From: "Bill Seddon"
To: "ROOTS"
Sent: Wednesday, September 13, 2006 4:56 PM
Subject: [roots] big apical preps

This premolar had a big apical parallel prep.  But it wasn't sealed.
The fact that I could remove it intact with a hedstrom file after a
little softening with the ultrasonic makes me question the seal.  The
molar is not one of mine but asymptomatic,  although I know dam wasn't
used.  If a crown is ever planned,  I will push for a re treat of that also.

I have now placed ca(oh)2,  and will obturate with MTA,  and then place
a fibre post passively in here as well.

It's not all just about one thing,  it's understanding the whole complex
issues of biology.  I was expecting a second canal here as well,  but
couldn't find one yet,  maybe next time I will find a branch? - Bill



Bill, Plenty of gutta percha extruding out the apex as well.

Did you mean you are going to obturate the entire canal with MTA?  Could you
expand a little more on why.  Not questioning you, just trying to learn. - Dr Huq

Dr Huq ,I don't think the gutta percha was the cause of the failure though.  It was simply down to bugs
and their non elimination from the system.  Having said that,  I am rather pleased it came out intact.

I would choose MTA as if I extrude it,  which I probably will,  it will allow growth of new cementum onto it
due to it's biocompatability.  In the past I could have used chlora percha technique,  or create an exaggerated
taper,  but these are not easy.  MTA leads itself so well to cases with apices > 60 approx.  As Joey D teaches
I would use a plugger on the MTA and then an ultrasonic tip lightly powered on the plugger to place the plug of MTA.

I would leave a plug of around 5 mm of MTA at the apex,  and then passively place a fiber post to help stop
the whole thing fracturing at gingival level.  At some point I imagine this crown will be replaced.
It's only a few months old now,  but it might not last the 40 years as it needs to.  - Bill



From looking at the rads,  I think you have a 3rd endo opportunity
available. - gary

Gary, Doing an upper tooth on him next,  typical UK mouth of someone who has
regular treatment but no real " care".  recently moved dentists,  so we
are both breaking him in gently.  - Bill

Might be a career opportunity for you bill :)  understood.  Get him out of
pain, get him used to you, and add in the bad news slowly. - gary