From: Bill Watson
To: ROOTS
Sent: Thursday, August 30, 2001 6:37 PM
Subject: [roots] calcification

Here's an interesting case that I just gave up on this morning.  I saw the pt for the first visit
and got as far down the canal as I could.  I placed Ca(OH)2 and saw him again today.  I could not
progress any further apically with hand files or rotaries.  I placed a bonded resin in the
canal/access cavity and have scheduled him for apical surgery.

I have another resorption case going like this one that is in the works.

Note on the photomicrographic images the characteristic white color of the dentin.  You'll notice
a 'white ring' that is where the replacement resorption dentin begins and then proceeds to the
most apical extent of canal penetration.  In my experience, canals such as these are practically
impossible to treat conventionally whenever there is no canal visible apically.  I'd much rather
see no canal coronally than apically.  At least if you see one apically you have hopes of
dropping into something. - bill



Sensitive teeth 

Drugs of choice .. 

Going to USA? 

Broken file case 

System A obturation

On bleach and biofilms 

Protaper case 

CaOH 

Miracle of CaOH 

Calcification

Latex Allergy 

Gold Crowns 

Patency files 

Sealing cap 

Secrets of paper points

Bleeding on scaling 

Disassembly and retreatment 

Extra root? 

Extra Canal 

Repair of cracks

Ozone revolution 

Sedation Case 

Nasty little curve 

Ideal root filling material 

A fun case



Nice pics Bill!  Now you can do this!  What did you change so you get pics of this quality!

I agree totally on your approach here.Sometimes you can get into these canals but more often, you
can't because there really is no canal at all.

I also think you are far better off with the resin than MTA in a case like this. It will make the
apico a lot easier too. - Gary

Dear Bill: Beautiful pictures and beautiful post. I am having trouble with my coolpix. for some
reason I am not getting the light into the canals. gary advised me to play with the white balance
but this far have not been able to. Maybe it's time to travel to san Diego and get myself in the
documentaation lecture. -    Uzi

From: Bill Watson

I think that a lot of getting images like this has to do with getting the maximal amount of light
down the canal.  The Carr mirror has been one of the major helps as well as adjusting the angle
of the mirror/scope to get the maximum amount of reflective light.  I also was using a low res TV
monitor before and now I use an SGI [overkill] monitor with 1200x1600 res that translates well to
WYSIWYG. Thanks for all of your tips., bill - the mirrors are great!!!!

Bill clarifies...

I do stand corrected.  It is the SGI 1600W LCD.  It is a 1600 x 1024, .23 mm dot pitch (110dpi).
I quite like the wide-format screen as I can display my radiograph and video display at the same
time.




Bill, Beautiful pics!!  I'm very impressed.  You have arrived!!

I agree with your treatment plan.  So many of these are quite impossible to negotiate, even with
the scope (for me, anyway ;-().

I wonder what it would look like if you placed Hypaque, for example, into the canal space and
then used a dental "plunger" to force it apically.  It would be very interesting to see if there
were any canal communications or spaces remaining.  I have some histology somewhere that showed
that there were small islands of necrotic tissue remaining in the calcified part of the canal,
but not a real canal, per se, that could be negotiated., Fred

Those would really be interesting slides to see.  I can picture it in my mind.
It would have been interesing to place some hypaque in the canal.  Where can you get the stuff?
- bill

Why the apical surgery?

I have seen many cases obturated to this point that have healed.   I've also
seen many that haven't, but I think there is a chance that it can heal without surgery.

Bill, was it symptomatic before you placed the CaOH?    Is it symptomatic now?

I've got a handful of these things where after I obturated, I see a string
of gp/sealer going down the root. - Jerry Avillion


Dear Bill. The images are great.

A couple of questions:

1) How often do you choose to encroach upon the incisal edge to vary your access to the apical
pulp system? and

Almost always, on lower anteriors, do I extend my access to the incisal edge.
That is one of the  single best ways to locate, shape and clean the second lingual canal [in my
personal experience and opinion].  - Bill 

2) I have the impresison on looking at your canal shots that the depths of the cavity is wet. Or
at least very reflective ( action rather than mood ). I find that drying the depths pf the cavity
makes visualization much easier/possible.

It was very reflective.- Bill 

Sunny in Melbourne, Garry J Nervo

Thank you for your kind words.

I have a few questions but it would be nice to see some pictures (I'm starting to sound like
Gary-let's see the cases) with the representative problems you are encountering.  You should make
a trip to Gary's course as it can significantly decrease your learning curve.

1-Are you using the 950?
2-Are you using a Carr mirror?
3-What are your camera settings?
4-What type of light source do you use?
5- When/where are you having your problems with inadequate lighting-an
accompanying image would be helpful?

If you answer these questions with accompanying images I, as well as many others will be able to
give you our thoughts. - bill