From: RafaŽl Michiels
Sent: Wednesday, March 25, 2009 2:17 AM
Subject: [roots] Today's cases
cases du jour :-)
All cases are shaped with protapers and some handfiles, cleaning with NaOCl and EDTA,
PUI and temp. rest. is done with GIC.
2.5 planned for a crown with post. Tooth was still vital.
Found 2 canals which joined apically. Looks a bit short on radiograph, but 0.5mm deeper
and the EAL went beeeeeeeeeeeep :-).
4.6 already opened by referring dentist, but closed again, since it was too sensitive
in the mesials. I opened it up, mesials still sensitive, I tried everything I can to
gain anesthesia, but nothing worked. So, I told her to just take the pain for a moment
and after about 4 seconds of heavy pain, I got an SX in and could succesfully use
intrapulpal anesthesia, from then on, she did not have any pain anymore.
4.6 with apical periodontitis and heavy obliterated canals. I could access all canal
until working length except the mesiobuccal, after 90 minutes I got an F1 to working
length in three canals, but still couldn't enter the ML. US & LN burs were used, also
alot of .06, .08 and .10 files together with some glyde.... nothing. Next appointment
I will try again.
2.3 with apical periodontitis, nothing special except the length. It was 29,5mm and you
know what? If you put the protaper into the X-smart handpiece and you get the edge of
the handpiece right at the incisal edge, you can get the 25mm protaper, for 29mm in the
canals :-). then just finish it some more with some handfiles. (or use a different rotary
sytem and just forget all what I said :p, TF's come in length of 27mm)
1.1 with apical periodontitis.
2.1 has a big internal resorption. It was opened by the referring dentist. I decided to
open it again and do nothing more than putting an EAL in, just to see if there was a
perforation. There was. I then probed buccally and the bone was lost and there was a
little wound in the gingiva. In other words, there was a connection between the buccal
sulcus and the canal. Tooth is scheduled for extraction. Evaluation will be done after
the socket is healed, to see if there is enough bone left, to place an implant. In this
situation however, there may be opted for a bridge. In the meanwhile the crown of the
extracted tooth will be placed in between with some stich tech for esthetic reasons.
Was the other case I posted today.
Rafael, great cases! Just a comment on the first case, do not rely on the EAL so much, go by the X-ray,
it looks short an my opinion is that it may very well be. The EAL also can read an accessory canal as
being the end of the root, and I believe this is exactly what happened in this case, you should have
taken it to the RT (radiographic terminus) and probably ended up with a beautiful case showing a
lateral canal. Fantastic work on the other ones and great judgement on the central with the internal
resoption, no hope there but an implant or a three unit bridge as you mentioned. - Jose
I'll keep in mind what you said about the EAL and the accesory canal. This is something I did not thought
about at that time. Next time I encounter something like this I'll take the files to length and maybe use
some paperpoints to confirm - RafaŽl