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Endo tips    Better Endo    Endo abstracts    Endo discussions

  Crossing canals

The opinions within this web page are not ours. Authors have been credited
for the individual posts
where they are. - www.rxroots.com photographs courtesy: Jörg Schröder

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 great case Jörg - Andreas

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