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7 Canal mandibular molar

From: Terry Pannkuk To: roots Sent: Wednesday, December 28, 2011 2:40 AM Subject: [roots] 7 canal lower molar I accessed this vital molar this morning. The distal crack extends two mm into the DL canal, but does not involve the mesial wall, pulp chamber floor and there is no other crack on any of the other walls. For that reason I assessed it as a fair prognosis and not worse, but warned him be careful until it is restored. There was a huge pulp stone in the distal half of the pulp chamber. Anyone who likes the term reparative dentin instead of irritational dentin probably think venereal warts should be called beauty marks. If you don’t remove all the irritational dentin you are going to miss anatomy, leave uncleaned tissue, and have an undesirable result and certainly not understand the tooth or the proper treatment very well. Two very common clinical sins are: 1. Failure to extend access properly 2. Failure to remove Coxcrap, aka irritational dentin. In this case removing the Coxcrap allowed more precise assessment of crack extension (and what Craig call’s crack density, I like to call it crack prominence for semantic reasons but we’re on the same page conceptually; the nature of the crack is important to assess and has a subjective element to it. Removing all the Coxcrap also allowed very simple visualization of 7 canal orifices in this tooth. 3 in the mesial (MB,MM,ML) and the distal (DB,DL, DMB, DML (distomiddlebuccal and distomiddlelingual) - Terry 7 Canal mandibular molar

7 Canal mandibular molar Terry, Assuming no distal probing adjacent to the crack... if a CBCT confirmed a vertical defect of let's say 2-3mm adjacent to the distal crack, does your prognosis or treatment decision change? - Mike Nope, no pre-treatment CBCT would have been a wasted set of rads and file space, why? What would a CBCT show? Exploratory access with a microscope, proper access extension, and removal of Coxcrap shows more than a pre-treatment CBCT could ever show. I might take a mid-treatment or post-treatment CBCT if I suspect there is something I need to see due to the extraordinary anatomy. Normal probing. - Terry proof that there is a huge difference in treatment planning a patient and taking care of a patient. - Craig barrington Sent: Saturday, December 31, 2011 5:58 AM Subject: [roots] 7 Canal mandibular molar 2nd appointment, one to go. This is my last patient of 2011. 7 canal mandibular molar, not finished yet (the one I showed earlier this week). You can see that I placed the files in the distobuccal, distomiddlebuccal, distomiddlelingual, and distolingual canals having to cut off the handles of the two files in the 2 buccal canals so that I could keep them positioned for the check radiograph. It looks like 3 main apical POE’s but we’ll see next week when I pack it. I may run a live video connection during a gotomeeting session having split macro-operatory and microscope video views during the obturation of the distal canal and share it live with a couple of friends connected as an AV test for future real-time demo education ideas. The patient is real easy going, might be a really fun real-time online demo - Terry 7 Canal mandibular molar

7 Canal mandibular molar

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