From: Marga Ree
Sent: Sunday, October 23, 2005 4:15 AM
To: ROOTS
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. I’ve 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 it’s 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 don’t anesthetize necrotic teeth with LEOs
like I don’t.) Those vital tissues are the ones that really pop during the down pack  it’s NOT caused by necrotic
lateral anatomy. We don’t intentionally want to cause discomfort but we always tell patients about this possibility
before packing a case

And that’s 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 Marga’s 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 patient’s symptoms by “popping” 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, wouldn’t I
have the same opportunity to cause the same problem, or does the wider portion of the canal reduce the lateral force
we apply.  I’ve 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.- Jörg
Really nicely done cases! Thanks for the inspiration! -  Alan