Calcification and the scope




The opinions and photographs within this web page are not ours.
Authors have been credited  for the individual posts where they are.
- Photos courtesy of Glenn A Van As - www.rxroots.com
From: "Dr. Glenn A. van As" 
To: "ROOTS" 
Sent: Thursday, June 30, 2005 11:11 AM
Subject: [roots] Calcification and the scope

Hi folks:  this is a case I did today that was pretty tough for me and its not perfect but it was tough.

This is a long standing patient who has elected for a few reasons not to have alot of treatment done until
recently when an emergency forced her to come in.  We are slowly making our way through treatment and today it 
was time to turn my attention to the lower right premolar.

This tooth had  an attempted endo where the previous dentist prior to 1995 attempted to get into the tooth but
was unable to find any canals and placed a tiny plug of Gutta percha in the tooth and bailed out.

Since she is considering a bridge, I tried to get into the tooth today. 

These are tough with the microscope let alone with only loupes.  You need great lighting (the Xenon light source
helps to see what you are doing), you need ultrasonics and a stropko irrigator to blow the dust away and if you keep
a little fluid on the calcification which is whiter and looks a little chalky, you can follow it til suddenly an opening 
occurs.  Calcification happens down the tooth from the crown down to the apex and typically after a certain distance
(in this case 10mm from the occlusal surface) there will occur an opening into the calcification to allow you to access
the canal.

I managed to get the canal to a 06 taper size 35 canal and irrigated with bleach and also with the laser.

The tough part in these cases is photographing the calcification as it is so tough to get light down to this level and
see what  you are doing.  I have not seen many good examples of the calcification in my practice but this case turned
out decent.

You can see the canal appear in the middle of the calcification, and please remember that this photo was 10mm down the
canal from the occlusal.

Hope you find it interesting, the case was not the easiest to treat (as you can see from the preop radiographs) and I
still have to put a post and core on it prior to the bridge but all in all I was pleased with just finding the canal - Glenn



















High Gary........

Xmount and Nikon D70
Flash system
Xenon
New Global G6
Dual Iris diaphragm
A reasonably large access in a composite filled tooth (easier toshoot)
Carrs great mirrors
ACDSee 7.0 post processing

I dont know if this makes sense but it is the system I am using.

I am rushing off to work.......late as ususal.  I will post more later 
on if I have a chance.  I hope it was a cool thing to see.  I was 
pleased to be able to shoot that far down the canals.  Kinda like my 
last case with the deep split in the canals.

Its all about light......you gotta have tons - Glenn

Makes perfect sense, but I was pretty much aware of your equipment setup.  I
was leaning more toward your thought process and aiming process in getting a
reasonably good shot half way down a lower bi.  With the self serving intent
of someday being able to do it half as well as my hero glenn :) - Gary

Hi Gary....thanks for the kind words. 

My thought process alot of times is just to take pictures along the 
way.  Sometimes I can use them, sometimes I cant.  There was a case the 
other day that I shot through a deep access into a crown and when I 
looked at the photos they werent usable.  This is a rarity for me 
because at present my main monitor hooked up to the camera is down.  The 
cable must have come undone inside the arm of the scope so I cant really 
see in large the pictures as I shoot them. 

Carlos taught me something a while back in that he likes to shoot 
everything indirect in the mirror and this is a very good idea as you 
get better detail in the mirror due to the light reflection down the 
canals.  I try to do this most times as I think it is a good idea.  
Sometimes I take direct shots though and find that they are as good or 
better.  Heck even sometimes if  you shoot more of the flash from one 
side than either straight on or even amount of flash on both sides of 
the ring flash that you get better photos as well.

All of a sudden the mess of confusion that occurs often at high mag in 
these teeth where you see colors and "stuff"  all of a sudden makes 
sense when I saw the calcification in the middle as I troughed.

I pushed a little with the DG 16 and thought hmmmm.... what is that hole 
when I looked down into the canal.  Before exploring it with a file, I 
took some photos then when I knew it was the canal I started taking photos.

One thing I noticed a while back is we tend to shoot photos with the 
canal dry but the camera does a much better job with water or bleach in 
the canal (not the pulp chamber) when you shoot it.

This goes the same for cracks and maybe if I have time later today I 
will post a case with a crack.

One last thing.  I had my associate ask me about Methylene Blue dye and 
it was weird because he mentioned that it didnt work real well with his 
loupes.  I tried it yesterday and at 2.5X power I couldnt see the blue 
dye enhancing the crack.  Bump up the mag to 12X power and wow it was 
obvious.  That is why I love Methylene Blue for cracks with high mag, 
much easier to see.

Gotta go Gary, hope that helps with the thought process, with the aiming 
process, you camera must be on your dominant eye.  I took crap for this 
a while back as being unnecessary, overkill etc.

Its not at high mag like the case I showed.  If you camera is on your 
non dominant side the pictures wont be exactly what you see.

Hope that helps.............Glad you enjoyed them - Glenn

Thanks for the tips glen.  Especially the moist canal and the dominant eye,
which as a photographer for many years I should have been aware of.
Methylene blue dye is an obvious help - Gary

One simple tip that I bet most folks forget is to make sure the scope is
par-focoled.  Since we have 5 folks in my office that occasionally take
photos (me, my 3 assistants, and my front desk who occasionally jumps to the
back), I set aside a couple hours one day for everyone to find their
personal parfocol numbers.   We recorded these measurements for each person
in the office and made a special little  cheat sheet for attachment onto
each of our 3 scopes.  That way before taking a photo, each person refers to
the chart and verifies the parfocol is correct prior to taking the photo - Mark

Mark, Another way that I record the parfocal settings on scopes used by multiple dentists is to put a piece of
white tape on eyeieces and put a color-coded mark for each Dentist. Dr 1 has the green mark, dentist 2 the red mark
etc etc. Just another method of doing the same thing - Stefan Luger. Microscope Consultant and Trainer

I parfocal the scope every  day for myself.  I find I like the accuracy I get by repeating this,
my eyes are not always exactly the same.  It only takes 10 seconds and is worth it.  The setting is slightly
different on some days - Bill

Bill, Tell me about the eyes not being the same.  I’ve been having a hard time reading.  I went to the optician
and explained that I think chronic use of the scope is affecting my eyesight.  He said that wasn’t the problem…the
problem was “1959”…..ie my birthdate.  

Anyhow, so far, keeping one set of parfocol settings seems to be working for me - Mark

In actuality, both of us are correct.  I’ve got seven more years on you, and never wore any kind of correction until
I turned 42.  I had better than 20/20 all my life.  Major emotional crisis at that time.  However, because we, as well
as jewelers, researchers, and some others who do close up work day in and day out, the muscles of our eyes tend to build
a “memory” to a specific focal length, that which we force then to do most often. After many years of this, and when we
turn to different tasks requiring a different focal length, our eyes do not want to rebound as quickly as they once did.

Theoretically, I think bill’s approach is more correct.  I know some days it takes me 10 minutes or more to be able to
focus on the morning paper, other days it is clear as a bell before the coffee is perked.  In reality, I set mine and
bolted it down, as I’m two lazy to do it daily.  I do occasionally check it, but I think it is still the newness factor
of the scope and wanting to play with it 

For what it’s worth, global recommends checking it once a year, based on what I have no idea - Gary

Camera is set on auto focus,  but yep,  when I turn it all on I check it. I don't need to do anything to the camera once
I am parfocalled,  the adapter,  carr 2,  and camera settings sort out all that out for me.  Plus,  I focus off a big TV
screen - Bill

So you do NOT set it on "flower and mountain"? - Fred

Fred, That's how I set up my 950,  but now I have the A95.  I find it keeps it's focus much better.
My 950 went kinda funny like they seem to.  I like the remote release and instant capture into TDO from the A95 - Bill