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Abscess on second bicuspid : Post drill out - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been credited for the individual posts where they are. - www.rxroots.com
From: Terry Pannkuk
To: ROOTS
Sent: Saturday, March 21, 2009 7:45 AM
Subject: [roots] Post Drill out on Dad

My father came in today with an abscess on this second bicuspid.  Here are a series of photos showing the drill out
strategy for a solid cast gold post that was long and narrow enough to require some extra attention and focus.
Access with a Great White bur making sure it was constantly directed toward the center long axis of the root.
Once down to the cervical level I carefully shaved the gold down to base in the center that demonstrated a
circumferential dentin periphery around the apically extending gold post.  That was the tough part making sure the
peripheral gold was left maximally intact so that the crown would be retained (if possible...it was in this case).
A 1/4 round high speed round bur was used to drill into the gold post making a hemispherical indentation directly
in the center.

I then used the low speed with the smallest Munce Discovery bur to penetrate another 1mm.  At this point I just used
low speed Discovery burs.  A larger Discovery bur was then used (one smaller than the circumference of the post) to
drill into the deeper pilot hole created by the smallest Discovery bur.  The smallest Discovery bur was used again
to penetrate the exact center going deeper into the middle of the gold post leaving the circumferential periphery of
the post intact. The sequence was alternated so that the smallest Discovery bur was always used after widening with
the larger Discovery bur, never penetrating so deep that complete visualization of the center axis cold be maintained.
As the larger discovery bur started going deeper I would carefully flare the more coronal gold periphery away to
dentin but without removing dentin.

The last photo shows the end of the post which loosened when the small Discovery bur penetrated through the end of
the post.  I placed one of Scott's explorers through the end post fragment to show how you can keep it perfect
centered and safely away from the peripheral dentin.  Keeping the drill out centered also allows you to keep enough
of the peripheral gold core attached to the coronal third of the canal to retain the existing crown which is nice
during a month of calcium hydroxide placement.

Dad's are good patients to use as demos. :) - Terry

Very cool Terry! I have never seen a past hoolw drilled like that (for lack of a better term) and then plucked out with an explorer. A tribute to your inspiration, ingenuity, mangnification and dedication. - Arturo Terry,,You and John are showing impossible made possible :-)) Terrific example of conservative access and preservation of structure (although crown one...) :-) - Dmitri Nice terry. Try that without a scope. I recently had a guy in with a problem on a 5 unit screw in branemark case done elsewhere. The composite plugs placed over the screws had no barrier of any kind between the screws and the composite. And all were custom slotted screws. Took me well over an hour, but I got all of them out without damaging any of the heads. The discovery burs were very much involved there also - gary yep.....John makes a handy bur. - Terry A very interesting technique for post removal. How long did it take you to drill the post this way ? - Thomas
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