From: John A Khademi, DDS MS
To: ROOTS
Sent: Friday, December 02, 2005 12:08 AM
Subject: [roots] Palatal ECIR

David was referred quite some time ago, but living in Telluride, he manana manana'ed until Tuesday.
We treated him yesterday. Pic2 and Pic3 show the classic pattern of wear, and as a consequence,
the access is "shifted" incisally. Pic4 shows the initial access and location of the chamber.
I then picked up an LAAxxess diamond, and extened the access to the final form in Pic5. I think
doing the repair before obturating gives a better result, so we cut a 40/.08 shape, then placed a
vaseline coated AutoFit .12 cone to block out the canal (Pic6). I reflected a palatal flap and
located the defect (Pic7). Crappy Pic8 "shows" a cut-in-half and sharpened anterior clamp
retracting the tissue. I could not get a dam on, but with the assistant in the scope, field
management was not a problem. Page2Pic1 and Pic2 shows the Geristore repair. I sutured him up,
then finished the endodontic case, places a small CRFC cemented with Geristore (which appears
as a void apical to the geristore in Pic4). We then cut back and placed composite resin to close.
He will have a residual periodontal defect here, but it will be only about 1mm more that it was
before the resorption. Total Tx time 2hrs. I would not have had a prayer w/o the assistant side. :-))
- John A Khademi




Nice case John! Instead of a vasiline coated autofit gp cone, you can use a canal projector
(John Munce) or a purple capillary tip (Ultradent). Much easier, and it saves you removing the
vaseline from the canal walls - Marga

Ahhhh....the purple capillary tip.  That would work PERFECT.
Great tip on the tip!!!!
Thanks Marga, that makes much more sense than a GP cone.
Sometimes when all you have is a hammer, everything looks like a nail.:-) - John

Nice work here of course
field management is a great term/phrase cause that is what it comes down to sometimes in addition
to having your priorities in order

My .02, although I am most likely not qualified to speak here, is you may have tried either 1.
suturing the tissue flap back to another place in the patients roof of their mouth or 2. use a
heavy rubber dam and do a split dam technique with a circular type of cut then suture the rubber dam
to the patient’s roof of their mouth to temporarily give you the control over the field you were/are
looking for

Medieval, but in the realm of it can be done/isolated..

Again..my .00000000000000000004 - Craig

Yep Yep,  I've done the suture back thing, but the clamp works much better.

The clamp was dangling on the bone, as you can see and I didn't want to put any more pressure on it.
It was just barely hanging on as it was...but I do use a split dam all the time.  Just not here - John

Dear Dr. John,
Isn't it better to pack MTA after you obturate it. After all the MTA which
is inside the canal but not in contact with the tissue is not going to do
any repair! whay pack it with something stronger. and the outside with
MTA??? just wondering.. :) - Vipin