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Endo tips    Better Endo    Endo abstracts    Endo discussions

Funky apical third "C" - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are -
From: "Rajiv Patel"
Sent: Sunday, October 10, 2010 9:21 PM
Subject: [roots] Funky apical third "C"

39 y old female Caucasian who probably had too much Chinese food
growing up was blessed with a C shaped configuration in the apical

No credit for the final fill since most of the work was done by
bendodontics in the apical third and tons of irrigation +

My estimate is that the intercommunications were filled with mainly
sealer  and some gutta percha. Should have squirted?? Fire on! 
- Rajiv Patel

Rajiv, Great case! Much better because you didn't squirt! Excellent apical control. - Terry very very nice - Kristina The Golden Touch! - Kendel Rajiv, Looks like a painting :). Your irrigation protocols must work very well :) - Thomas Beware Rajiv you GP is melting :-)... Awesome job. - Sachin Dr. Patel: Wonderfull work. When you say tons of irrigation, could you say to us The protocol of irrigation, the name of used solutions and the ml aprox used ? Thanks to you in advance for your response. - Laura Great case! I think you handled it as good as one can possibly do this. - RafaŽl Rajiv, this is beautiful. Thumbs up! - Hani Coooool!!! - JŲrg _awesome_ looking case :-)))))))))))))))) - christoph Awesome Rajiv! - Arturo Thank you Christoph, JŲrg, Hani, RafaŽl, Nirav, Thomas and Arturo for your kind comments. Nirav - instrumentation - hybrid of hand instrumentation, protapers, profiles, filled with warm vertical condensation gp + Kerr EWT, total time spent over 3 hrs ( 2 appointments) - Rajiv Dear Rajiv, thank you for posting this amazing case to this forum. I'm familiar to this kind of anatomy due to my laboratory work with the micro-CT. Beside all posts regarding apical puffs that have entered this forum recently- i would never have thought to see such a result of a clinical case with that kind of a complex root canal anatomy. Yes i know, it is only a x-ray and yes i'm familiar with the content of all the papers written by Vertucci and all the others regarding cleaning and filling of lateral canals, apical deltas, ramifications , and so on - but i don't care at the moment. I just wanna sit down and enjoy the final x-ray of the case you did. Next i was looking through my 3D library and found a quite similar case that i like to share with you and the forum. Panel a and b gives a view onto the buccal and mesial aspect of the root of that lower second molar, respectively. Panel c displays the numerous portals of exit. Please enjoy the pictures and the similarity to the root canal anatomy of your clinical case. Last, I would kindly ask you if i can use the x-rays you posted for lectures on root canal anatomy. Full reference will be given - as a matter of course.- Frank

Frank how much more of this material do you have, itís spectacular. - Kendo Dear Dr. Paque, Thank you for posting this wonderful scan and illustration. I just hope we keep this in our mind's eye whenever we treat a case or are shown another new product/technique that will supposedly revolutionize Endodontics. To some of the others on this forum I offer these challenges: 1. How exactly does one establish a consistent "apical constriction" in a tooth such as this? Closer examination of this tooth shows that it looks NOTHING like the recent cartoon (with apologies to Kendo) "apical constriction concept" drawing that was posted on here. Where is the "constriction" in that tooth? Is there one at all? Can one even me made and if so ...where? 2. If we assume that this scan NOT unusual and that many teeth have similar anatomy (perhaps not C shape but certainly not a "single canal") ..... how can ANYONE expect that a single reciprocating file technique ( without numerous hand instrument recapitulations and explorations) can do an adequate job of dealing with this anatomy? I'm not saying that a hand instrument type technique cleans completely. But it is certainly more likely to do a better job ( with adequate irrigation) than an engine driven handpiece technique technique that that is based upon the concept that you drives a single super twisty .02 or .04 piece of spaghetti metal to the apex until the incorporated EAL in the handle says "Stop!, You're done!". That results in irrigation times that are measured in seconds rather than minutes and treatment times that dwarf what is necessary to have irrigants come close to being effective in helping to digest tissue. That's no longer an art, or a surgery....that is a TRADE ...just like a carpenter drills holes. This is where we are heading. 3. How can ANY cold fill technique that does not plasticize the material as it is being applied, hope to come close to being driven into such anatomy and replicate it? Can we expect a single cold cone surrounded by sealer or whatever your favorite bioceramic/Hydron/Resilon/flavor of the week filling material is (that will no doubt be found wanting - once the research is done) to do with this reliably? After many years on ROOTS, watching it wax and wane, I am rapidly and sadly losing respect for what is happening on here. The simplification of our specialty is killing us. Combine that with the Christensen opinion of endodontics and what you get is "This Endo stuff is TOO HARD....lets just extract and place the implant. Or at LEAST make Endo simpler, faster and easier so that ANYONE can do it after a weekend at the Holiday Inn." And as for retreatment? Its a waste of time...that's even HARDER ? Why bother? I can keep the money in MY office and not make the endodontist rich." Think this isn't happening NOW? Check what's going on in Endo practices in the US. Retreatment practices are down, some as much as 40%. I know guys that have holes in there days that have NEVER had this happen in 20 years. Now Endodontists are scrambling to get into the implant biz. They see the writing on the wall. And it sure as shit isn't because they are part of any fancy 'Endo-Implant Algorithm". Its survival. I fear that my willingness to be part of this trend has reached its limit. I will continue to monitor the forum for interesting .pdfs and .ppts to add to my site. But I'm weary of defending quality endodontics over expediency. I have no interest in Implants, other than when to recommend them to my patients. And I have little else to offer ( in the opinion of some) than constant carping, complaining and insults. So I guess this is adieu. - Rob Kaufmann Same thing in Greece Dr Kaufmann. Why bother saving a tooth? Its difficult for the GPs and someone else get the money. Lets extract and place the implant!! Its all about marketing the endo and marketing the implant. It seems to me the implant marketing is better and we are struggling to catch up with their promo. But there is more to that in this part of the world. There are dentists that call themselves Endodontists who take an endo motor and a portable system b unit and go from one general practice to another and perform white lines. The GPs are happy and when it fails they will place the implant!!! So why bother with microscopes, PUI, EDTA etc. and the Endodontic office is dead for the society? Its really sad and no one seems to do something about it. I am trying but can'ít do this alone, I need my other endo bodies with me. - Antonis APICAL RESERVOIR Rob......we get so incredibly bogged down in words.....itís a concept, not a word....that was Dr. Schilderís legacy, veer away from the semantics and folks blow a gasket. Itís the forest not the trees..... no one can argue that using any material in a manner that doesnít take into account itís biochemical properties is luddite. Gutta percha is plastic - to use it cold may work well in golf balls, dishes, or whatever it was used in a century ago, but not to use it thermolabile and compressible in a void in endodontics is lunacy. Capture zone, control zone at the apex is simply a training wheels term to ensure that folks respect what they can access not violate it or fail to negotiate its vagueries. The key to endodontics has been debridement and disinfection.... if you want words that have to have all encompassing power and meaning then think DEBRIDEMENT AND DISINFECTION........ Where endodontics has gone a bit off the rails is the failure to invest the same interest in biology and rheology that it has in ergonomics and photography. All this is marvellous and wonderful et al.......but at the end of the day, itís about a functional, morphologically intact and accurately aligned unit in the dentition that is sacrosanct in regard to itís biologic integrity. Again, words, not software, cameras, optics et al......concepts and words that lead as Terry so elegantly points out that are related to critical thinking, an appreciation of concepts that engender technical perspectives that lead to approaches that are based on logic and science. Whether folks are selling DVDís on ergonomics or whatever, it is not the heart of the matter....the heart of the matter is what goes on between the tip of the index finger and thumb and the cerebral cortex...........and we continue to spin away from that two point contact. - Kendo
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