Missed canal and the role of sandblasting - Courtesy ROOTS
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From: Marga Ree
Sent: Tuesday, January 12, 2010 9:02 PM
Subject: [roots] Missed canal and the role of sandblasting
I have posted this case before, at least treatment at the first session,
to show the benefits of sandblasting the pulp floor to identify a canal orifice.
Patient was referred because of acute apical periodontitis, and identification
of MB2 was a piece of cake. A drop of alcohol may further enhance the visibility
of its orifice.
I use my sandblaster every day, also after obturating the canals, to clean the
pulp floor prior to bonding.
After the first visit, the symptoms subsided. Doing endo and a subsequent coronal
seal can be so easy...... sometimes.....;-)) - Marga
Marga, "Simple" case... hmmm.... in your hands - yes!
I would have done a couple of ledges and perfs... and followed that by obturating
with multiple voids :-)))
It is always a pleasure to see your cases! Thanks for sharing. - Dmitri
It just goes to show that there are typically alternate ways to do something.
I also use air abrasion on the pulp chamber floor after obturation when placing a core.
The reason I don't use it to find canals is primarily the mess and the fact that it
scratches the microscope lens and zirconium mirrors. Smoothing with a fine round
composite finishing bur and clearing the floor with EDTA reveals the same orifices
and grooves without making a mess....but as usual I agree with you about it being a
nice final aid at the end of treatment before core placement. - Terry
Terry, There more ways to skin a cat. I use several tools to identify orifices.
They all have pros and cons.
1. Burs, I particularly like the Munce burs if there is quite a bit of tooth structure
that needs to be removed. Advantage of burs is that it is a very efficient way of
removing dentin or obstructions
2. US tips. Useful as well, but not very efficient. I use them when I want to smooth out
an isthmus, or change the direction of an orifice, but you can also do that the way
you described it, with a composite finishing bur. US tips may cause damage,
e.g. chipping of porcelain
3. Air abrasion. Just to satinize the pulp floor, not to remove a bulk of tissue. Ideal
for removing a minimum of dentin and cleaning the floor and walls in particular after
4. EDTA/alcohol, to make the color map of dentin more vivid and easier to interpret.
Yep, and cat always has sharp claws. :):):) - Terry
Terry, you wrote: the fact that it scratches the microscope lens
Hmmm... do you have 50mm objective lens forced down directly onto the tooth? :-)) Or why
particles are able to scratch it? - they should have plenty of space to travel after bouncing
off the tooth surface and magically avoiding if not aspirator itself then at least it's
tubulence ??? - Dmitri
They scratch my scratch proof lenses on my glasses and they are a long way from the tip.
Unless you swing the scope away when using the etcher, you will eventually scratch the scope
lens - Guy
All I know is that sand particles get out on stuff scratching mirrors and lens. I doubt
it's from bouncing from tooth to lens scratching it directly, but more likely when the lens
gets wiped down later with some particles littering the area. My aspirator doesn't catch all
sand particles. You must have an amazing vacuum system. :)
I use an old mirror when I do the blasting so I don't ruin a zirconium mirror. The beauty
of composite finishing burs is that you are sweeping away dentin as you are clearly seeing
the floor anatomy. It's more efficient and does the same thing without making a mess of things.
I simply use the air abrasion before placement of the core, it cleans up the floor beautifully
to confirm all anatomy is taken care of and prepares the prep for better bonding. I'd rather
make a little mess at the end rather than multiple times throughout the access phase. It doesn't
work for me; it apparently works well for Marga and you. It's great that Marga brought up
the idea because it is another useful way of identifying orifices and floor anatomy - Terry
Terry, Iíve got a Bulldog dry vac that will suck the chrome off of your bumper and pumice is
still floating in the room - Guy
Hi Terry, Yes, I use an old mirror as well, and my assistant holds a suction canule near the
tip of the microetcher. If you feel more comfortable, you can even push the scope away - Marga
Hi marga. Thatís exactly what I was referring to, and in fact I think I originally learned
that tip from you. and we always use it after endo obturation but before core buildup to
remove all remnants of anything and provide a clean textured surface to which to bond - gary
Nice stuff Marga! - Mark
Marga, It looks very nice, but without sandblasting I bed you would find the canal as well.
I have had a big sandblaster to bur with it, I have sold it because of all the dust in my office.
After seeing this case I will try it tomorrow - Rob
Bravo Marga....Bravo. Nice tips about the sandblaster ( I just got one - Danville ) and like
it alot as well, and the alcohol. Thanks for sharing another gorgeous case both technically
( what else is new) and documentation wise. - Glenn
Very cool, Marga! :)
Now question to everyone. I have one more reendo patient with canals filled with gutta.
Yesterday I cleaned 2/3 of the canals and today I have to work with the apical parts.
Just want to make sure I use all the right ways to get gutta out, tell me plz in what way do you
take gutta out of the canals in apical part if the canals are really thin? Any tricks? - Nazariy
Chloroform, handfiles, rotaries, paper points and a lot of patience...:-) - Marga
Terry, The way I handle the concern over scratching scope lens and mirrors is to use my Danville
etcher blind. I push the scope away, I put the high volume suction over the tooth, I do direct
vision with the etcher. Then I pull the scope in and rinse the field and typically find that
things worked just fine even though I was working blind - Mark
Mark, I have a small funnel with a large tip. Iíve cut it off so that it wedges in my evacuation.
I think it helps when placed opposite the micro-etcher. I had one at the office that worked like
a champ and have looked like crazy for another and cannot find one that fits as well and is as small.
It is too large to place intraorally but it works well place opposite to the direction of the etcher
tip. I think this funnel came with a disinfection concentrate - Guy
Yes Mark, I used to do that as well, and it works fine, although these days I don't push the scope
away anymore. I have got a plastic cover over my lens, so I am less concerned about scratching the
scope lens - Marga
I have got a plastic cover over my lens, so I am less concerned about scratching the scope lens
- Mark Dreyer
Don't worry about it. Between pts have your assistant blow some dry air or use one of those
computer keyboard air cans to clean off the objective lens. If there are any UFO's left after
this use a cotton filled 2x2 with Windex or other glass cleaner to wipe the objective lens.
I have used a scope and air abrasion (mostly for restorative dentistry and some endo)
for over 10 years and have not had any problems with the objective lens. - Arturo