MTA driven apically via UltraSonics
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Probably was a five canaled molar but you couldn’t see for all the resin blocking the dentin map and isthumes between canals ... KIDDING!!!!!... Extremely nice work as usual - Craig I realize that some guys like to keep looking at the floor of the chamber for the entire duration of treatment, but I have to ask at what point are they EVER willing to cover the chamber floor? Why would they be willing to cover it at the completion of their RCT--maybe they'll discover something else right at the last minute.... It's just a matter of how you sequence your procedure--it's not at all unusual for me to spend a couple hours grinding around on the floor and deep into the roots before I elect to do my "pre-endo" build-up. By that point, I'm so sick of looking at the road map and the other morphologic elements of the floor and deep radicular areas, that I can't wait to cover it all up and get down to the definitive endo........ cjm. nice presentation CJ. with regard to MTA who not place it in the apical 1/2 then immediately fill the coronal half with a resin and let the MTA then set. Why is it necessary to come back at another visit after setting? Someone had suggested to me to mix the MTA with KY jelly instead of the sterile saline that it comes with he says that makes it more plastic but i have not tried it yet. Has anyone had experience with this? - Gregori M. Kurtzman, Gregori--I have been one who sugg'd KY Jelly as the moisture for MTA in the past, but was admonished by Mahmoud that there were no studies showing the efficacy, which I knew, but was using it anyway. Don't know who first sugg'd it to me. Anyway, I stopped using it, and can't say whether or not it had anything to do with setting or not setting of MTA or with fluidity of MTA...... Regarding bonding directly over unset MTA, I will do this sometimes, but in this case, I just wasn't convinced there was adequate moisture available from the apical foramen to set the entire MTA collumn, and didn't want to take the chance, so I checked it a few days later. I have at times packed MTA in the apical 1/3, condensed GP over top of it, and then bonded composite over the GP in the cervical area. When I do that, I make the judgement that there is adequate moisture through the apical foramen to set the MTA in the apical few millimeters. In the case I just posted, I wasn't certain of a good set of MTA all the way from terminus to cervical area. Also, while I will in some circumstances bond composite deep in a root, I do it only in specific cases where I know I can deliver the composite to the depth needed w/o the risk of voids. Wasn't sure of that in this case...... cjm. Where are you getting the saline? My mta comes packaged with sterile water. The reaction to cause mta to set is a hydration reaction requiring water only. Ky jelly is a combination of sodium carboxymethyl cellulose, sodium alginate, water, and edta. Is that really a good idea without knowing its effect on solubility, leakage, effect on its ability to induce cementogenesis and bone remodeling? - Gary And that would be why I don't use KY Jelly--anymore........ BTW, what kind of person would know the exact components of a substance like KY Jelly? cjm. don't even ask him whats in ASTROGLIDE grin - Gregori M. Kurtzman Looked up the ingredients of KY and they are; Ingredients:Chlorhexidine Gluconate, Glucono Delta Lactone, Glycerin, Hydroxyethylcellulose, Methylparaben, Purified Water, Sodium Hydroxide We know that CHX has antibacterial properties in canals that can last 48 hours. The purified water is helps set the MTA. Methyparaben is a water soluable wax like substance which is biologically inert. Glycerin acts as alube so should make the mix with mta more plastic like allowing easier placement. hydroxyethylcellulose is used in eye drops so it should be safe in the tooth. Glucono Delta Lactone (GDL), an ester of gluconic acid, is manufactured from glucose derived from corn or wheat starch. The only one of concern would be the sodium hydroxide. I didn't see EDTA or sodium alginate listed amoung its ingredients.- Gregori sorry my mistake I meant the sterile water that comes in the package - Gregori M. Kurtzman It was Ken Koch who recommended using KY said there have been some who checked setting at it set the MTA to a similar hardness as saline. But if we look at it logically the saline may be absorbed int eh dentine or out the apex from the MTA but the KY since its water soluable and a gel may stick around in the MTA longer providing moisture longer ensuring setting. with regard to delivering resins deep into the canal I like to use Centrix needle tips have found you can place the tip to the depth you want then back fill the canal with less chance of voids. Also like a dual cure resin that flows well. - Gregori M. Kurtzman, Gregori--I use so many Centrix NeedleTubes they should just transfer a portion of the company over to me..... At ~1mm in external diameter, they won't reach anywhere near the apical third in MOST canals, which is the depth to which I think you could reliably expect moisture scavenged from extra-canal tissue fluids to penetrate. You sugg'd packing MTA to mid-root, and NeedleTubes MIGHT get to that length, but I think not in many if not most cases--and then you are relying on that tiny entryway for moisture at the canal terminus to allow adequate moisture to be sucked into the MTA such that it'll set all the way the mid-root(??). For the NeedleTubes, it's not a length thing, it's a diameter/flow/fluid dynamics thing. I won't tolerate a bubble between the GP or MTA and whatever backfill I'm using, so if I can't reliably avoid the void at the interface, I won't use the method. That said, I immediately overlay MTA in certain kinds of cases, relying on moisture through a perf or apical moisture for the set..... I use a lot of Centrix Encore AF auto cure composite b/c it flows nicely through NeedltTubes and comes in tubs rather than syringes. Regarding KY Jelly and MTA, seems to me that there was a study that looked at KY Jelly as the moisture for MTA--can't produce it at the moment (where's Ben Schein when you need him?). cjm. Someone had suggested to me to mix the MTA with KY jelly Hmmm....this might change the sealing properties of MTA....I'd be a leary of this. "Suppose the KY jelly increases particle distance between the particles...could this change the sealing properties?" - Joseph Dovgan
