions.” I believe two points could be clarified. No men
R. E. JO RD A N , D D S, M SD D. H. SK IN N ER , DDS M . S U Z U K I, M S , DMD LONDON, O N T A R IO , CAN A D A
tion is made of a medical history of these patients, and there is no refer ence to indicate that they were given prophylactic antibiotic ther apy. I mention this because of what appears to be a rather high unsuc cessful treatment result, higher than 50%. Thirteen of 24 teeth were un successfully treated.
The article and research involved are very interesting. . . . Additional academic and clinical input on this subject can be most helpful to our patients. E R N E S T B. JOH N SO N , JR ., DDS T R EN TO N , NJ
A u th ors’ com m en t: The medical histories of patients treated in our research project were, for the most part, noncontributory. Inasmuch as the apparent inflammation was en tirely localized in the periapical re gion, and systemic manifestations of any kind were entirely absent, prophylactic antibiotic therapy was not indicated.
In the absence of histological findings, we believe that the cases in which conservative therapy was
Broken diam onds □ I would like to call T h e Jou rn al readers’ attention to two errors in “Status report on rotary diamond instruments” which appeared in the August issue. Dr. Nuckles incorrectly stated that our study tested diamonds when run “continuously,” whereas in fact we stated repeatedly that we used them interm ittently. Also, he based his reference to our work on an IADR paper given in 1976 and a phone conversation early in 1977. Thus the quotations he used were from the first half of the study and not from the final published study which made the whole effort more meaningful and more accurate. Five of the ten manufacturers of diamonds that we first reported were not too happy because their instruments broke at 5 oz. On the basis of complaints from a manufac turer, we then repeated the whole study and used a much lighter load (1.8 ozj. We simulated the “heavyJADA, Vol. 97, November 1978 ■ 781