Retreatment of the day

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  Retreatment of the day


The opinions and photographs within this web page are not ours.
Authors have been credited  for the individual posts where they are.
Photos: Courtesy of Glenn Van As - www.rxroots.com
From: "Dr. Glenn A. van As"
To: "ROOTS"
Sent: Saturday, June 18, 2005 8:38 PM
Subject: [roots] Retreat of the day

I had a retreat scheduled today of a upper first molar which was originally done by an associate
around 1 year ago.  The tooth never settled down and was still sensitive to cold (yes that is
right) and more to chewing , palpation and percussion.  He completed the tooth pretty well with
his 2.5X loupes.  I didnt do any better before I got the scope.......molar endo is darn tough.

The original associate only found three canals but noticed an accessory branch (lateral canal )
in the post op film on the MB root.  I felt that he had gotten some sealer in the 4th canal but
never cleaned it.  The DB was short but the main area of the lesion was around the MB root.

On access (which is always the exciting part because you have NO IDEA what you are going to find,
its like being a detective.) I noticed some resin on the pulpal floor between the MB1 and Pal canals
and I immediately thought that there might be a canal there.  Removed the resin with a DG16 explorer
by poking into it and dropped into the MB2 with a #6 file.  I used the reciprocating M4 handpiece
to get down into the 4th canal and was ecstatic to get all of the GP out and gain patency
on all the other canals.  The MB1 and MB2 never did join at all and I was surprised by the final
radiograph.  I used the Er:YAG laser, bleach, chlorhexidine to irrigate the tooth.

The final radiograph shows the delta formation with at least 3 portals of exit on the MB root and
an accessory lateral canal high up on the Palatal that the associate got partially into but not all
the way.  I thought WOW doesnt that look great.

Now for the negative part, I am not happy with the palatal.  I am almost sure that there is another
delta there at the apex that I wasnt able to get into.  So much so that I may remove the Palatal and
redo that canal at the next crown prep appt where I plan to replace the crown.  I am
sure that there is a delta forming there that I didnt get downpacked into.  Made me mad.

Anyways, I post this because Molar retreats arent for the faint of heart.  Always there are four canals
(or almost always) and I always get nervous if I dont find one.

I hope these photos that I put together from this case treated in 1 hr and 45 mins will give you some
insight into the details that a scope can give you.- Glenn











WOW....WOW....WOW  Mr. PREZ (AMED)...beautiful!!!!!!
Regarding terminology used in your post you sound like Robbie Kaufmann ;-)

Beautifully documented glenn.  Only problem is it would have taken me an
hour and 45 minutes to position the scope and take the photos!

And I'm sure joey appreciates the infomercial :) (I'm getting another couple
of sets as I can't stand using my setups that have the other pluggers on
them.) - gary

Hi Gary......thanks alot.  I still wasnt 100% satisfied with the palatal
which I know has anatomy that I didnt get into.  I learned a while back
how to position the scope for the case and endo is easy with the scope.
Static view through the occlusal for most things except at high mags
(especially on the lower molars).

As for the pluggers.......Joey needs his 3% !!  He is ready to retire
soon from those great courses he and John put on and all the royalties
from his GREAT pluggers.  They are awesome.  I like them alot and the
Spartan Obtura ones are good too. Thanks again for your kind remarks - Glenn

If I knew it wouldn't give him a swelled head, I would go on record as
saying they are the best I've ever used.  I used to think a plugger is a
plugger until I used his.

I'm still stumbling around positioning the scope, especially for lowers.
And just when I thought I was getting the hang of it, I had the global rep
out, we put on the balanced arm for my protégé which effectively
counterbalances the way the g6 deluxe does, and changed the light source to
xenon.  Then I had the carr adapter modified by global, so now I'm
struggling with 4 different learning curves simultaneously; light, arm,
camera, and positioning.  Oh ya, then I'm also trying to do the endo.
I'll get it.  Back to your dvd. - gary

Thanks for the kind words about the DVD on microscope positioning that I
made. I am glad that it is helpful.  Lowers are not the easiest to deal
with but do remember to incline that patient into a semisitting
position, lower the chair as far as it can go.  Tip the binocs towards
yourself and often you can get a direct view of the distals.  Sometimes
I will have to tip the scope the other way and put a mirror at the
straight distal to get a view of th mesials.

As for the learning curves......the light is pretty easy, I have mine
almost all the way up, the arm once set needs little movement.  The
camera and positioning are the two biggies and in the upper arch its
pretty easy.  The lower molars are more difficult.- Glenn

Thanks Glenn.  I will take you up on your offer of specific questions.  I am
hoping to complete installation of all my video cabling this weekend.  I've
then ordered in a dental school head typodont thing which I'm going to bolt
to the headrest and practice positioning for each sextant of the mouth, play
with the camera position and settings, adjust so the camera is seeing what
I'm seeing, then record the results.  The global is so much different from
my previous scope (in a good way) that it is almost like starting over.  The
best analogy I can think of is back in my early scuba days.  For the first
25-50 dives, you are equipment fixated, checking gear, making sure you are
not running low on air, etc.  dealing with the technical stuff, and not with
the purpose for which you entered the water.  After that, the gear stuff
becomes 2nd nature, and one is able to start diving, and in my case,
shooting video of my surroundings.  Right now, I'm fixated on the scope, and
eventually it should be nothing more than a tool to do whatever procedure
I'm embracing better. - Gary










Awesome photos. Some of the best documentation anywhere. DougR

Thanks Doug, I appreciate that alot.

System

Global G6 with Xenon light source
Nikon D70 with SB29 ringflash on bottom of scope
XMOUNT DIGITAL SLR MOUNT
Dual Iris diaphragm (Global)
Gary Carrs Excellent Mirrors
Software done in inexpensive ACDSystems 7.0

The software post processing include 15-20secs per picture (levels,
brightness, contrast, sharpness and placement in a collage format).
Adding text is done in same program (Fotoslate 3.0)

Here are a couple of shots of the setup as it exists at present.

These are from when I had the setup on the old scope, the new G6 is 30%
more light due to improved optics compared to the Protege Plus.  I have
to take some pictures next week of the new scope and the camera setup.

Thanks again Doug.......PS the radiographs are digitally taken with an
old 990 Nikon from the hardcopy radiographs on a lightbox in macromode
and placed here.  They are not digital radiographs , maybe int he next
office.

Wonder what kind of digital sensors a GP office would look
at......scanners or sensors for you folks? - Glenn




As to the case, - a nice result.

How some people expect to do careful treatment like that in
15 or 30 minutes (without a scope) is beyond understanding.

And as to the magnification - Loupes only? Sorry  you’re STILL gonna miss
LOTS of stuff and that’s a good example of the difference a scope can make -
Robert M. Kaufmann DMD MS(Endo)



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