Extremely dangerous mesial root curve - Courtesy ROOTS

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From: Terry Pannkuk
To: ROOTS
Sent: Thursday, November 09, 2006 9:40 PM
Subject: [roots] Extremely dangerous mesial root curve

This is a case I finished yesterday .  I was sweating bullets making sure I handled it carefully.
The curvature, patient’s huge tongue, difficult isolation, limited jaw opening, and long, narrow
roots made it an extreme challenge. It had a borderline restorable crack - Terry




Very nice, Terry.  Doing a tough case like this in front of an audience is even more of a challenge.
- Mark

3 crummy canals! Nice result - gary

I understand the tongue, length, and limited jaw opening making this case challenging.
The curve doesn't look nearly as threatening as implied in the subject line of the thread... unless
I am missing something... ;) - David Prusakowski

To get apical shape that truly cleans the canal system requires flaring that risks perforation on
the outside of the last apical curve.  If you settle for sepsis; you are right, it’s not that
challenging - Terry

Dave,   The curve you see on the film is not usually the one that breaks your file, in my experience.
there was probably a buccal-lingual curvature here as well.  I am willing to bet that Terry did a
lot of coronal flaring to provide straight line access to the apical curves.

The cases where I have broken files have almost withour exception been those where I wished I had
done more coronal flaring.  You can provide visual access to the broken file to try and get it out,
or you can provide the same acess to the apical curve before you break the file - Dan Shalkey

>> You can provide visual access to the broken file to try and get it out, or you can provide the same
access to the apical curve before you break the file. Nice line  I like that - Simon

Dan, you said: "You can provide visual access to the broken file to try and get it out, or you can
provide the same acess to the apical curve before you break the file".

If I had any left, I would give you at least  R100   [100 Rootsuros]   for such a wise sentence - Dan

To be honest, most of the rotaries I've fractured have been because of limited access, inadvertently
running the instrument with flex instead of straightline in upper second molars, mb and mb2's of firsts.
I wish my nsk hp had the ability of my m4, which is to attach it with the file in place in
the canal. The latch makes it a pia to do.  Even with bite blocks, hovering a 25mm instrument above the
tooth before plunging inward can be a challenge. That's one of the reasons I've become a firm believer
in one of the tips john khademi offered in his presentation at amed;  whack the tooth down BEFORE beginning
access prep.  It's going to be crowned in any event, we have better visibility, I have better lighting for
vision and photography, and I've gained a couple of mm for access - gary