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Long lower third : constriction of the mesial canals - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been credited
for the individual posts where they are - www.rxroots.com
From: "Guy Moorman"
To: "ROOTS"
Sent: Sunday, September 06, 2009 7:32 PM
Subject: [roots] two from a couple of weeks ago

Don't post much here because don't usually get critiques like I used
to...great learning.  But I keep trying for some reason.  I'll post this on
EndoFiles this afternoon.

Leaving for a week in Maine tomorrow so these are the last two for a while.
There were interesting.  Plus did a palliative on a three rooted lower first
bicuspid this morning...referred...going to be fun.

Fletcher was a long lower third.  This one started with tiny canals.  I'm
deficient here in not posting pre-0ps but both were referred by a young
dentist who prints out the preops from digital.  It is getting scary.  The
first films I take are often of me measuring my cones.  I adjust length with
the EAL as I go.  Twisted files starting with a 0.10 25 tip and moving down.
Was able to get to length with a 0.06.  Finished apexes with 0.06 tapered
K3s to 35 on mesials and 40 on distal.  Mesials merged.

White was tougher because of the constriction of the mesial canals so far
coronally.  I started my crown down with a 0.08 Twisted file and got around
the constriction without engaging the flutes.  Moving the orifice away from
the furcation with a SX helped that.  Finished a mm shy of the constriction
due to some complicated anatomy at the apex...little curves and twists.
Finished the last two mms with a 0.02 tapered K3.  Canals were sized to 0.06
and apexes finished with the K3s.  The lesion on the mesial was marked for
the referring dentist.  It interferes with the film so I did it without
also.  I stayed patent with a 20 stainless K file.  Distals merged and
mesials appear to but are actually separate.

Obturation was with Resilon and Real Seal with bonding agent.  Warm vertical
using System A/Pac Mac and Dovgan pluggers or a mishmash of sealer and
dentin chips as Terry would say.  Sort of just pray you don't strip perf.
Would have stayed with a 0.04 taper but flutes of 0.08 and 0.06 went by
constriction passively - Guy W. Moorman, Jr. DDS

Guy, Your cases reflect and underscore the lessons learned by being an active participant on Roots and other list serves. Perhaps it is more important to share your knowledge with newbees on Roots so all the valuable knowledge you have assimilated can be passed on to the next generation of focused and earnest clinicians. As Will Geer said to Robert Redford in the movie Jeremiah Johnson.... "You've come a long way pilgrim!". Self criticism is the best way to insure that the excellence in endodontics you pursue remains at the highets level possible. Enjoy your vacation - Marc Thank you, Marc. When you were president of the AAE you had a goal of raising the bar. For some reason that hit me squarely between the eyes. As I said, I had started on a path of going strictly endo since Im sort of working because I love it. But I found that the bar needed raising everywhere. Raise the bar and not just for endodontists. I took that to be your goal since 80% of endodontic tx in the US is by GPs and too often poorly. Several young dentists send me their molar endo and tough endo. I found that the bar needed raising in their restorative so we developed a relationship that allowed me to tell them my opinion on post endodontic treatment. Raising the bar is done a small step at a time. It is not going to be done instantly and it is not going to happen even overnight. It happens in small victories. One for me was getting the Sargenti removed from the Endo section of DT. Your goal of raising the bar did certainly hit me directly between the eyes and told me that I had things to do to help the young dentists in my community to grow. When I had the three major coronary arteries opened, my cardiologist told me that I should have been dead 20 years ago and hed never seen that much collateral circulation form around a blockage. He told me that the Good Lord had something else for me to do. I think it was to help the young clinicians in my community. - Guy

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