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Photos: Courtesy of Gary, Randy, Kendel - www.rxroots.com
From: "gary l. henkel d.d.s."
To: "ROOTS"
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 in comparison.
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
Monster canaine
