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Tooth with long roots - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are - www.rxroots.com
From: Patrick Wahl
To: ROOTS
Sent: Friday, March 12, 2010 10:36 AM
Subject: [roots] Today's Meet 'n Treat

Yes, I am aware that the pre-op shown is inadequate. We took two or three 
additional pre-ops in order to see the whole tooth, but my assistant emailed 
me only this one. This tooth had very long roots, and I have noticed that it is
often difficult with digital x-rays to get a good picture of the whole tooth 
in a situation like this one. Yes, I am aware that the mesial canals look a
bit long -- I certainly drove some sealer a bit long with my PacMac and plugger,
and possibly a bit of gutta percha. Yes, I am aware that I did a lousy job 
cleaning up the pulp chamber. But the general dentist was thrilled that the tooth 
was all ready for his post and core and crown, and he didn't mind at all
finishing the chamber clean up. In fact, he found it much more convenient than
having to remove a temporary restoration on a patient returning from another office.

The patient left with a build-up and temporary crown finished. His final crown 
will be inserted in a couple weeks.

I have two points:

1) This patient received a fantastic service -- he came in with a toothache, 
and left with a root canal, post and core and crown. He didn't have to miss 
any more work. He got done what he needed to get done without any unnecessary pain
and suffering. And his tooth was protected sooner, not later.

2) Patients value not the number of delays in their treatment; they value 
treatment which is efficient and effective. Patients are not stupid.

I am not here to serve my specialty.

I am here to serve my patient.

Finally, my clinical comment for Sanjay:

I use a combination of Twisted Files and EndoSequence files. The more I use 
the Twisted Files, the less I use gates-gliddens, sonics, and orifice openers. 
The Twisted Files do an incredible job of flaring the canal and making
room for the finishing (EndoSequence) files. With no apologies, - Pattycake

Protaper flaring

6 yr old Empress

Cvek pulpotomy

Middle mesial

Endo misdiagnosis

MTA retrofill

Resin core

BW importance

Bicuspid tooth

Necrotic #8 treatment

Finding MB2 / MB3

Deep in a canal

Broken file retrieval

Molar cases

Pushed over apex

MB2 and palatal canal

Long lower third

Veneer cases

CT Implant surgury

Weird Anatomy

Apical trifurcation

Canal and Ultrasonics

Cotton stuffed chamber

Pulp floor sandblasting

Silver point removal

Difficult acute curve

Marked swelling

5 canaled premolar

Sealer overextension

Complex anatomy

Secondary caries

Zygomatic arch

Confluent mesials

LL 1st molar (#19)

Shaping vs Cleaning

First bicuspid

In Vivo mesial view

Inaccesible canals

Premolar 45

Ortho and implant

Radioluscency

Lateral incisor

Obturation

Churning irrigant

Cold lateral

Tipped to lingual

Acute pulpitis images

Middle distal canal

Silver point

Crown preparation

Epiphany healing

Weird anatomy

Dual Xenon

Looking for MB2

Upper molar resorption

Acute apical abcess

Finding MB2

Gingival inflammation

Irreversible pulpitis

AG BU ortho band

TF Files

using TF files

Broken bur

Warm technique

Restorative prognosis

Tooth # 20 and #30

Apical third

3 canal premolar

Severe curvature

Interesting anatomy

Chamber floor

Zirconia crown

Dycal matrix

Cracked tooth

Tooth structure loss

Multiplanar curves