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Authors have been credited for the individual posts where they are.- www.rxroots.com
From: Joseph Dovgan
Sent: Wednesday, April 11, 2001 18 36
Subject: It is the water!
Rick,
I too had the same reservations. It's Like believing in the force! If
someone had told me that before I would have thought it hogwash.
Gary your a visionary without who's advice I still be trying to take them
out without water. Thank you and John S too for bringing it to my
attention.
Joe D, I believe in the Force (of water). Still feeling pretty sick.
From: "Richard Schwartz"
Sent: Tue., Apr. 10, 2001 8:59 PM
I think that without a doubt, the tip about removing separated
instruments with water irrigation is the most valuable thing I've learned
in > > the past year. I have to admit, I am a bit uncomfortable doing it
blindly, but I've removed 3 instrument fragments successfully, and with relative
ease, since reading John Stropko's post a few weeks ago. I removed a
Gates Glidden today. Thanks to you, John, and of course to Gary Carr who
originally figured out how to do it. - Rick Schwartz
From: Mark Dreyer, DMD, PA
Sent: Wednesday, April 11, 2001 17 07
I have gotten two file segments out using this technique also. This is a
case I'm still working on. I ran out of time, and will try again next time.
I have the segment well visualized (with loupes-no scope yet). I have one
of those Endo Extracter kits. I will try to put some Resiment (a metal
bonding resin cement) in one of the tubes from that kit, and pull the
segment out. Since it is such a long segment, I'm thinking that it is
unlikely that I can just spin it out with the ultrasonic, although I haven't
given up on that yet, since I remember Jerry saying it sometime takes him an
hour with an ultrasonic to get a file segment out. I'm at about 30 minutes
right now.
Mark Dreyer, DMD, PA
3503 13th Street
St. Cloud, Fl. 34769
Photos courtesy of Mark Dreyer - www.rxroots.com
From: Kachman
Sent: Wednesday, April 11, 2001 11 26
Perhaps those of you who have had success with this method could refresh the memories of the rest of us as to exactly what you are doing...is your assistant irrigating while you are using the Spartan file holder?...if yes what size of file?....are you using a CPR tip instead?...on average how long do you persist before you get PO'd and try something else?.....do you have straight line visibility through the scope before you begin?....what kind of motion are you trying to impart on your instrument (circular, pecking)?...what sort of power levels are you at?....obviously there are no cookbook recipes for success here but some details pertaining to your specific cases would be a terrific help. Thanks
Phil Kachanoski, Peachland, BC
From: Richard Schwartz
Sent: Wednesday, April 11, 2001 09 29
I think that without a doubt, the tip about removing separated
instruments with water irrigation is the most valuable thing I've learned in
the past year. I have to admit, I am a bit uncomfortable doing it blindly,
but I've removed 3 instrument fragments successfully, and with relative
ease, since reading John Stropko's post a few weeks ago. I removed a Gates
Glidden today. Thanks to you, John, and of course to Gary Carr who
originally figured out how to do it. - Rick Schwartz
From: John J. Stropko, D.D.S.
Sent: Thursday, April 12, 2001 07 38
Mark, Trough around it since it is so close to the orifice, expose about 1.5mm,
then take any flat ended needle (Ultradent has a nice variety, mix up a dab
of CorePaste (Denmat) and fill the end of the needle (also Brassler tubes),
make sure the end is wiped clean, insert over separated instrument, wait
4-5min, twist the tube/needle out CCW---- and viola! I found out a long
time ago that cyanoacrylate (super glue wasn't so predictable). If
instrument doesn't come out first attempt, at least you don't have a mess to
clean up. just have to trough a little more and try again! BUT be sure to
trough with water (the CARR TECHNIQUE) between attempts. Never had one not
come out after 2 attempts for the last year. Also, haven't had to use the
CorePaste since my mentor turned me onto using water. BUT, in this case,
due to the length of the instrument, you may need the extra persuasion.
Hope this helps. - John J Stropko, DDS
From: John J. Stropko, D.D.S.
Date: Thursday, April 12, 2001 08 04
Mark, Honest-to-God, get a Stropko Irrigator for your assistant and bent the tip
of your Lur-Loc needle of choice, so it "sits" over the edge of the access
and directs a precise stream of air, or water directly onto your working
tip. In all the modesty I can "muster-up" you will love it, and won't know
how you got along without it! - John J Stropko, DDS
From: "Mark Dreyer"
Sent: Thursday, April 12, 2001 12:50 PM
John, Who sells it? - Mark Dreyer, DMD, PA
From: R. Kim Bleiweiss
Sent: Friday, April 13, 2001 07 10
You can get it at Ultradent - together with all the tips you need! Call
1-800-552-5512
From: John J. Stropko, D.D.S.
Sent: Friday, April 13, 2001 09 15
Mark,
Denmat for the CorePaste. Great material to work with! - John J Stropko, DDS
From: Richard Schwartz
Date: Thursday, April 12, 2001 09 13
Phil, This technique is new to me, but I've used it several times now and had good
success. Previously I would enlarge the canal to the instrument fragment, visualize
it and then go through the slow, tedious cycle of vibrate, irrigate, dry, vibrate,
irrigate, etc. It worked well with stainless steel instruments. The problem with
niti instruments is they would break up and come out a piece at a time. Sometimes
after a lot of time and effort, a piece would come out but the remaining segment
would be around a curve so that I couldn't see it.
In my very limited experience using water irrigation (3 cases), the instrument
fragments came out intact in a couple minutes. In each case, I enlarged the canal
to the instrument, positioned my ultrasonic tip (Spartan CRP 5) under the microscope,
and had my assistant irrigate with a Stropko tip. I wasn't aware of when the
instruments came out, but in two of the cases my assistant apparently removed them
with the suction. In the third case I saw it loose high in the canal and flicked
it out with an endo explorer. Working blind is a little uncomfortable for me, but
I guess I'll get used to it. In one of the cases I got off line and added some
"internal resportion" to the canal. I didn't do any fancy movements, just tried
to keep the CPR tip on the instrument fragment and used the lowest ultrasonic setting.
As far as how long to keep at it, I'm rather impatient, so my limit would probably be
about 10 minutes. Now that I've done 3 cases I can say that it works very well
in case after case after case..... - Rick
From: Kachman
Sent: Thursday, April 12, 2001 09 24
Thank you to all who replied to the call for more detailed info on your aquatic
experiences...it was exactly what I was looking for!
Phil Kachanoski, Peachland BC
From: John J. Stropko, D.D.S.
Sent: Thursday, April 12, 2001 21 59
Rick,We all owe a lot to Sir Carr for this "tip" (pardon the pun). BTW, I have also noticed
the "internal resorption" on occasion! - John Stropko
From: Yosef Nahmias
Sent: Friday, April 13, 2001 02 40
Did this one yesterday! Videotaped the whole thing (even with the water all over the place!) ,
oops, "internal resorption" ( heck, it was there before, wasn't it!) If you look close at the
Preop PA you will see why the DDS broke the NiTi, , he also created a nice ledge with it!
Three PAs
Photos courtesy of Yoseph Nahmias - www.rxroots.com
From: "Tim McManus"
Sent: Sunday, April 15, 2001 8:32 PM
This case was referred to me last November but the patient declined treatment
until two weeks ago when she became symptomatic.
I was unable to remove the file at the first appointment. I was under the
scope, removing all the coronal obstructions with an ultrasonic avec H2O but was
only able to loosen the coronal third of the file ( It seemed to be taunting
me). I unsuccessfully attempted to tap the file and pull it out with a post
remover.
Any suggestions, comments would be appreciated. She is returning to my office
Monday for another attempt.
using water irrigation
