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Endo tips    Better Endo    Endo abstracts    Endo discussions

  Limited opening

The opinions within this web page are not ours. Authors have been credited
for the individual posts where they are. - photographs courtesy: Bill Seddon
From: "Bill Seddon"
Sent: Friday, October 03, 2008 1:26 AM
Subject: [roots] limited opening

Case done today,  had been accessed and Ledermix placed at emergency dentist.

Pt had maximum 22 mm opening,  couldn't tolerate a prop and didn't
really like the dam.  I dammed an entire quadrant here as I knew I was
doing the build up and find that having the dam lying flat makes
access that much easier. I used a 9mm mirror which only just fitted,
and files introduced with tweezers then lots of hand filing.  She was
always biting on the clamp on the second molar. I used on rotary in
the case to smooth at the very end.  One false move from the patient
and she would have been eating titanium.  With the scope and the
patience it really wasn't a big deal,  pt had a rest every now and
again,  total treatment time was 1hr 43 minutes.  Reduced the cusps so
out of occlusion.

This was the most severe limited opening I've dealt with,  at times I
couldn't get one finger in there,  but she was really good and let me
get enough in when I had to.  Without lots of handfiles I would not
have been able to do this,  there simply wasn't room for rotary even
with the micro head I have.  I was able to get most of the temp out
with U Sonics and inly needed about 10 seconds with a handpiece.

Lessons learned,

1.  Get referring doc to tell me about limited opening,  pt describes
having been like this since 5 yrs of age,  would have been much easier
with some oral sedation.
2.  Wrote to referring to suggest occlusal splint as lots of wear and
fractures in the tooth.  Pt has headaches etc and tender lat pterygoid
and masseter.
3. I can't take good pictures in a 9mm mirror :-(
4. Glad I watched Terry P work last week to see how to handfile really
well,  and glad I saw GBC again to show mirror skills and how I could
do all this from 12 O'clock at the scope without getting stressed.

Without a scope,  forget it. - Bill

Bill, have you ever tried spraying endo ice on the masseters?
You can sometimes coax a little more opening that way, and for sure some pain relief.
-  Dan Shalkey

Dan, You are right,  and yes I have tried it,  I clean forgot about it in this case,
good reminder thanks. - Bill

Dan does that mean spraying extraorally on the Masseters? -  Sachin

exactly,  I have a picture somewhere that I will dig out later - Bill

From: Bill Seddon
Sent: Friday, October 03, 2008 8:27 PM
Subject: Re: [roots] limited opening

Here we go,  found them now.

I've seen this patient...she's a T3 if ever I've seen one :::))))) - Joseph Dovgan

Sachin, Yes, I usually block the spray from the eyes with one hand and spray endo ice
directly on the skin overlying the Masseters.- Dan Shalkey

Dan, i would not recommend that.
spray ethyl alcohol. not endo ice.
the only time i did it, patient developed necrosis of skin overlying the masseter.
it took 9 months for the skin to return to normal. she is still upset with me,
and quite rightly. - Sashi Nallapati

Oh my G!!!!  I have been doing this without incident on probably 20 patients already,
but based on what you say, I will stop!  BTW, I am pretty sure you mean ethyl chloride
and not ethyl alcohol.  Thanks Sashi! - Dan Shalkey

my mistake,  ethyl chloride it is.
It says on the canister of endo ice, NOT TO BE USED ON SKIN...
I only saw that after my patient reacted to it. it was like frost bite... sashi

Good point brought up Shashi.........thanks. Any special precautions with Ethyl Chloride ?
- Sachin

can't tell, never used it. - sashi

Never heard of doing this before. Had a patient today where it would have come 
in really handy, but we only have CO2 in our clinic. Would holding an ice pack 
for a short while on the masseters work as well? How much gain in mouth opening 
have people been able to achieve? Thanks for your advice.

Nuria, re: gaggers, our prof finds that applying salt to the tongue works, 
not sure why. I've found administering a lingual block or separate palatal 
infiltration further posteriorly to work really well. If you had some lignocaine 
spray handy, you could always use that instead of giving LA.
Cheers, - Vivian

I use ethyl chloride for this,  endo ice or my Maplins equivalent is -50 C,
Ethyl chloride is only around -10 Celcius   -  Bill

I never had heard about that. Thanks for share. Any tip for GAG patients,
I have heard about acupunture point in the ear, but I have not tried. - Nuria

In the case you show , sorry but for me it seems a TMJ Blockage with reduccion,
usually Nelaton Handling had worked in the same way. If it´s a chronic Blockage
I do endo at this time, but if its an acute painfull blockage
I prefer delay, only emergency treatment in any case, prescribe muscular
relaxants according  to the TMJ specialist prescription.

IMHO if the patient had a chronic TMJ Blockage without reduccion,
really I doubt that any freezing spray could work. - Nuria

Endo Ice or equivalents - 50 ºC is not recomended to aply directly over soft tissues,
and with Sashi´s experience I don´t take the risk. - Bill

What is ethil cloride? Perhaps a topical cryo anaesthetic?
I`m looking the composition of the avalaible here but none have ethil cloride. - Nuria
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