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From: "Jörg Schröder"
To: "ROOTS"
Sent: Friday, October 03, 2008 5:30 AM
Subject: [roots] Crossing canals
This one has been a tough one!
Vital Case , due to some weired anatomy I could not finish it in one visit.
MB and ML crossed each other and still had their own POE after the
crossing! I recognized after the wire-film. The distal canal had been
ribbon shaped and had a severe curvarture at the end. Here I only
worked with prebended SS-handfiles and with prebended RNiTi up to a
30/06. Due to the ribbon shape it looks kind of overenlarged in the x-
ray. The problem has been how to obturate the mesials without blocking
the end of at least one canal. To verify the crossing I did 2 MP-xrays
with each cone to WL. The result: only one cone reached WL, the other
stayed short. I was afraid of not getting the GP to the end or extrude
a large amount while trying to get the GP to the end of the canal. So
I first obturated the ML(35/04) with the MB MP( 35/06) at its place.
Then I was able to get the plugger (40) down to WL minus 2 mm in the
MB and the apical part of the MB could be obturated. When I looked at
the backfill I was wondering why there all of a sudden has been some
kind of material near the distal canal(apical third, mesial from the
canal) I took a look into the canal and saw GP at the furcation wall
of the distal canal. blocking the distal canal. ;(( After bypassing
the GP I obturated the distal and surprise, surprise: there has been a
big communication between MB and D! Maybe not a beautiful look, but I
was satisfied with my irrigation-protocol. ;))
Best regards from Berlin - Jörg Schröder
Great job on a tough case, Jorg. Guy
Thank you Guy, for me that's a pretty good example that there is no easy endo. (Hey,
it's just a second molar with 3 canals. ;)) - Jörg
what an odd communication! - makes me think of some C-shapes, with all sorts of variations
in anatomy and communication. - Kendel
That's what I thought too, when I saw the backfill. I have been too shy to write it ;))
Looking through the scope I never had any reason to think about a communication.
In my records it will run under half-c-shaped ;))) - Jörg
Beautiful work Jorg
Nice to see these cases from time to time - Mehdi - Melbourne
Beautiful work Jörg - excellent work as always
very weird communication! - Veiko
Hi Veiko, Funny thing has been that instead of thinking properly about the white stuff
next to the distal after obturating the mesials , I just "wiped" it away as something
strange with the sensor maybe. ;)) - Jörg
Dear Jörg, Congratulations for your case! Very difficult one! - Noemí
Great work Jorg. - Sachin
Thank you Sachin. Has been more difficult in terms of thinking/strategy than the manual
work - Jörg
Indeed a strange kind of C-shaped. well done! - bart huybrechts, DDS, MScD, DRS
catholic university of leuven, belgium
Thank you , Bart. the view into the access cavity never gave me the idea, that there might be a
communication: no exchange of fluids between the canals, no c-shape anatomy. Maybe the appearance
of the root in the x-ray may be a indication (roots do not seem to be separated) - Jörg
Indeed the roots made me think of C-shaped, certainly in a lower 7 but surprisingly there was indeed
nothing in the access cavity to make you think of a C-shaped. You managed this one very well :-)
- Bart
Hey Doc Schröder! Very nice case. :-) - Christoph Kaaden
What type of prebend RNiTi did you use in the distal? - chris
Hey Chris, thanks a lot. Pro Files up to 20/06, then PT F1, followed bei PF
25/04, 25/06, then a 30/04 PF followed by a PT F2. The MP has been fit
to a 30/06. - Jörg
Dear Jörg, You did some excellent work here. Excellent documentation as well. I wonder
how long does a endo like this take you from start to finish. What is your irrigation protocol ?
Indeed your patients are very lucky to have you around :) - Thomas
Dear Thomas,
As anesthesia in this case did not work at all, (only when her ear had
been numb, I could treat the tooth) it has been a long visit. All in
all it took me about 5,5 hours. I know that's pretty long, but first
of all they call me slowhand and second I did not want to ruin the
case with getting in a hurry. When I recognized what kind of tooth I
was treating, I did not care about earning money, it's just the
curvarture the crossing and me. ;))
I am using belach in full strength, patency files after every rotary,
agitating the irrigation with US, and used the endoactivator in the
distal, because the tips follow even those curvartures pretty easy. At
the end I think a major point is the long time of NaOCl inside the
system that made it possible to clean the communication. MP are placed
with CHX and before final irrigation(NaOCl) I use 17% EDTA for about 1
min. Thanks for the compliments - Jörg
When I recognized what kind of tooth I
was treating, I did not care about earning money, it's just the
curvarture the crossing and me. ;)) ....YOU´VE GOT A REAL PURE ENDODOTIST SOUL... Noemi
Dear Jörg, very sophisticated piece of work again. In these cases - this is only my
personal experience - you'll find the pulp chamber blocked very often which
makes it so difficult to follow the line. In your case there is a small
hint. Easily said after the work is done ;-)
I had a similar one last week and it took me quite a long time and some tips
to "reconstruct" the pulp chambers floor.
http://picasaweb.google.com/Endotainment/N42767
One question as I rarely use hybrid-instrumentation. Why did you use the
PT's at all? - Marc
Crossing canals
Great job on a tough case, Jorg. Guy
Thank you Guy, for me that's a pretty good example that there is no easy endo. (Hey,
it's just a second molar with 3 canals. ;)) - Jörg
what an odd communication! - makes me think of some C-shapes, with all sorts of variations
in anatomy and communication. - Kendel
That's what I thought too, when I saw the backfill. I have been too shy to write it ;))
Looking through the scope I never had any reason to think about a communication.
In my records it will run under half-c-shaped ;))) - Jörg
Beautiful work Jorg
Nice to see these cases from time to time - Mehdi - Melbourne
Beautiful work Jörg - excellent work as always
very weird communication! - Veiko
Hi Veiko, Funny thing has been that instead of thinking properly about the white stuff
next to the distal after obturating the mesials , I just "wiped" it away as something
strange with the sensor maybe. ;)) - Jörg
Dear Jörg, Congratulations for your case! Very difficult one! - Noemí
Great work Jorg. - Sachin
Thank you Sachin. Has been more difficult in terms of thinking/strategy than the manual
work - Jörg
