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  NonaGenerian RCT

The opinions and photographs within this web page are not ours. Authors have been credited for the individual posts where they are. Photos: Courtesy of John Munce - www.rxroots.com
From: C. John Munce To: ROOTS Sent: Wednesday, November 30, 2005 9:53 AM Subject: [roots] NonaGenerian RCT OK--I just finished a really complex mand molar RCT on this 93 year-old gentleman who had to give up riding his motorcycle after a recent accident where he ran into his neighbor's car--while it was parked!!!! He also lost his license over that unfortunate incident.... He said that he had been having probs walking over the past few years, so he started riding a motorcycle to get around...... IMAGES 1 Pre-Tx. Obviously, all three of these teeth need endo therapy, but his current CC is related to #s 18 and 19. Had to mollycoddle (sp?) him along to get #19 finished--always asking "aren't you done yet?" 2 Deep exploration with narrow-shafted 34mm-long tiny round burs deep on the M and into mid-root on the D before all 4 severely-calc'd canals were located. 3 The canals were projected from their exploratory depths to the cavo-surface of the access cavity with bonded composite, and Ca(OH)2 was placed. Sinus tracts traced on #s 18 & 19. 4 After painstakingly picking my way through each millimeter of progress, the case was completed in 3 long-ish visits. 5 Patient asks at this point: "YOU MEAN WE STILL HAVE ANOTHER TOOTH TO DO YET??!!" I didn't have the cajones to tell him we have 2 teeth left to do, and they're probably both going to be as big a bugger as #19 was.... He wants the NonaGenarian discount b/c it is taking so long...... Guess his reasoning would be that the cost should be directly proportional to how long the actuarial tables say he has left to live.... :-{

Great Case Dr. Munce, 1- i have a question related to your No.2 step, the Tiny round bur, is it a custom made one (i mean is it a modification of other bur) ? 2- IN picture 2, (winnkelman, klaus #19b.JPG), that radiolucency in the canal, is made by your round bur right?, if yes, how much you think it is enough to go (i mean at which level you stop using the bur, and start to use the files)?. 3- Can you give us a short guideline and tips about managing calcified canals please? (offcourse if you have the time for that). Thanks, and again sorry if my questions seems to be basic questions.- yours, Mohammed Jamal (newly graduated dentist) No need to apologize for being inquisitive. In response to your questions: 1 Yes, I make these modified-shaft burs myself chairside. In the ROOTS Multi-Media Library ( http://www.comprehensivecareone.net/ml/search/search.html), you can do a Key Word Search for Deep Access, and you'll get 2 short .wmv videos I posted there that show how to make these narrow-shafted 34mm-long round burs for deep access. The blanks come from Brasseler (to order, see below)--you have to modify the shafts yourself chairside. I describe the technique in detail in a paper that will appear in the January '06 edition of Dentistry Today--along with several narrated videos nested on their website and linked to the paper. 2 I explore as deeply as required to confirm that I've located all canals in the root--one, two, three, however many there are??? That may take me to mid-root, or perhaps to a millimeter or two from the root end (as in the case I just worked on this morning--this one a 91 year-old mother of an out-of-town dentist). 3 For tips on managing calc'd canals, stay logged onto RxROOTS (and see my Dentistry Today paper in January.... :-). Also, when working with any deep radicular exploratory methods, you've got to have high magnification, lots of illumination, and a steady hand with a light touch.... You must understand the external anatomy of the root you're working in, and you should take multi-angled radiographs with a radio-opaque marker at incremental increases in depth to ensure that you're remaining within the body of the root with your exploration. You can't be in a hurry with these kinds of cases--with this 91 year-old lady I saw this morning, it was a 2.5 hour visit without interruption. These delicate procedures can't be done in 45 minutes--often not even in 1.5 hours--and I'm not talking about completing the RCT in that time, I'm just talking about managing the calcification in that time--possibly.... Be patient/Be excellent......... Be cool too..... ;-} cjm. Brasseler 34mm-long tiny round bur item numbers #1/2 round--015225UO #1 round --015272UO #2 round --015260UO #4 round --016035UO Ya, but look at the result you gave the guy. Few could have done it better! Motorcycle. I figure at that age the only thing Id be riding would be my Depends. Or a flip top box. - Gary
Your comments please

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