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Endo tips    Better Endo    Endo abstracts    Endo discussions

 Cracks on the molar
The opinions within this web page are not ours.Authors have been credited
for the individual posts where they are. - photographs courtesy: Dr. Glenn A. van As

From: Dr. Glenn A. van As
Sent: Thursday, 9 June 2005 1:48 PM
Subject: [roots] Just for fun

This case was tough because the Working length was 25mm.  I have always
found that I am short on the fills on these cases.  My local endodontist
who is a great guy gave me a hint to take what the canal gives you on
this vital case and I only opened to 04 taper size 30s.  It was very
difficult with alot of recapitulation done in two visits with CaOH as I
learned from Fred.

The vitals were.....

Difficult diagnosis as patient in extreme pain on lower right, uncertain
with pulp testing and tapping if lower premolar or molar responsible.  I
took out the amalgam on the molar and premolar (the Preop PA was at
work) and I got worried about the cracks on the molar.

The cuspal fracture on the MB cusp was an incomplete fracture and didnt
worry me as much as the one that was on the straight mesial coming from
the marginal ridge and moving towards the pulp.  This was to me the
culprit and the cause of the irreversible pulpitis symptoms of
spontaneous pain and lingering cold pain.

Endo was initiated with VTVT K3 sequence and System B obturation and
Obtura backfill.

I ground down the occlusion and patient will have a crown soon.

I show this to provide proof as to what Roots can do for you if you pay
attention.  Any successes are due to what I have learned here on Roots,
any failures are my own.

I am pleased that I got down to the apex this time, hope you enjoy the
details like cleaning the GP of the pulpal floor (I use high speed
diamonds , low speed round burs and isopropyl to clean the sealer (use
very little as Gary taught so long ago).

Its the revelling in the details that is the essence of roots, its not
about speed, its about quality and a focus on continual improvement.  I
am proud of what Roots helped me obtain, and I am sorry I cant be more
active on here but unlike so many others who have disappeared to greener
pastures,  I continue to lurk and pick up new tips from Fred and crew.

Hope this is of interest, I will be out of town lecturing on lasers in
Charlotte NC at the Nash Institute til Sunday so if I dont get back to
you, dont despair.  - Glenn

Great case with excellent documentation, Glen. Hardly an average GP though - Simon Thanks Simon........I appreciate the kind comments about the case. - Glenn Glenn, The extra cone to prevent pull out - how does that work and when is it indicated? Is this something for very elliptically cross-sectioned canals (eg, lower distal on molars and lower anteriors)? - Michael Moran. Hi Michael.......sometimes I find Obtura plug of material in these large elliptical canals helps keep the cone in a little better and also the extra cone here helped me. - Glenn Isnít that the same as starting lateral condensation and then changing to something else? - Gary Nice stuff Glenn. I know that wasn't an easy root canal. What helps me on a case like that is after coronal enlargement with gg's, ample use of size 10, 15 & 20 hand files in the M4. Once you get a really nice glide path, pull out some brand new protaper files (S1, S2, F1) and after a few recapitulations, you'll get those protapers to length in no time. Then if you want to give yourself some deeper shape, use 20/.12-.08 GT's. Try it next time, you might like it! The endo is the easy stuff-your photography is much harder-dude you rock on that. - Mark Hi Mark.....thanks. I have Protapers but gosh they are fragile in my hands. They are aggressive but I am such a dufus with them that all to often I try to push and leave a piece prematurely obturated. I agree with your thoughts on widening them up more with GT tapers to get a better deep shape. - Glenn I actually used the M4 ALOT here as I just couldnt get it widened up fast until I used it. It helped me a lot here. - Glenn Glenn, awesome stuff. I hope it's ok to use these photos for educating some of my referrals? It's tough to explain in words what we see through our scopes. Of course with appropriate credit. Thanks - Kendel

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