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Mesial and distal root - Courtesy ROOTS
The opinions within this web page are not ours. Authors have been credited for the individual posts and images where they are.

From: Kendel Garretson
Sent: Fri 4/15/2005 18:47
Subject: [roots] hanging 'em long, and other random thoughts

Some random observations on a Friday afternoon

First, I will reintroduce myself, since apparently there are many new lurkers out there

I've been a Rooter for over two years.   I'm a GP and I make most of my living doing endo now.  I've been in practice
for about 16 years.  In the last 9 months I've gradually limited my general dentistry.  I travel four days of the
week to other GP offices and do endo for them.   I carry most everything you can imagine - global scope, u.s.,
sysB/obtura, EFL, irrigants, etc., and almost any other endo related supply you may think of.

I'm not an endodontist, and I don't have any advanced training, so my opinions are not coming from a position of
authority, but thought I'd share them anyway since that's what Rooters do.

Secondly - although it may not be evidence based, in my experience "hanging small files long"  works for me, even
the small rotaries.  I find Khademi's comments to be right on, all apologies to my pulp lover friends.  I know, I
know, there's no "evidence" that patency is critical, yet I fight for it and achieve it 99%+  of the time.  If I'm
not patent it is an unusual situation and of concern.  When I get to size 20 stainless steel I begin to be much more
cautious - these are a bit stiff to be casual about working length.  I've noticed that getting the EFL to beep does
not equal "patent" by my Apical Barbarian definition.  (I must now be truly on the Dark Side) I suppose this is what
some mean by "smooth" patency - I want the file to go to length, and "hang long" freely - no pressure necessary.
Am I bruising and resecting and trashing the PDL? Maybe, but I can't detect any post-op problems - except when the
case is short.

Thirdly, I attach a case of no particular import, except that I did it this morning at an office with digital
radiography.  I found that I could just take a pic of the image on the monitor with my Coolpix and it turned out
reasonably well.  Previously I couldn't easily get images from the offices with digital rads.  And yet it is
obviously quite simple.  I know the case is no beauty - especially to a pulp lover and advocates of larger apical
preps.  I would have struggled without a scope - and some experience looking thru the scope.

Fourthly - and always, comments are welcome - Kendel,

I must say, kendel, that my perception and understanding lead me to be on the very dark side too not having scientific evidence of patency benefits does not mean it doesn't/can't work - Marcos-Arenal JL Kendel. I think that case looks great by any standard .... and I can't see anything on the post-op that a 'pulp lover' ( which I regard myself as)c ould take exception to (Interesting tip about photoing off the monitor - must try it) - Simon, Oz Simon, Thank you for the kind comments. Crazy thing about using my Coolpix to take images from the monitor. I like to study my cases after the fact and it had been quite inconvenient to get images from the referring docs that use digital radiography. I guess this means the server is going again - Kendel Kendel, Very, Very nice work. No beauty? Send me the films so I can take credit. How close to the apex did you take your #2 peezo? LOL. Classic preoperative radiograph of this case type. Distinct and normal looking mesial root and "what the hell happened" to the distal root. I noticed the date--not from the archives???? Day-to-day cases! Not the same dozen or so that I see in some people's ads and your articles! It is a continued delight to see these complicated cases managed well by your "day-to-day dentist" practicing in Smallville USA.- John A Khademy Kendel, Marvellous efforts and wonderful result - Samir John and Samir, I appreciate your kind words, but I am serious when I say this was "nothing special". The anatomy of the case may make it apear a bit flashy in a final film, but seriously there were no tricky apical ramifications, hooks, etc wanting to ledge, no serious obstacles that can cause problems, no difficult negotiations once canals were identified. It was satisfying however to know the situation from examining the pre-op. And also satisfying to be able to move thru the access development a bit more efficiently now that I'm getting a bit more experience looking thru the scope. This one did have more pulpal calcifications than I anticipated - Ken

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