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K-file well jammed into the mesiobuccal- Courtesy ROOTS
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From: Simon Bender
Sent: Friday, September 01, 2006 12:34 PM
Subject: [roots] saved

Here’s one I got from a new ‘referral’ patient is a 21 yr old girl with 
nice teeth and she’s got a section of K-file well jammed into the 
mesiobuccal. Talking litigation.

Here’s the chutzpah requested to remove the file and return patient 
to her for completion!

Had it out of there about an hour later, thanks to the scope, 
the ultrasonic and Cliff Ruddle. The little IRS worked like a 
charm - Simon Bender

I am absolutely totally amazed that a GP would send a patient to an endodontist to remove a file they broke and request the patient be returned for them to complete tx. Amazing!!!! - Guy I like Jerry Avillion's approach in these situations. Not sure he does it this way, but he's mentioned that a good way to approach these situations is to charge the normal rct fee for the file removal. Then you can tell the patient it's $X to remove the file, and it isn't any more $ for me to finish the root canal - Mark Nice recovery. I find the irs helpful on occasion, a little too wide in others. Actually prefer a capillary tube with resin most of the time. Might want to have a discussion with the referral that you accept cases for comprehensive care only. You are accepting legal risk once you get into case, whether it is partial or not. I’ve got to admit, she has big brass ones to even ask that of you, if in fact that is anatomically possible. - gary Hi Simon, Fabulous recovery! Could you tell us your steps before engaging the IRS? did you use gates ? what ultrasonic tips did you use? Approx how much of the instrument did you expose before engaging etc..? - siju Siju, Thanks I was pleased to be able to get this one out for various reasons but it’s always nice when a plan works. As for procedure, I pretty much went by the book : - straight line access until I could see the file under the scope; Stainless steel LA Axxess drills for this - enlarged it until I could get the IRS into the full depth. I didn’t use any ‘staged’ Gates. I prefer to use the Mueller drills, and the red one with a diameter of approx. 1mm is just right to accommodate the red IRS ( = 0.8 mm) - exposed about 1mm of the file by troughing around it – my favourite instrument for this is a #25 s/s file in an endodontic adapter in the EMS ultrasonic. It is very slender and you can bend it so that everything is out of your line of sight as you look down the canal under high power. Used alcohol, narrow bore suction and Stropko to clear debris. - when I had a bit of file exposed I started ‘trephining’ with the IRS – it has a sharply bevelled end which helps it to seat itself around the file. - screwed in the ‘capture’ rod and of course I could tell I had engaged the file due to tug-back. This has an anti-clockwise thread, so I carried on turning anti-clockwise with a gentle coronal pull and out it came. Neat. - Simon Bender

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