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The opinions within this web page are not ours. Authors have been credited
for the individual posts and photographs where they are. - www.rxroots.com

Calcification


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



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 of 
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

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