From: sashi nallapati
To: ROOTS
Sent: Thursday, July 28, 2005 3:02 AM
Subject: [roots] 2 of 7

Here is my second 3 canal bi at the school,
two in  seven max first bis. i have done so far at the school have three canals
keeping  25% incidence  intact ;-)
I was on the undergrad clinic floor teaching, and this student walked to me for help in taking radiographs for this
case. I did help him take the radiograph , but took away the case after seeing the rad and found  the third canal..
it was a tough case in the sense , the split was slightly beyond a curve and even with the scope i could not see the
actual orifices..looking at the common buccal canal critically, the straight line access to the split could have been
improved and the cone fits could have become a little easier.

you can see the 2 files in both buccal canals...one buccal cone at a time with the palatal cone intact
passive down pack mesiobuccal , remove the material that blocked  the distobuccal with a file and place a cone
in the db an downpack active downpack of each canal..and backfill.

with gp as the cones , i am confident i would have seared the cone to the level of the split with out pulling the cone
or blocking the second orifice. with resilon on the other hand, even at 100c the cone gets too soft and a liitle
mushy.i struggled with resilon on this case but am happy with the final result.

comments/critique is welcome... sashi nallapati




Sashi, Superb as allways. How did you find the biforcation if it's not visible with a microscope ?
Did you know it's there from the x-ray ? Clap, clap, clap - Thomas
P.S Your remarks on Resilon are very important

Thomas, the initial preop (in film) made me suspicious.(in my book, every max bicuspid has three canals until proven
otherwise) the working length image with buccal and palatal files were a little off centre and that led me take over
the case from the student dentist.prebending a 10 file with a little manipulation got me to the split.remebering the
path of insertion and the angle of the file led me consistantly to the split to clean and shape.i used only hand SS
files in this case.prebent Niti files like hand GTs and hand PTs would have worked great also.but i didnt have them at
the school.

The more we use this obturation material in every clinical situation, the more we understand the pros and cons of it.
most  presenters do not talk of these issues, may be because they dont see these type of cases and these are anecdotal
clinical issues ..;-) - Sashi Nallapati



You still got it Sashi.........keep em coming I love it.
What are you filling with now. - Glenn

I am using resilon at the school.
I still have some samples left from what bruce generously offered me at the AAE meeting.- Sashi  Nallapati

I said this on TDO, but I'll say it here as well...
Sashi, I don't think I would have got this one.  Very well done.
This goes in the "I would have been oblivious to the mistake I was making" category.- John A Khademy

Dear Sashi: I agree with John, I just thought of all of all of  my 2 canal upper bi´s that looked like this one’s pre-
op. Our mutual friend  Valle says “geographic success” (due to patients moving away from city to city) saves us from
seeing all our “left behind” canals.- Jorge

Beautiful case, Sashi - Jorge Vera

Excellent! Did you take pictures with the scope? - Jörg Schröder

No, i could not see the split through the scope. its too far apical to get a decent pic of..Sashi  Nallapati

Sashi, This belongs in a textbook ! Wow, gorgeous case ! - Marga

Fantastic work Sashi. You are indeed very gifted. I wholeheartedly support all the positive comments you've received
from all other respondents to this post.

Three quick questions though:

1. What where your final apical (open) sizes for each canal? They seem a little small to me.

Answer: mb 40(06 T), db 25(02T) and palatal 40 (08T). the apical size of the db can be improved a little bit more.
from a  scientific standpoint ,however, the apial sizes of these bifurcated buccals in only 20 (kerekes,tronstad), and
thus the sizes that i imparted are well supported ;-) - Sashi

2. In one of your final radiographs you seem to be 'fairly' short on the palatal. Judging by the sealer tract, I don't
think the foramen is at the level you've obturated to. What is your view on this?

Answer: since using resilon , i am fitting my cones 1mm short of the my wl to see if i can get to push the cone to
length.hence, yu see the fill in the palatal half a mm short of where i would like to see it. since i am patent,
maintained patency and instruemnted to the rad terminus i am not expecting any harm.- Sashi

3. Are you not concerned about the open restorative margin on the distal?

Answer: I am concerned.hopefully it will be removed in a week by the student who actually replaced the amalgam with
that IRM, during his initial attempt. - Sashi

I know my questions are verging on pedantics, and I certainly do not want them to detract from your beautiful work.
Additionally, as you and I know, there is no doubt this case will succeed.

Keep up the good work. I love your posts. Cheers,- Peter

Thank you for your anwsers Sashi. You've adequately addressed all my concerns. And yes, I also agree that GP would
probably have been a little easier for this case. Let's hope the student restores your beautiful work appropriately
very soon. Once again, I commend you for your effort of this tricky (and in my view, infrequent) clinical scenario.
Regards,- Peter

Fantastic Shashi....is it possible to do such cases without the scope? - Sachin

good question sachin.. yes , it is possible.
scope use would make it  more predictable and more efficient.
particularly in the location and obturation phases.- Sashi Nallapati