From: Ahmad Tehrani
To: ROOTS
Sent: Monday, April 09, 2007 9:50 PM
Subject: [roots] laterral

22 y.o. Female. She just wanted this tooth filled. I told her it wold be no problem as long as I extended the filling to
the apex..-:) So to make my point, we started with pulp responsive testing first
against her adjacent teeth.

EPT, ice and hot test....all negative.

Necrotic lateral....Totally asymptomatic....No sinus tract. I am always fearful of causing a flare up with these "dormant" CAP cases.
So I always explain in detail (till I am blue in the face ) during consultation, not to make "excuses" afterwards..
Started cleaning out the caries, accessed the pulp and filed to a size 25 with pre-curved tip.
Projected the canal and built up the tooth temporarily with composite. CH and closed with cavit.

My question is how do you maintain the natural canal curvature with larger files? The wire film is a size 25 which looks like itis
straighteneing the canal already. bending bigger files is a laborious task for me, so I probably follow
the mantra of keep it small as practical I am afraid to strip perf the thin areas around the bend and wrecking
it. All laterals have an apical hook that is easily mismanaged with blind rotary files.

Been there , done that.....)) - Ahmad

 

 

 

 

Ahmad, I don't think you can maintain that natural curvature if you are
going to clean the apex.  This one has more than one curve so bending a file
is not going to prevent straightening.  So you straighten it out a little.
Do you think that hurts the case?  I'm betting you will get a great result.
You are right about that little apical hook.  We are going to screw those up
sometimes.  Why not one step this one?  The ones I worry about are the ones
with the well formed lesions.  They are the ones that blow on me and lower
bi's seem to live to screw with me.  Guy

Ah.  Another anterior elastic anterior rubber dam clamp fan!  I hate those
big honkin things that are always in the way.  This is so much easier - Gary