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4 canals
From: J. Terry Frey, D.D.S. To: ROOTS Sent: Wednesday, March 19, 2008 8:53 PM Subject: [roots] 4 canals I saw this nice looking young lady a couple weeks ago and she is, of course, is 18 and HH/ Hoosier Healthwise/ Medicaid. Well, she’s been having pain in 8 & 9 and 14; so I say, no problem I can whip these out in an hour and a half. Hope. Need help and advice and no, I still don’t have a scope, but just my 3.5 X magnifiers. I really want to help her, because she’s getting ready for senior pictures and there isn’t an endodontist within 30 miles of here that will touch Medicaid. So, good, professional, caring suggestions and advice will be much appreciated. I just couldn’t find the entrance to get to the apex. Obviously, it is there by the way the Vitapex looks. Suggestions on locating it and getting patency? - Terry
The only way I have been able to handle this type of case is to use an operating microscope
and lots of imaging to make sure your stay in the tooth. Remember when you are looking into
the tooth you cannot see the labial/palatal angel and are at risk of perforating the
facial aspect usually. - Jody Welch DDS
Terry, put a nice sweeping bend in your file and try to have the file engage the palatal aspect
of the canal as you move apically.----usually the tendency is for the ledge to be on the facial
aspect and it is difficult to engage the palatal aspect of the canal wall. Be patient and use
a light hand hopefully it will be detected. Then work sequentially larger hand files, pre-bent.
You may never get a rotary down there and don't worry about that. If all else fails, and
referral is no option, disinfect to the best of your ability to that length, obturate, and
seal tight, monitor, and if there are no symptoms you may have healing despite not being able
to instrument to full length. I have seen this happen on some retreat cases I have done.
Certainly not an ideal answer, not likely a long term solution, but may buy the patient
some time until other options can be exercised.
If you were asking about negotiating the MB2, you still have a dentin ledge covering the orifice,
and if you attempt entry into the mb2 at this stage, your file will be directed mesially and
likely cause a ledge. Unroof, open the orifice, then attempt further negotiation - KendelG
