Home page
Nice curves in mesial canal
Apical periodontits
Type III dens case
5 canaled molar
necrosis periradicular..
Triple paste pulpectomy
Endo cases - Marcia
"C" shaped canal anatomy
Psycho molar
straight lingual
Doomed tooth
another molar
Tooth #36
Instrument removal
Tooth #27
Nice curves in mesial canal
Troughing case
6 year recall
9 clinical cases
Flareup after best treatment
Fred Barnett cases
Cases by Marga Ree
Glenn Van As cases
Sashi Nallapati cases
Cases by Jorg
Terry Pannkuk cases
New dental products II
New dental products
Difficult retreatment
Canal anatomy 46
Freak case
huge lateral canal
Separate MB canal
Crown infraction
5 year recall
Palatal canals
TF retreatment
Fiber cone
Bio race cases


 Mandibular anterior shift
The opinions within this web page are not ours.Authors have been credited for the individual posts where they are. - www.rxroots.com photographs courtesy: Rob Kaufmann
From: Rob Kaufmann
Date: Thursday, November 1, 2007 3:25 pm
Subject: [roots] Mandibular anterior shift images
To: ROOTS

Mandibular right central incisor treated by General Practitioner who
practices approximately 4 hours away from my office (by car.)  The
referral film was sent to me because the periradicular pathology was
persisting as was the draining buccal sinus.   The patient had taken
multiple courses of Abs including Amoxicillin and Flagyl. Not only was
she tired of this whole process, she was beginning to have some real
GI upset problems after all of the Abs. This is NOT the type of case
where you can say" Why not stop in for an exam, so I can check you
over for 15 minutes and then reschedule you."  Its 4 hours drive EACH
WAY.

I examined the single referral film (awful) and the documentation that
was sent to me.  I concluded that if this woman was going drive in and
be treated in a single appointment, we would most likely have to do a
NSRCT and SRCT retreat if we were sure we wanted this thing dealt
with, once and for all.

I examined her today ( she was scheduled for the SRCT tomorrow a.m.)
and the sinus was draining purulent material. A periapical radiograph
( straight on) showed a decent endo procedure with a bit of sealer
overfill  nothing overtly wrong. I asked my staff for a shift shot
and was rewarded ( unfortunately) with something less than what I
wanted. While the sensor was being used in another room, I  explained
the reason for the retreat and the SRCT. I suspected a 2nd canal but
the patient was skeptical - she couldn't see it and neither could my
staff . (Remember, she only wanted to make ONE trip.) I suggested that
an NSRCT retreat two appointment( CaOH2 med)  procedure might be a
better option than SRCT but that she would have to come back for me to
do it that way.  We might be able to avoid the SRCT.

I then took the shift image myself. It showed a 2nd canal, filled only
with sealer, with excess extending out of the apex. This uncleaned and
improperly treated canal clearly was the reason for the failure. I
have her scheduled for tomorrow to perform the clean and shape and
CaOH2 placement. She has agreed to come back in 1 month and thereby
likely avoid the SRCT.

Watch out for those 2 canal anteriors - staff taking films can easily
miss them without a proper (and seemingly excessive !) shift film.

Rob Kaufmann DMD MS(Endo)

Nice - Glenn That is teaching at its best ..............Thanks Rob - Sachin Yup...patients will agree to multiple visits when we properly explain the benefits of optimal treatment. - Fred Of course, this patient did not need to risk life and limb for another eight hours of dangerous highway travel, or undergo another invasive procedure, and all for very questionable benefit. This patient needed a MISSED CANAL TREATED ... Wasn't that the teaching point? Those missed canals can be very annoying! Ignoring these canals is certainly less than optimal; it's not treatment at all. This patient will heal because the canals have finally been treated, even if inefficiently. - Ron That's the kind of stuff we need to get back on roots. bravo rob. You totally rocked on this one, and provide an excellent learning experience for all of us. Superb! - Gary

Searching for MB2
Implants #18, #19
Nice retrofil
Molars with lesions
Tooth #4
Apex locators
Large Apex
Access pictures
Lower incisor retreatment
Horror case
porcelain onlay
Conservative access
Peri radicular healing
Beautiful cases
Resilon cases
Unusual Apex
Noemi cases
2 upper molars
2 Anterior teeth
Tooth #35
Anecrotic molar
Direct capping
Molar cracks
Obstructed buccals
File broken in tooth
Separated instrument
Delta
Dental Products
Dental videos
2 year trauma
Squirt on mesials
dens update
Palatal root exits
Color map 3
Middle mesial
Continuous pain
Anterior MTA
Previous trauma
Ideal case
Dens Evaginitis