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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