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Roots Digest 2

From: kendo To: ROOTS Sent: Monday, July 06, 2009 3:32 AM Subject: [roots] Uh oh.........the smell of napalm Part 2 Continued from Page 1
Fig 4a Panel of anatomic preparations from the classic work by Professor Walter Hess of Zurich The Anatomy of the root canals of teeth of the permanent dentition, London, 1925, John Bale, Sons & Danielsson.
Fig 4b - Vertucci FJ 1984.Two thousand four hundred human permanent teeth were decalcified, injected with dye, and cleared in order to determine the number of root canals and their different morphology, the ramifications of the main root canals, the location of apical foramena and transverse anastomoses, and the frequency of apical deltas
Table I and II derived from Antibiotics and the Treatment of Endodontic Infections Summer 2006 American Association of Endodontics Colleagues for Excellence

Figs 5a, 5b Flat field sensors provide a sense of the extent of osseous pathology; however, the periapical radiographic image corresponds to a two-dimensional aspect of a three dimensional structure. Periapical lesions confined within the cancellous bone are usually not detected. Thus a lesion of a certain size can be detected in a region covered by a thin cortex, whereas the same size lesion cannot be detected in a region covered by thicker cortex
Fig 6 All cone beam tomography units provide correlated axial, coronal and sagittal multiplanar volume reformations. Basic enhancements include zoom or magnification and visual adjustments to narrow the range of grey-scale, in addition to the capability to add annotation and cursor-driven measurement.
Fig 7 Strategic extension of the access perimeter is too often undervalued in terms of successful endodontic treatment outcomes. The shape of the chamber must be regressed to its native state to ensure that axial interference is negated as an instrument traverses the length of the root canal space.
Fig 8a Dystrophic calcification confounds even the most experienced clinician. The key to identification of the orifices is to regress the inner space using the continuum, cusp tip, pulp horn, canal orifice. In lieu of an ultrasonic tip which tends to chop the stone and scatter debris, gross removal is best done with a diamond bur in a high speed handpiece. The fine removal of residue can be done with a multi-fluted carbide bur to trace the fusion lines
Fig 8b Keeping the chamber wet with alcohol improves optics and highlights colour differential. The most important tool for orifice identification in addition to dyes is a micro-etcher. The satin finish produced highlights the disparity between the natural tooth structure of the floor and the secondary and tertiary dentin of the calcified orifice.
Fig 9 Micro-etching ensures the removal of oils and debris as well as eliminating the residue in fusion lines and fissures. Routine dentin bonding is then performed. The composite chosen in this instance is Permaflo® Purple (UPI, South Jordan, UT) which enables differentiation of restoration and tooth structure should re-entry be necessary.
Fig 10 A vast array of equipment exists in the marketplace to optimize irrigation protocols. Radical change may well be in the offing, however, R&D on bio-active obturating materials may prove to be the defining variable in total asepsis.
Fig 11 Numerous investigators have shown that the concept of keeping the apical foramen foramen as small as practical does not mean a size 20 or 25 file. This Schilderian concept should read as small as the apical morphology permits in order to ensure that the free flow of irrigant to the apical terminus enables more definitive cleaning of the apical segment of the root canal space.
Fig 12 The artist/clinician recognizes that negative space surrounding an object is equally important as the object itself. In the case of root canal therapy, the positive space is alterable, but must be created in balance with the encompassing negative space to ensure morphologic integrity.
Contd....Page 3


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Toughest root canal

Retricted mouth opening

Deep decay

Upper second molar

Open sinus lift

Implant after extraction

Implant # 20

Implant # 30

Irreversible pulpitis

2 step necrotic case


Lesion on MB

Endo perio case

Surgery or implant

Silver point removal

Series of cases

SS reamers and files

Single visit RCT

Ortho resorption

Apico retreatment

Apical perforation

Funky canine

Crown preparation

Two tough molars

Epiphany recall

To squirt or not

Core distal end

MTA miracles

Pain with LR

Instrument removal

3 canals upper Bi

Acute pain

Dental decay

Calcified chamber

Mandibular first molar

Ultrasonic activation


TF and patency

Interim dressing

Huge lesion

Tough distal canal

Debris in pulp chamber

Access and success

Restricted mouth opening

Broken drill fragment

MB2 or lateral

Gutta percha cases

Another calcified

Big Perf

Canals and exit

Dam abuse

Amalgam replacement

Simple MTA case

MTA barrier

Restoration with simile

Immediate implant

Traumatic accident

Lesion on D root

Extract / Implant

Carious exposure