great work Marga . excellent! What about 17 - also tender?, palpation, percussion? - x-ray shows, let's say mildly, "not the best work"! - Veiko Thanks Veiko! This patient was very unfortunate, due to her persistent complaints, subsequently 17, 47 and 46 have been root canal treated .........., without relief of her complaints..........useless to say that the quality of delivered care is less than optimal...... Marga Hello Dr Marga , never seen such great documentation and above all its seems so easy when u show it , but i know its tough when we do it , great job - Gurpreet Hello Marga. Great case and documentation. I recently got the Munce burs and have found them excellent. They provide the visibility of the Muellers burs but have enough rigidity to cut where desired. Also I think they are a bit longer than the Muellers so you can get into deeper areas - Larry Hi Larry, You hit the nail on the head, yes, that is exactly why I like the burs - Marga Very nice case Marga. Glad you've found good applications for the Munce Discovery Burs. I designed them specifically for locating hidden MB2 canals, calcified canals, gaining access to sep'd instruments, etc.... Did you use it to navigate to the alloy retrofill on the MB or was that simply done via your standard cleaning/shaping? If I were to attempt to expose a retrofill like that, I'd navigate down the canal with decreasing-diameter Munce Disc'y Burs, always working into the bulk of root structure--away from the furcal wall (nothing you don't already know, but that'd by my strategy....). BTW--keep an eye out for additions to the Munce Disc'y Bur line this fall....... cjm. Nice case Marga! Can I use this for my residents? Of course you get all the credit for the case - Randy Hi Marga, Another informative, educational endodontic tour de force! Your last sentence here reminds me of some of my experiences. From the x-rays you provided I can see (but can't be certain due to lack of other information) that the molars are very flat. They appear to have lost their cuspal anatomy. That could be from successive treatments or form clenching/grinding and successive treatment. That and your mention of teeth that have apparent endodontic pain but do not resolve upon treatment reminds me of similar situations I have been in where the causative and overlooked agent was the occlusion and myofascial pain. If you have a chance you should read Janet Travel's book "Myofascial Pain and Dysfunction" the Trigger Point Manual, upper half of the body. IMO a classic text about often overlooked or misdiagnosed Myofascial Pain from the head and neck muscles which can refer to certain teeth and mimic tooth ache pain even after the nerve is gone! Each muscle has a mapped referral pattern to corresponding teeth. I think it should be a must for endodontic (as well as any dental) education. I know this is a known phenomenon, but sometimes it is worth getting the original text and reading it for yourself. This is one of those - Arturo I could not agree more, Arturo. I have used that text for twenty years. DougR Excellent as always Marga! Have you had a chance to know if the pt. has had relief from symptoms? - KendelG
