From: D. Kendel Garretson
To: ROOTS
Sent: Tuesday, September 27, 2005 5:07 AM
Subject: [roots] max. first bicuspid

This one  was really tough: Tooth 17 (#2US) vital case, emergency, 2 appointments, 4 hours total time.
Almost inaccessible mesial canals: file had to be inserted way from the distal side. Two seperate mb canals
that were VERY crooked. I did not not dare to prepare the buccals any more than Flexmaster 30/04
(40/06 in the palatal canal). mb1 was 22mm, mb2 only 20 mm (which I veryfied several times), palatal only 18.5mm.
Resilon/Epiphany (Real Seal cones) with System B/Obtura. Sorry, I screwed up the scope pics - Winfried




Beautiful case...patience, persistence and passion. - Fred

Ditto to those comments!  Beautiful work on a very tough case, Winnfried.- Mark Dreyer

Winfried ... Great job!  I can only imagine the difficulty.  In a case like this, do you charge a different fee,
because of the difficulty or are your fees controlled by the government?  I've always faced a dilema about how you
set fees for procedures, based upon the differences in how difficult they or the patient is.  I guess most feel the
"win" on some and lose on others.  No matter, that was a very impressive endodontic treatment - Terry

Hi Terry, if you want to charge a higher fee, you have to make a  contract with the  (private) patient PRIOR to
starting your treatment. I  underestimated this one. Thus it actually cost me money. (I'll charge
the pt. extra for the next treatment to compensate). For  social security patients, it has been ruled that such a
treatment is not possible (because the roots are too crokked) and the tooth should be extracted, unless the patient
pays himself - Winfried

Congratulations !!!! Winfried Beautiful work !!! Thanks for sharing - Carlos Heilborn

Winnie: The more I learn, the more I realize that hand filing is still the king and what separates the boys from men.
specially when you pre-curve each one individually to match each canal.

my only negative comment is the over-flared palatal canal , what was going on?...otherwise it is case to be proud of...
clap, clap, clap - ahmad

Wow, That looks tough! Nice! DougR

Fantastic case Winfrie! You are nominated for the oscar for patience!! - Vipin

Super! - Carlos Murgel

Excellent result on a very difficult anatomy. How did you manage to get those x-rays to see the the roots so well ?
On the pre-op I can't see much, is this just scanning problem ? - Thomas

Hope the endo works.  That will be a good one to take the tuberosity off with an extraction.  Guy

No problem, Guy. In a case like that I would seperate the roots, take the palatal out
first and hope to get the rest out without fracturing them - Winfried

beautiful! - Marcos Arenal

That's some endo there. Nicely done - gary

Thanks to you and all the others for your nice comments. The preop is a scanned (600dpi) Kodak insight film
(from the patients  complaints, the first or the second molar could be the culprit, and I can't get 2 molars
on my sensor) , the others are digital x-rays  (Planmeca), where I played a little with gamma and contrast to get
optimal visibility of the roots and the instruments - Winfried

Awesome job Winfried.....are you using Reamers or Files for the Glide path? Looks like a Reamer.! - Sachin

Dear Sachin, thanks! I used  06to 15 Reamers in an M4 Handpiece for the glide path.
For  the X-rays, I always use hedstroem fiLes in the Lingual canals, so I can tell immediately even a hundred years
later which canal is which.. Winfried

Great idea.  Different files in different canals.  Wish I had thought of that - gary