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Endodontics

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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 Glenn Van As- www.rxroots.com
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 Email: glennvanas@home.com
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
From: Glenn van As Sent: Wednesday, May 23, 2001 7:58 PM 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
From: Harvey Sent: Wednesday, May 23, 2001 8:06 PM 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 anomolies.... so 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)
From: Jerry Sent: Wednesday, May 23, 2001 8:27 PM 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
From: Jerry Sent: Wednesday, May 23, 2001 8:42 PM 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
From: Joseph Sent: Wednesday, May 23, 2001 9:27 PM I always bring the obturation down to the CEJ--- and then use self curing resin instead of light-curing ;) jab
From: Thomas Sent: Wednesday, May 23, 2001 9:49 PM 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
From: Thomas Sent: Wednesday, May 23, 2001 10:12 PM 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
From: Jerry Sent: Thursday, May 24, 2001 12:06 AM 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