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From: Mark Dreyer
To: ROOTS
Sent: Monday, March 14, 2005 7:54 PM
Subject: RE: [roots] Another 2 visit case
Mark Dreyer wrote:
Chances are this could be a root fracture right? 10mm pocket on straight
mesial and 7mm on ml. Patient really motivated to try to save the tooth
and knows it might not work. This is one of those situations where 2 visits
is a nice approach. No fx seen on access. Cleaned/shaped placed the
white stuff. All pain went away after first visit. Finished it today-he
said he’s a new man (at first I thought I might have slipped him a Viagra,
but then I remembered he was having severe pain before).
I’m not sure of long term prognosis here. His opposing is a complete denture
so I guess if there is no fx, then there is a halfway decent chance of healing
even with the mesial tipping.- Mark
LOL. That is one mean mesial curve on the mesial root/s!! Did you prepare
the last mm or so or was it a squirt through the patent area?
Another thing Mark.. there are a lot of dentists who feel that such a
taper is inadequate.
I for one think that this "look" is adequate. In a lot of cases I do
not push the issue of imparting more taper at the risk of an
instrument separation .What are your thoughts on this?
If the tooth tilts more.. the perio will worsen.
BTW.. what is that white stuff that you use around the clamp for isolation?
Regards, - Samir.
Hi Samir, I did instrument the mesial canals in the apical curved area,
but not with rotaries-only hand files.
I agree with you about the fact that some times we risk instrument
separation by attempting to get a bigger taper in some canals. I'd
emphasize though that this is not very often. In the majority of canals, it
is possible to get a 20/.08 to length quite safely.
The white stuff I use around the dam is a product sold by ultra-dent called
oral-seal caulking. - Mark
Hi Mark,
In the pre-op film the mesial apical curvature is not too evident. At what
stage did you realize that in order to avoid taking your rotary to apex? I
don't believe you took a wire film in this case right? - Tony
Tony, I rarely take wire films. It's easy to know when you're not to length
with a rotary because it just doesn't go without pushing, and I try to never
push. If I have patency with a 20 hand file then the rotary should go to
length. If it doesn't I don't push it. I just use the hand files. - Mark
What I'm trying to say , is that I am looking at the mm measurements on my
rotary file while going into the canal. If the file doesn't get to length,
I know it by looking at those measurements in combination with the tactile
awareness that there would be a need to push if I were going to get it to
length. At that point the decision is to push or to get out. I recommend
getting out. - Mark
i used to use ultradent's oraseal, but recently i've switched to the light
cured blue stuff, i think they market for blocking out undercuts. much less
messy and prettier to look at. give it a try.- gary
Seriously, I like Oraseal, and the blue stuff, but with meticulous dam
placement, it's hardly ever needed. Let the Belgian's enlighten you - Bill
Nice and I'm betting against a root fracture. Guy
Beautiful result Mark, it would be a shame if it were to fail from root fracture.
Questions: How far along were you able to negotiate either canal, and if
you were able to reach the terminus of each to what size did you finish at
the working lengths (presuming WL is around 1.0 mm or less from the apical
constriction)? What files/sequence were used?
The puff on the M is something of a "Signature Mark Dreyer Puff" - I can see
it as being similar to many other cases you have posted.
Viewing the radiograph immediately following obturation for this case must
have been akin to hitting a golf ball well and admiring its long flight down
the middle of the fairway (ie, the one shot for the round that brings you
back again on another day). Sweet! - Michael Moran
Mark, I think the pocket depth is artificially created to a point by the
tipping of the tooth. It is very hard to fracture a tipped tooth.
I can't remember seeing one. Guy
Interesting, I have never noticed this but I think you are right - DanS
Hi Michael, I took a 20/.08 GT to just shy of that little curve on the mesial.
(the 2 canals merged) Sometimes I’ll bend a rotary niti file for a curve like
that, but I don’t always feel comfortable doing that since I separated a
file doing that once.
I maintained patency with a 20 k file, and did 1/4mm step back starting with
a size 30 hand file (first file to bind at beginning of the curve) going up
4 sizes higher in stepback fashion. On the distal I was able to take a
rotary all the way to length. The MAF was 40. Once again I did the 1/4mm
stepback in that canal also.
Yes, I was happy with the result. Thanks for your kind remarks! - Mark
Dear Mark ! The result wouldn't shame any textbook ! I do 2 visits every
time I see apical periodontitis or pain due to acute apical. periodontitis.
Why didn't you remove the amalgam on the mesial to check for fracture ?
How many times did you use patency files to get the sealer/gutta into
those ramifications ? - Thomas
Thomas, I didn’t remove the amalgam, because I could see very clearly under
the most apical extent of the amalgam and there was no crack visible.
I use the patency file past working length at least 20-30 times during a
procedure I’d estimate. Every time I replenish my irrigant,
I follow with the patency file. - Mark
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