Apex Locators in the diagnosis of perforations
Just a molar case
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From: Noemí Pascual
Sent: Saturday, April 07, 2007 07:52 AM
Subject: [roots] Just a molar case
A 47 year old female was referred for endodontic therapy for tooth 27.
Her doctor did the pulpotomy as an emergency visit. Clinical examination
revealed that the tooth was not tender to percussion or palpation.
Three canals were located. The working length for each canal was
established to approximately 0,5mm from the apical foramen using the
apex locator. Race rotary files were used to prepare the canals.
5,25% NaOCl was used for irrigation. The canals were rinsed with citric
acid and the final irrigation was performed with 2% chlorhexidine.
Calcium hydroxide was applied with a lentulo-spiral. The access cavity
was sealed with Cavit. 2 weeks later, the patient came back asymptomatic.
The calcium hydroxide was removed from the canals. The obturation was
done by a lateral condensation technique with guttapercha and AHPlus.
A sponge was place inside the cavity and Cavit was used to completely
fill the access cavity.
Any suggestions? - Noemí Pascual, Barcelona - Spain
Nice case Noemi................. I normally prefer to place the coronal
restoration on the same sitting at which I do the obturation it reduces
the chances of coronal leakage a lot - Sachin
Hi Noemi, very well done.
Qué puedes decir sobre las limas Race, no las he probado todavía.
Las usas sistemáticamente? - Carmen
Carmen, thank you for your comments.
Well, the name Race is an acronym for Reamer with Alternating Cutting Edges.
In the ad of Race you could read:
1. Triangular section - better penetration and better cutting
2. Non-threading blade - no pulling-in motion&better operator control
3. Electro-chemical surface treatment - smoother finish,
easier to clean + longer life span
4. Rounded non-cutting Safety Tip - slides against the canal walls
5- Safety Memo Disc (SMD) - to count number of uses which guards against
metal fatigue and promotes economy
I do not use Race systematically. The problem is that I work in different
places and I do not have the same material in every place. So maybe in some
practices I have the chance to choose the file because they have sets of
Protaper, K3, M2 or Race but in others there is only one set available.
Although I like to work with Race. For example, when using crown
down technique, PreRace instruments ISO 40/.10 and ISO 35/.08 are
available in stainless steel that are cheaper than in NiTi. Stainless
steel instruments have a high cutting and debridement efficiency so I do
not use gates glidden.
The Safety Memo Disc are useful to control how may times the instrument
has been used. Although you could buy it separetely and use in other files.
I also like the NiTi .02 files till ISO 60 and more things.
But as a teacher told me "If you could have all of them why marry with one??"
I hope this helps. If you want more information tell me and I will scan
the information and papers I´ve got about Race.
- Noemí Pascual , Barcelona - Spain
A very nice case Noemi. Were the canals very calcified ? Why cavit ? - Thomas
Hi Noemi! You didn´t use EDTA as irrigant? Why? - Marcela
Hola Marcela! I learned an irrigation protocol at my university and
instead of EDTA the chelating agent was citric acid. Both can be used for
irrigation of the root canal to remove the smear layer. For sure...some
controversy...there are some studies...Yamaguchi et al. who found that
the powdered dentin-resin mixture was more soluble in a 0.5,1 and 2M citric
acid solutions than in 0.5M EDTA solution. Although Liolios et al. found
better removal of smear layer by EDTA preparations than with 50% citric acid.
Other studies (Di Lenarda et al. and Scelza et al.) found no difference
in smear layer removal between both.
Furthermore, Machado-Silveiro et al. found that 10% citric acid had more
demineralization capability than 1% citric acid which was more effective
than EDTA. In addition, Amaral et al. found that EDTA and citric acid had
effects on macrophages cells ex vivo, but citric acid was less toxic in
periods from 1 to 7 days of use - Noemí
I mean...I use citric acid as penultimate irrigation and chlorhexidine
last irrigation but during all the instrumentation I only use hypoclorite,
no alternate with citric acid or EDTA... .except if the canals are calcified...
in that case I would need a chelating agent at the beginning... Noemí
Why not single visit in this case - Sergiu Nicola
-Although the pulpotomy was done by his doctor the patient was still symptomatic,
quite painful and very distressed so I prefered to wait till she was asymptomatic
to finish the treatment. In my opinion her postoperative condition was better
than I´ve had done in one visit.
-I only was able to find three canals and I had time to clean/shape and irrigate
all three but I needed a new "fresh" look...the last try for the MB2. Although
in the second appointment I didn´t find it - Noemi