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From: "Ahmad Tehrani"
To: "ROOTS"
Sent: Tuesday, April 24, 2007 11:10 PM
Subject: [roots] Next patient today...Apical finish
Filing cases unnecessarily to bigger file sizes, doesn't do
anything except weakening the root structure, making retreatment
difficult and transporting the apex, inability to seal
the apex, etc.
I have no idea where this notion of "Big = bacteria-free"
came from. I guess from the same folks who advocate sugar free gum,
making people believe it is cavity free.
We instrument for one reason and one reason only:
"to clean the apical extent of our preparation with irrigants
(to clean and disinfect). so that we can obturate the space with
ease afterwards."
Cleaning doesn't render the canal bacteria free, it is all about
lowering the bacterial colonies and their efficacy below the body's
immune response mechanism. Since we have no idea what that is,
we use rubber dam, NaOCL, CHX, MTAD, BioPure, Smear Clear and
variety of other irrigating solutions to "disinfect" , not to
"sterilize". It doesn't matter if you finish all the
apices to size 100, it will never be bacteria free!
so when is "big" would be "big enough"??
Taper of preparation becomes important, to deliver the irrigating
solution deep in the body of the canal and to subsequently
introducing pluggers for warm compaction of GP.
Each case warrants its own size. I don't have a particular size
to finish cases to, nor do I care what the file should be.
A necrotic anterior central with chronic AP case may requires
larger files (like 50 or even 60) for apical shaping, but a thin
MB root of a lower molar confluent with ML canal, will never
accommodate such file. Using bent, pre-curved files in presence
of irrigating solutions, under a rubber dam with a surgical
microscope is the only way to address the delicate apical third.
- ahmad
Well, that is one opinion, but is certainly not the only one.
Here is a differing point of view that was presented at our own
summit in Monterey 2 years ago.
Dr. Senia is of course a lightspeed guy - gary
I think Dr. Trope&Dr. Card will not agree. They have a important
article for big apical preparations. Preparing a simple single
canal to #60 rendered it bacteria free. Very close for molar
canals (81.5%). Lightspeed did not help much after the canals
were already at #60. I think the more you clean, the less bacteria
you get. I don't think you can get completely rid of all bacteria
but I hope we come close. And I am not talking biofilms at all.
Very important dead horse. Local Lightspeed gurus use it all the
time to sell their "gear". - Thomas
Damn, it was a honest question. It wasn't my intent to beat a
dead horse. The cases are very nice. I simply asked why many
require larger apical finishes than others. If what you say is
true then I can just stop at my F2 and not worry about enlarging
the apex. I wasn't being pissy. I just asked an honest question.
See, this is the problem for a lot of GP's who are on here and who
might attend the Summit.
Now me, I could give a roaring crap how I'm answered but some
people would take this as a belittling response to an honest question.
I have great respect for Ahmad and all the top guys on here but when
no harm is meant, a demeaning answer is not necessary. Ken, you
think people are going to pay money to fly to Miami to get the crap
kicked out of them. Yea, I've been steadily kicked around on here
for a good number of years. Some deserved...most not.
I wasn't beating a dead horse but I guess Ahmad assumed I'm an idiot
and was being a horse's ass. That I can be but this was an honest
question - Guy
If the pre prep size is 40 and you clean upto 40 or 45
will it weaken the tooth ? - Goel
Everything weakens the tooth, it's just a matter of how much and
what kind of pressure vector is applied to make any damage - Thomas
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