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 Tooth #31 necrotic pulp
The opinions within this web page are not ours. Authors have been credited for the individual posts where they are. Photos courtesy Randy Hedrick - ROOTS

From: Randy Hedrick
Sent: Saturday, October 01, 2005 12:04 AM
Subject: [roots] #31

#31 necrotic pulp in the chamber, vital in the canals.  Widened PDL around apex and up the distal.
Coronal flaring with #2 & 4 Gates.
D canal 24.0mm #65 LightSpeed
MB canal 24.0mm #50 LightSpeed
ML canal 24.0mm #50 LightSpeed
I could tell the MB & ML joined about 5mm from apex because of the tactile feed back from the non tapered instrument.
Obturation is with Resilon/Epiphany.  Sealer applied with a paper point then a Simplifil Resilon plug coated with sealer
in each canal followed by Resilon injected with Obtura (145oC) followed immediately by vertical condensation with a single
push of a 5/7 plugger, followed again with Obtura to backfill the plugger void.  Epiphany sealer was applied over the top
of the obturation and set with a light.  A bit of an over extension of the mesial obturation after it crossed the distal,
happy to see the lateral canal on the distal.  One appointment, 2.5 mag loops.- Randy

Randy: Now you're talkin a language i understand......with nice cases......looks impressive for 2.5X mag ;-) See...images are worth a thousand words. ;-) - Ben. Ben, remember he’s using scary white stuff to fill.- gary Randy...a little overextruded.......think how good it would have been with a scope!! Just kidding. Nicely done and not easy to do. How do you like the Resilon. In addition are these digital radiographs and if so , what system. PS Are you going to do Number 30 next! PS I need 2.5X loupes to just read the paper now adays! - Glenn Glenn, Preop is scanned from the referring dentist. Post Op is digital - Lightyear. Lightyear is attempting to write their own software which should improve the contrast of the image. I'm a bit disappointed with the image contrast. I have been using Resilon since August last year. It is a littel different to work with than GP. Most noticebly it is stringy when trying to remove it from the pulp chamber. I had a problem with voids with the Obtura backfil at first but now I only get an occasional small one, like this one in the MB. #30 has a short and the obturation has a very narrow diameter but is asymptomatic, no obvious lesion and has a good crown. I'm going to leave that one alone.- Randy
When you say white stuff I think Calcium Hydroxide not Epiphany or Resilon ;-) By the way here is a message I posted in another list regarding bio-film ;-) and other films I include the picture of a film of white stuff (CaOH) which I could not get rid off in the second visit. - Ben FILM a thin coating or layer; "the table was covered with a film of dust" or a thin sheet of (usually plastic and usually transparent) material used to wrap or cover things so we exchange the biofilm or cover it with a film of white dust (CaOH) and later with a thin film of sealer or resin pushed against the walls od dentin with gp or resilon. Or we mix the biofilm with dentinal debris and make a smear layer. In other words endodntists are full of....film. I’m sorry. I think sashi made a comment on his first use that the resilon/epiphany fill was “scary white,” and it stuck with me. Just trying to cause trouble where none existed - Gary Thanks Randy, for all the details, that's a great looking case.- Kendel Good Job indeed Randy. Do you think the 2.5 mag loupes make a difference as long as one doesn't get a scope? I don't use any form of magnification but would love to - Sachin Randy very nice. Why do you think you had that over extension of the mesial?? Did you test the apica; stop with finger preasure?? - Carlos Thanks Carlos. I don't routinely test the apical stop with an instrument by hand. I do recapitulate with LS rotating in the handpiece one final time to clear debris and facilitate my final irrigation regimen. I obturated the larger distal canal first and softened the tip of the mesial Resilon plug for 1s with chloroform to get better adaptation since it appeared that all three canals merged. I don't routinely soften with chloroform. The distal Simplifil plug was a 65 and 5mm long so I would think it would block the path of the #50 mesial plug as it was seated unless they crossed to the buccal or lingual of each other. That would allow for a slight overextension of the softened mesial Simplifil plug. It's one of those cases you'd like to extract and section so you can see what is really going on. I'm confident it will heal, the radicular pulp was vital - Randy Certainly you are going to move or be able to move the resilon plug a little further with chloroform and/ or heat under vertical condensation than you would have simply by putting finger pressure on it. You’re going to get excellent healing, that case is damn near perfect and well done. - gary Great Case Randy! Thanks for share. You comment that Resilon is "stringy" when trying to remove it from the pulp chamber. I suppose that´s sticky more or less, then: how do you remove it, with alcohol or other solvent perhaps? - Nuria Yes, Sticky is another way to describe it. I use the heated tip of a System B to remove excess and condense the remainder onto the top of the obturation and then cover with Epiphany. I don't use any solvents on the dentin to remove the excess because I don't want to contaminate the dentin preparation (with the primer) that allows the Epiphany to bond to it- Randy
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