From: "Jörg Schröder"
To: "roots" 
Sent: Friday, October 14, 2011 11:16 PM
Subject: [roots] My first ProTaper Case

Last Case of this week:

2 visits due to very limited mouth opening. Referral fractured a handfile in the MB. Did he have a preop x-ray??
I doubt so, because if he would have had one ...

When I took handfiles ISO 8 to length according to the EFL the tactile response had been:  curved & narrow.
After looking at the wire x-ray I was between dream and nightmare. Seems to be more than 90 degree in the distal.
First it looked like only one oval canal in the mesial root. After some time I found the split into MB and ML.
Due to the inclination of the tooth I had a hard time to negotiate ML without creating a ledge.

Today I finished the case and thanks to Chaniotis Antonis I managed to get around with my files. Only prebended
handfiles or NiTi rotaries used by hand in the distal up to a 25/04. I then chickend out.

MB and ML merged in the apical third. I was wondering how to prepare the canals when I remembered CA's astonishing
cases he posted last week. So for the very first time I used Pro Taper NiTi rotaries in a case. MB & ML to F1 after
using about 20 handfiles from ISO 006 - ISO 15. Then ISO 17,5 followed by S1 , S2 and F1 to length. Could have
preserved some more dentin in the mesial root. -  Jörg Schröder





Jorg,congratulations very nice case, great way to end your week!, outstanding - Dr. Carlos Saucedo Mtz.

Hats off for this case, Jorg! Great case! For me at this point this is a nightmare and a bad one for sure!
Beautiful curves! Thank you for sharing! - Bojidar

Very good case and documentation. I understand that maintaining those curves could be more nightmare than anything else.
-  Miguel González Rodríguez

Dear Jörg - the result and outcome for sure A dream, the need to deal with such an anatomy A nightmare.
Wonderful case and great result. Tough one dude - Peter

Jörg,  What an awesome case, there are many so reasons why this can turn into a nightmare, but you nailed it!!
Congrats, and please let us know what you did to prevent separation and ledging - Marga

WOW!! Excellent! I would say this is a dream that could have turned into a nightmare, but you managed to keep it a dream.
Grtz, - Rafael

terrific Jorg, How did you maintain patency in distal canal and how did you cone fit these kind of canals. - Raghu

Truly fabulous. Well done - James

Thanks Imran, Peter, Chaniotis , Marga and Rafaël.

@ Marga: In the distal canal I used only 21 mm handfiles because they are stiffer. I never recapitulated as often as
in this case: 006 until file felt kind of loose, then prebent 008 the same way 006 came out of the canal. Then 006 again
and 008 as long as it did not felt loose. Then 010, back to 006 & 008. That took me almost 20 minutes. 12,5 started
to have to much friction so I went back to 010 and tried to rotate a little (15 degrees maybe) Next file has been
Race 15/02 used as a handfile. File came out with distorsion!! My puls raised. Back to 010, 008, and 006. I then tried
to place a Race 20/02 by hand. No way. ProTaper handfile S1 to restistance. After a while 20/02 Race went to length.
Pro Taper handfile S2 to restistance. Then Race 20/04 to lenth after going all the way back to 006, 008 and so on.

In the MB 006, 008, 010 until it went kind of easier. Then 15/02 Race (rotating) to length. Recapitulation 006, 008, 010.
Race 20/02 (rotating) to restistance. 15/04 ProFile (rotating) to length. Recapitulation 006-010. M2 15/05 (rotating)
to length . Makes it easier to get the 20/04 to WL. PF 20/04 to length. PT S1 to length (rotating). M2 20/06 to length.
PT F1 to length.

ML has been tougher because I had a hard time to enter the orifice due to the angulation. I tried to kind of calculate
where the instruments cut and avoid to big steps in size and taper. And I discarded the instruments although they did
not look distorted under the scope. But that happens just out of feeling/bad experience in similar cases. ;) - Jörg

Thanks, Raghu.Recapitulation as I wrote in my just sent email. ;)
Cone fit only in the mesials. Distal canal has been squirt technique. - Jörg

Hi Jörg, awesome case! What made you choose Protaper rotaries for the first time in
this case? I finished a similar case on Friday evening (treatment of 38,
severely curved but not as extreme as your case) but I didn`t dare to treat
the canals with Protaper rotaries bigger than S2 and finished the case with
Protaper handfiles respectively NiTi k-files because in a similar case a
Protaper F2 rotary separated a couple of weeks ago and I wasn`t keen on
repeating that...  	 	Bernard