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19 year recall - Molar case
From: Terry Pannkuk To: ROOTS Sent: Tuesday, May 04, 2010 3:21 PM Subject: [roots] 19 year recall scanned Here’s a molar I treated in 1991 in two steps. The patient came back for a maxillary tooth today and I took a free CBCT scan for him today. I didn’t start using a scope until 1994 so this was when I was using loupes. I started using rotaries around 1994 also. Personally, I think my cases were better in 1991 than they were from 1994 to 1998. Learning to use rotaries was much more of a problem than the microscope was a help. J It took a little while to learn how to use them less and blend them with the use of hand files for apical shaping. Rotary files have not improved endodontics, other than making it a little bit faster and easier physically on the dentist performing a case with difficult access. No one can convince me that quality has improved because of rotary files unless you are considering that the bar has been raised from terrible to mediocre for those trained solely by weekend courses. There was a large lesion circumscribing both roots and it appears to be completely healed. - Terry
hi terry, what are the clinical consequences? retreatment? control? nothing? - Dennhardt H
Clinically, rotary files do not clean complex apical thirds of roots very well. They are
predisposed to separation and just simply should be used only for opening better angles and
paths for a series of precurved hand files. The problem is that the entire profession of
dentistry has been bought and sold by commercial hoodlums selling products instead of
committed to discovering clinical truths. I trust very few people in the profession to teach
me anything that I can believe because they are usually just selling their lies to promote
their ego or pad their wallets. Apparently I am one of the few people actually stupid enough
to state that in public.
The specialty of endodontics would have been much better off, fewer patients would have been
abused if rotary NiTi files had never been invented. I’ve simply played around with them to
find safe limited ways to use them in ways that benefit me as an aging endodontist who’s back,
fingers, and arms get tired from doing an entire case with hand files. If I was age 30
I probably wouldn’t be using them at all - Terry
About using hand instruments what sequence would u suggest to use or u would use if were 30,
if no rotary is to be used. - Anantpal
It depends upon numerous subtle things:
1 Access
2 Apical complexity
3 Apical configuration
4 Degree of calcification
5 Areas of calcification
6 Operator nuanced behavior such as left-handedness.chair position,posture,
hand-finger patterned movements, etc. etc.
but in general principle encountering an apical disruption that prevents simple patent file
passage through the apex, requires that one go through a passive set of recapitulation series
with precurved files to remove that disruption allowing a smooth cone fit that binds apically
with tug pack so that the form of the cone when compressed has less complex, simpler, less
volume space to fill with sealer. Experience and a confident history of dealing with a
myriad of apical forms allows one to appropriately and more ideally choose an apical size and
execute cleaning and shaping of the root canal system to remove just the necessary amount of
dentin and leave the apical opening of the root as “small as practical
There is no cookbook sequence but simply general case sequence patterns that allow you to
ideally clean certain types of systems:
As a rule, I spend quite a bit of time getting access, finding all the orifices, troughing
all the grooves, then tweaking the access walls ideally so there are no overhanging dentin
ledges that will cause problems later. Next I run through series of passive hand file
recapitulations that allow entry of “passive” Gates (“forced” Gates create the problems of
all those who don’t use Gates claim they cause; i.e. Coke bottle preps). Passively used
Gates simply create slightly more circular cross-sectional diameters in the coronal third
allowing better irrigant flushing and removal of debris. Next, Length determination,
next some rotary use if safe, then final apical prep with hand files. Basically,
I only use rotary files when safe to briefly open up the middle third and create a little
more space for irrigant flushing. If safe I use rotaries a bit in the apical third.
Judgment and experience guides safe use and the precise sequence. This is the cleaning
and shaping protocol I have great confidence in feeling it is very safe and predictable
for a great number of cases.
Rotaries are overhyped, don’t’ clean well, and are dangerous. I use them, but very
carefully and safely - Terry
So do you do a step back from the apex? Do you use flare files? How about H files?
Apart from GG do you use Peesos? How about Protaper, Profiles, twisted files, Hero shapers,
Bio Race files which do you prefer?
About your GP cones which brand do you use? Schwed? Which pluggers and spreaders do you use?
Do you use Kerr Sealer?- Sanjay Jamdade
I’m used to Schwed K-files, ProTapers, GG’s; that’s it. I think trying different files
constantly is risky and requires relearning file characteristics that are unique to that brand.
I switched to different rotary files three times (Greater Taper to Quantec to ProTaper over
the last 15 years) but only when there is a problem with what I was using. If I had time
to bench test a bunch of files I might make changes a bit more frequently. It doesn’t
really matter what file you use as long as you understand the limits and capabilities of
that particular file. I don’t like the idea of trying something new on a private practice
patient and finding out it didn’t’ work as well as what I normally would do.
Experimentation should be done elsewhere - Terry