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10mm pocket on straight mesial
The opinions within this web page are not ours. Authors have been credited for the individual posts where they are

From: Mark Dreyer
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 heís a new man  (at first I thought I might have slipped him a Viagra,
but then I remembered he was having severe pain before).

Iím 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 Iíll bend a rotary niti file for a curve like that, but I donít 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 didnít 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 Iíd estimate. Every time I replenish my irrigant, I follow with the patency file. - Mark

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