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Torturous apical anatomy - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are -
From: Mark Dreyer
Sent: Wednesday, October 14, 2009 7:10 PM
Subject: [roots] My best impression of Terry's apical recapitulations

My initial impression from viewing the lesion at the distal on the 
pre-op rads was cracked tooth. There were no probing defects and no 
crack was noted internally so went ahead and shaped/packed caoh
and brought her back a month later.  All symptoms and sinus tract 
resolved by visit 2.

My first impression on seeing the final rads was I transported the 
canals.  However after studying the multiple angles I think I may be ok.  
There was no rotary files used in this tooth beyond the junction of 
the middle/apical third in the mb/ml canals due to the torturous 
apical anatomy. Wacky tooth for sure.  I'm betting Terry will like 
my ugly "non-Tulsa" shapes.  :-)) - Mark Dreyer, DMD

The root sure looks cracked and it looks like a Khademi access so 
I'm not sure you really know if it is cracked.  This is precisely 
why I don't agree with Khademi pushing his access design principles. 
It may appeal to the pop culture of "Biomimetics Feel Good Restorative 
Empowerment" but it doesn't do crap for eliminating the endodontic 
vector of disease.  Lower molar access preps should be extended to 
create a more rectangular form so that each corner creates direct 
access to 4 canals, which is common in the distal and may be present 
in your case.  If there isn't a 4th canal the rectangle still needs 
to be formed to insure that a wide ribbon is clean and the oval 
orifice form is peeled away and explored for deeper unexplored 
anatomy.  This is also necessary to smooth the walls and detect 
otherwise missed subtle cracks.

Sorry about the bluntness, but this message has to be relayed 
because this concept is so grossly misunderstood by those preaching 
"conservative access" - Terry

"Biomimetics Feel Good Restorative Empowerment"  ROFLOL...this is 
hilarious - Joey D

I donít think that all lesions seen like this are cracked roots 
seen too many heal and get crowns when they heal.  The highlighted 
statement is just solid common sense.  I donít know where John gets his
philosophy and his passion about it but you nailed it - Guy

Hi kendel terry loves natural shapes  as he is not someone who 
loves artificial shapes and people and keeping things natural and 
being natural is the most difficult ,superb execution . Gurpreet
Protaper flaring
6 yr old Empress
Cvek pulpotomy
Middle mesial
Endo misdiagnosis
MTA retrofill
Resin core
BW importance
Bicuspid tooth

Necrotic #8 treatment
Finding MB2 / MB3
Deep in a canal
Broken file retrieval
Molar cases
Pushed over apex
MB2 and palatal canal
Long lower third
Veneer cases
CT Implant surgury

Weird Anatomy
Apical trifurcation
Canal and Ultrasonics
Cotton stuffed chamber
Pulp floor sandblasting
Silver point removal
Difficult acute curve
Marked swelling
5 canaled premolar

Sealer overextension
Complex anatomy
Secondary caries
Zygomatic arch
Confluent mesials
LL 1st molar (#19)
Shaping vs Cleaning
First bicuspid
In Vivo mesial view
Inaccesible canals

Premolar 45
Ortho and implant
Lateral incisor
Churning irrigant
Cold lateral
Tipped to lingual
Acute pulpitis images

Middle distal canal
Silver point
Crown preparation
Epiphany healing
Weird anatomy
Dual Xenon
Looking for MB2
Upper molar resorption
Acute apical abcess
Finding MB2

Gingival inflammation
Irreversible pulpitis
AG BU ortho band
TF Files
using TF files
Broken bur
Warm technique
Restorative prognosis
Tooth # 20 and #30

Apical third
3 canal premolar
Severe curvature
Interesting anatomy
Chamber floor
Zirconia crown
Dycal matrix
Cracked tooth
Tooth structure loss
Multiplanar curves