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Endo tips    Better Endo    Endo abstracts    Endo discussions

  Lateral canals

The opinions within this web page are not ours. Authors have been credited
for the individual posts where they are. - photographs courtesy: Marga
From: Marga Ree
Sent: Sunday, October 23, 2005 4:15 AM
Subject: [roots] Lateral canals

Tooth # 26, irreversible pulpitis. Two sessions, in which I was struggling 
with mb1, you can see a ledge which I created in the apical third of mb1 at 
the angled rad. I didn't manage to get patent in this one.The patient was
experiencing some discomfort during the downpack of mb1, and I was wondering 
by what this was caused. Probably there was still vital tissue present in 
the mesial root. I used tons of irrigation, and I routinely use U/S to 
activate the irrigation solution - Marga

Fabulous marga, fabulous. I occasionally get a patient experiencing discomfort during the initial downpack with system b. Iíve always attributed that not to remaining vital tissue but to my hydraulics producing a short but very definite apical pressure. It rarely lasts after the initial downpack, and never during the backfill condensation. Do you think perhaps that could have been the case here? - Gary Thanks Gary, I guess you might be right !! Because there was such a significant reaction (the patient really jumped in the chair, despite he was numb) and I picked up quite some additional anatomy, I attributed this to the remaining vital tissue. - Marga At BU we used to call it popping laterals. Many times itís a sharp, one time sensation that occurs with proper hydraulics (ie/ press and HOLD the plugger during the downpack). My favorites are those necrotic anterior teeth with a tiny bit of vital tissue in the lateral canals. Irrigation works very well on the necrotic main canal but sometimes the vital lateral anatomy remains intact. (More evident if you donít anesthetize necrotic teeth with LEOs like I donít.) Those vital tissues are the ones that really pop during the down pack itís NOT caused by necrotic lateral anatomy. We donít intentionally want to cause discomfort but we always tell patients about this possibility before packing a case And thatís also why you never get em during backfill. ( I recall reading a BU Thesis on this very topic). Other times there is more protracted soreness during packing - when you have multiple foramina or in complex MB root anatomy case like Margaís case - Rob Interesting remarks Rob, I never heard of the expression popping laterals before. I think it describes pretty accurately what is going on. - Marga Marga....all the BUers use the term..."popping laterals" - Joseph Dovgan Resilon? - Kendel Yes - Marga Rob, Exactly, and many of us get the distinct impression that we relieve the patientís symptoms by ďpoppingĒ the lateral inflamed tissue out of the root. - Terry Makes sense rob, but if I had accessory anatomy coronal to the apical plug I establish after downpack, wouldnít I have the same opportunity to cause the same problem, or does the wider portion of the canal reduce the lateral force we apply. Iíve never heard this discussion before, and it kind of intrigues me. Often I attributed it to my apical barabarian ways and forcing a little extra sealer through the apex, but I have seen it on case where the fill appears radiographically spot on also.- gary Wonderful result Marga......could you tell me the System B downpack technique you are doing, and how close to the apex do you come with your tip to get these beautiful results. Do you think the MB root had two separate POE or only one. Great photos and documentation.......what else is new. Thanks as always for sharing.- Glenn Glenn, Thanks for your very nice compliments! I am usually 4 mm from the WL with the tip of my plugger when I do my System B downpack. I expected 2 separate POE. However, in vital cases, I am not so concerned when I don't obtain patency - Marga Marga, beautiful treatment.- JŲrg Really nicely done cases! Thanks for the inspiration! - Alan

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