From: Carlos Murgel
To: ROOTS
Sent: Thursday, February 23, 2006 7:45 AM
Subject: [roots] Just a case to keep things going

This is the kind of case that I get down here:

Patient had a vital tooth that received a fixed bridge, started to have pain, received root canal treatment,
continues to have pain, received a root canal retreatment and bridge removal and continuous to have pain.

The initial Rx is form the referring Dr showing the final root canal treatment and when the patient came to
me with the canals empty and medication.  You can see at my Rxs that there is a lesion at the mid root
(see how important it is to take several Rxs for the diagnosis).

The initial pictures you can see the occlusal pattern that is very complex and the wear of the canine.

When we started to do the access we can see that there was a isthmus, guta percha and all kind of things.
I located another canal at the distal and was able to get patent there.  Not able to be patent at the MB canal
(I am not sure that it is the original canal or a ledge from the first treatments) and also not able to get
patent on the palatal.

Took me 4 appointments to get this patient asymptomatic and today I obturated.  All apointments the
medication was Ca(OH)2.

Not the best looking case but I hope now the patient can continue with his routine. - Carlos Murgel








just beautiful Carlos...
I don't know how many cases like this we have to see to truly appreciate what excellent endodontics is all about.
This is a case where it could have been done in a single visit, filling only 2 canals a little denser and longer
would have "looked acceptable" on the x-ray.
But not a clinician of substance, such as yourself.
As your excellent post illustrates it is more about the knowledge of endodontics and commitment to highest
quality of practice that sets your apart from the rest.
Your photography is mouth watering by the way... ahmad

Ahmad my friend thanks for the nice words and I agree with you about the commitment to excellence.  It is not easy
to see your colleagues saying that endo is easy and very profitable and that they take no longer than 30 minutes
(well now it is 15 minutes..) to treat a bicuspid like this, an easy tooth.

I was very fortunate to be trained in Iowa by Dr Walton, Keith Krell, Lisa Wilcox and many others where quality was
a must (even being short you can do great quality work) and later was espoused to Roots and now at TDO.  I have been
doing only endo for almost 20 years and I still fell very humble about my capabilities and my results.  I strive
every single second to get close of my masters but it is very tough.

Thanks again and my pictures are as good as yours since we use the same system and learned from the same source: Gary
Carr. - Carlos



Not the best looking case?  Looks excellent to me.  These are very satisfying.  I agree that I think this is
perhaps a ledge not a true canal..  All that matters is effective debridement and disinfection.  Ledging is only
relevant if it prevents reaching the biologic objective.

This case is hopeless without a scope and someone willing to spend time and energy that no one will ever appreciate
unless they've been there.

Thanks for showing this awesome effort, - Kendel

Thanks Kendel and I agree about the scope being essential to treat cases like this and like any other.
The situation that we are facing now is that many speakers and faculty members say that scopes are just a plus
and not a must. - Carlos

Great work Carlos and excellent photography . Tough cases do take extra time and thanks for sharing the fact with us.
I did a 3 canal lower premolar this week and it took 4 sittings and I was a bit upset at the amount of time I had to
spend and I thought that I was extremely slow. Am posting the case which might not be comparable to your effort and
expertise but still...... Sachin

You have great perseverance as well as technique. What do you tell the patient about why they have been through so much ?

What does the patient ask you about all the difficulties they have endured? Did the dentist refer to you, or the patient
find you in some other way ?  Will the dentist be responsible for your charges, remaking the bridge ?