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From: "gary l. henkel d.d.s."
Sent: Wednesday, November 30, 2005 8:21 PM
Subject: [roots] End of the canine that ate new york saga
I finally completed the monster canine #11 ada on my nephew last evening.
Very entertaining. Slide one is the pre-op he presented with 2 months ago
with a huge abscess. Tooth was necrotic, we opened, grossly instrumented
and irrigated with naocl, then placed the crappy caoh2 medicament in slide
2. you guessed it. Slide that is missing is the I&D I did that Sunday
afternoon with my wife assisting where I drained about 5cc purulent exudate
and left an iodoform gauze drain in place for about a week. Drain was
removed a week later and fluctuancy resolved. Tooth was instrumented with
gg #4 buried to its full 19 mm length, pulling it along the walls
as the canal was much too wide even for that size instrument. Middle and
apical thirds were completed with veterinary length ls lsx to apical gauged
70 size. Irrigated the hell out of the tooth with alternating naocl, edta, 2% chx.
Slice 3 is caoh2, which was subsequently replaced 2 weeks later (vitapex).
I think my caoh2 fills looked better than the final. Obturated last night.
As nothing we owned would reach a 33.5mm, #70 (let's get crackin here bruce),
we made the decision to squirt the entire case. Fill took not one, not two,
but 3 real seal carpules in the elements unit. We stopped after the initial
downpack with the now way to short joey xls (we need the 31mm models now)
to verify I hadn't shoved resilon up into his sinus as unlike a lot of you
I usually place an apical plug and backfill. Backfilled with the elements unit
and the joey stompers. For the first time in my memory, I used the wide end of the
largest stomper within a canal! Yes, the preparation looks to damn parallel,
yes I pushed a little sealer out the bottom so the caoh2 film looks better than
the final, but all in all I'm happy with the results, and it appears
bone fill is already on its way. Slides 4 and 5 are final fills.
I also realized I had prepared and purchased all the necessary 31 and 50 mm
instrumentation, but hadn't thought as much about the obturation. Any
recommendations on equipment, techniques for future monster teeth are welcome.
We had a lot of fun with this, busting my nephew's chops about using instruments
we use on zoo animals. He thinks it is major cool to have a 33mm+ canine,
almost like some kind of badge of honor. We advised him we will treat his next
one at the animal facility at the philadelphia zoo! - Gary
Gary, I have a suggestion for cases that have long root canals like your cuspid.
Since you are already using LightSpeed and know what size the apical preparation is,
you can make your own Simplifil obturators that have a longer plug on the end of
the carrier to compensate for the extra canal length. Here is a picture with a standard
length #70 Simplifil and a custom made one that is 34mm long.
Take the carrier from a standard length Simplifil, remove the plug, and measure
the metal shaft length (22mm). Take a standard .02 taper cone and cut the tip to
the diameter that matches the apical diameter then cut the cone at a length that
will make up the difference between the length of the metal shaft and the canal
length of the tooth, in this case 8mm. Then press the tip of the metal shaft into
the longer plug and you're ready to go. Use a lot of sealer, seat the obturator,
remove the carrier and proceed with your preferred backfill method.
If you want to use System-B to condense the apical plug before the backfill,
that works too as long as you have a reliable apical stop. It takes my assistant
about 2-3minutes to make one of these so it's not going to delay
treatment at all. The blue diameter gauge is made by Miltex. - Randy Hedrick
Great idea. I should have thought of that myself. Thanks buddy. Steve emailed
me and told me that ls has simplifill available for the vet lengths of 31 and 50 mm,
but how much of this once in a while inventory do we want hanging around.
I actually pulled a simplifill out for this case and had my girl put it back
after we measured it.- gary
Gary, This was a home made Simplifill case (attached)----a McGyver moment---
just skewered on a file, squirted behind. This was because I wanted the tapered
point but the apical size was inadequate. By the time I cut it back to the
apical size I wanted, the cone was too short to hold, so I made a handle.
I don't remember my gauging here, but I agree with Randy, LS gauging will
change your numbers significantly. That's why I always preface a size with
"LS" if I used those instruments. A 40 LS is tiny, a 40k file is pretty stout
If I had this to do over I'd try gray MTA, at the time I only had white.
I could use tyhe MTA practice. Or just do an incremental squirt. This was
a resilon case. I don't know why the backfill has such a dense appearance---I don't
usually see that - Kendel G
Beautiful, Gary. Great tooth to work on. Don't you love those graceful curves.
I had a 33+ mm canine...lower... a while back. I told her if they ever pulled
it she would have a surgical fracture. Guy