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where they are. - www.rxroots.com photographs courtesy: Carlos Murgel
From: Carlos Murgel
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,gutta 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 appointments 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 ?