From: Sashi Nallapati.
To: ROOTS
Sent: Tuesday, July 10, 2007 8:31 AM
Subject: [roots] coronal 1/3 root calcification

I have seen coronal to apical calcifications , mid root and apical calcifications but never
have seen pulp horns intact, mesial canal orifices intact but the coronal 4 mm or so beyond
was calcified. and then apical 6 mm or so patent...it took me a good hour and half to penetrate
through the coronal third of the mesial root calcifications. Munce burs and some M4 action...
- Dr.Sashi Nallapati





Hi Shashi .......................excellent job.

I for the moment am using Rotary Ni Ti files in a reduction handpiece and hand files but also
would like to start using a Reciprocating hand piece like M4 or m/b if NSK has to offer something
(as NSK has a good presence here in India and the after sales wouldn't be a problem.).
What do you say ...............will it be more helpful than hand filing?? - Sachin

Sachin, I would highly recommend the NSK TEP-E10R - Gopal

hi sachin/Noemi

I definitely find it very useful in three occasions.

1. when I can advance a 08 to length and after multiple recapiluations with 10,15,20 hand files
   I find it still hard to advance a 10 or 15 to length, then i place the 08 or 10 to length
   and hook it up to the m4 and that will loosen the canal. then place a 15 to length and repaeat.
   after that you can go back to rotaries.
2. when I have an abrupt apical curve where I can get patency but hard to maintain it. place the
   file that goes to patency and hook it up to the M4. keep increasing the file size to 15.
3. when the canals appear calcified and I can see a small white dot then i try to penetrate that
   with an 08/ 10 file in the M4.

apart for these reasons I dont routinely use it for canal filing.. - Sashi

You can guess, some questions in my head?

Some literature on M4 indications?

When you say you use:

1. when i can advance ..............you can go back to rotaries.

   are you saying that in case that you have no patency with 06 or 08 even precurved, you try going
    to the lengh you arrive with 08 or 10 and hooking then M4 to obtain patency? Do you precurve this file? 

2. when i have an abrupt apical curve where i can get patency but hard to maintain it. place the file
   that goes to patency and hook it up to the M4. keep increasing the file size to 15.

   Could it be useful for abrupt curves or ledges in the medium or apical third that you bypass but many
   precurved files, patience and efford was necesary and you can progress to the next file without
   precurvation?, in this cases I´m not able to use rotary ones. 

3. when the canals appear calcified and i can see a small white dot then i try to penetrate that
   with an 08/ 10 file in the M4.

   Do you precurve the file?

Finally, do you ever use M4 with Stainless Steel files? Have you ever tried with hand
Niti 02 taper ones?Which is your diameter limit to use M4, 15,20, ...?  - Nuria Campo

hi Nuria
I  have no idea of the literature to support the m4. but I have done some cases with m4 and cross
sectioned the teeth and found it to be quite fine.

1. I try to get to patency first, after that, if the canal is very tight,  place the file (10) to patency
   and hook it to    m4 hand piece. and go upto 20.
2. yes it will be useful for mid root curves or ledges
3. precurving helps in an already located and partly negotiated canal. If the canal is not found,
   then you dont precurve.
4. I use m4 with SS files only. havent used with a Niti . upto a maximum of 20 size SS file.

-  Sashi