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 Simple Case
The opinions and photographs within this web page are not ours. Authors have been credited
for the individual posts where they are. - Photos courtesy of Glenn Van As

From: Glenn van As
Sent: Wednesday, May 23, 2001 10:57 AM
Subject: I huffed and I PUFFED and I blew it out the apex

Fred..........close your eyes, I was not only the apical 
barbarian but the big bad wolf as I puffed with sealer.

I wanted to show this simple case and to ask:
How often does the lower incisor have 2 canals that have 
seperate orifices. Thanks again for allowing me to 
participate - Glenn

Photos by Glenn

preop magnified laser to fire
laser firing Bleach closeup
to shear off conel cone sheared off
downpack completed downpack 5mm from end
M3 Obtura 3 O2 better one
Radiograph A pre-op Radiograph B WL Radiograph B WL inverted
Radiograph C WL film Radiograph D final Radiograph D final inverted
From: Bill Watson Sent: Wednesday, May 23, 2001 5:32 PM Glenn, Very nice photography and a very well done case. If I may make one suggestion that could improve the case, at least from an aesthetic point of view. If I interpret the radiograph correctly, there appears to be GP incisal to the crestal bone. IF this is the case, there is potential for future discoloration of the clinical crown from the sealer/GP mass. Suggestion: When aesthetics is a concern, always remove GP and scrupulously clean out the remaining sealer remaining incisal/coronal to the GP which should be 1-2 mm below the level of crestal bone. Again, nice case. - bill Point as always taken!! Thanks for the kind words and yes I looked at it too and realized it might be a little high but that was after the final radiograph. Patient wants full crowns on the lowers now to prevent this happening so I figure this might not be the last endo I do...... I will go back and remove GP......Glenn Hey Glenn, Freddie forgives...He's a real nice guy. Not to worry. Now to the issue of 2 canals in lower anteriors. I always assume there are 2 of them until I can positively prove I am wrong. I know it's hard to believe but lower anteriors are not easy teeth to treat. They have a myriad of anatomical variants and my approach is to always prepare for the worst scenario and then I'm covered. Stropko has the numbers on the variants. Don't lose any sleep over that "puff" because your patient won't either. When it heals and most of it resorbs you can put it back on the web for further dissection by los "rooters". - B.Harvey Wiener, DDS, MScD, FRCD(C) I agree with you Bill, but I get alot of crap from referring docs because they don't want to have to place the resin down that far - Jerry Avillion Glenn, I can't believe you are worried about that sealer. How many times have you personally seen (or seen someone post) cases like this that have failed? If it happened, one would think the pulp lover camp would be showing these things in seminars all over the earth. On the other hand, any one of us could post a zillion cases of root canals treated 1mm short that have failed. Gary Carr probably has a bunch that were done by endodontists. - Jerry Avillion I always bring the obturation down to the CEJ--- and then use self curing resin instead of light-curing ;) jab Hi Jerry ! Agree 100%. Your docs are lazy. I am a GP too and I have no problems what so ever placing resin 2-3 mm under CEJ. I even use the Machtou pluggers to make it sit well :) About the puff, I don't like it but in a tooth like this I think it's unavoidible. Nice treatment ! - Thomas Hi ! I have seen a presentation, I think by Prof' Friedman showing a big puff (err well, huge ;) ) that failed quite nicely. - Thomas Did he re-treat it short and get it to heal? - Jerry Avillion As Fred has repeatedly said, the puffs are not bone magnets. Typically the failure would not result from the puff but because of inattention to detail in another area. There are many more things in endodontics to be leery of other than a puff. Just my two cents - Blake McKinley, Jr., DDS Has there EVER been any research to show that 'puffs' somehow adversely influence healing? As far as I can tell from my own cases (which is all anecdotal), the ones with the BIG puffs seem to heal as well as the ones with the little puffs. It's the ones with NO puffs that are the ones that seem to fail. - Jerry Avillion
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