Sealing Cap
| 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 |
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Photos courtesy of Jerry Avillion - www.rxroots.com |
From: Dr. John McSpadden Sent: Friday, April 20, 2001 2:27 AM Subject:sealing cap Fred, I am not so sure shrinkage works that way. John
From: Fred Barnett Sent: Sunday, April 22, 2001 5:38 AM JOHN, It wasn't my comment about the shrinkage of sealer. I am of the opinion that if your obturation material shrinks after placing it into the canal system, then it violates the criteria of root filling materials. Voids will be the end result. Dimensional stability would appear to be an important property of root filling materials. - Fred
From: John J. Stropko, D.D.S. Sent: Saturday, April 21, 2001 8:37 PM John, I have found that these SOB roots need as much "straight-line" access as you can reasonably get. The canal will generally exit the pulpal floor at about a 20-30 degree angle to the lingual. Then about midroot it will take as much as a 45 degree turn to the buccal! Visualizing this DL canal like that has enabled me to successfully instrument the canal since. BTW, I strip-perfed the first two I did before I figured it out....guess I'm a slow learner. Hope this helps. Just another one of your secret fans. Had to do a surgery on one of these last August! Dr Olover Pontius, from Germany, was my assistant and even with his expert help, it was a bugger....but healed well! John Stropko
From: B. Harvey Wiener, DDS, MScD, FRCD(C) Sent: Friday, April 20, 2001 2:50 AM jerry, what sealer do you use? It sure looks more radiopaque than my Kerr Sealer and those puffs would make a BU puffer weak at the knees. Harvey
From: Jerry Avillion Sent: Friday, April 20, 2001 8:59 PM It's Kerr's pulp canal sealer, but this last batch I got came in new packaging and it sure seems more radiodense than the older stuff. From what I understand, they made the silver particles smaller, but I don't know if they added more silver or not. Maybe Bob Gannon or Steve Jones can find out. Jerry Avillion Fort Smith, Ark. MCV '84, MCV Endo '86
From: Richard Schwartz Sent: Friday, April 20, 2001 7:22 AM Jerry, I can almost always get patency with a small, flexible rotary instrument. They seem to snake their way out the foramen. I use the size 2 or 3 Series 29 from TDP. Of course, I showed a case the other day where I couldn't get patency, but that is rare. BTW, did you remember to say hi to Charlie Hartsfield for me? I haven't seen him in about 10 years. He probably doesn't know I did an endo residency. Thanks. - Rick Schwartz Jerry writes: They make series 29 rotary instruments? - Jerry Avillion From: Richard Schwartz Sent: Friday, April 20, 2001 8:00 PM The were TDP's first rotary instruments. From: Uziel Blumenkranz Sent: Saturday, April 21, 2001 4:44 PM I believe they are out of the market, originally manufactued and following Dr. Schilder's idea of the more instruments in the small diameter instruments. Each one 29% larger diameter at the tip. - Uzi
From: Mark Dreyer Sent: Friday, April 20, 2001 11:20 PM Thanks for the tip, Rick. I sometimes have a tough time getting patency on the distal canal of vital lower molars. It seems as though alot of these canals have a bit of a curvature in the last couple mm. I usually don't use those small rotary files, but following your tip, pulled out an .02 taper size 15 tip quantec file, and sure enough, it waltzed its way right through the foramen. Great tip! Mark Dreyer, DMD, PA 3503 13th Street, St. Cloud, Fl. 34769
From: Gary B. Carr Sent: Saturday, April 21, 2001 3:01 AM A word of caution here please. I'm not so sure the rotary "snaked its way out of the foramen" as Rick suggests. It may be just making its own foramen. I'm not a big believer in using these rotary files as suggested at the apical 2mm when a hand file will not go to patency. Try your technique on some extracted teeth with apical curvatures and observe what happens...... You'll be suprised. If you look closely at Ricks posted case, you'll see the apical shapes look unusual. The question is why? - Gary
From: gary Sent: Sunday, April 22, 2001 12:26 AM
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Photos courtesy of Gary - www.rxroots.com |
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From: "John J. Stropko, D.D.S." Sent: Sunday, April 22, 2001 3:39 AM I don't have one of those gizmos that put the curve in your k-file. I just bend the tip of the file by hand. Is the bending tool worth buying and if so, who sells it? I use the Endo Bender from Analytic. I find it useful. It's especially nice to put a very nice curve at the end of a hand file especially when seeking to obtain patency in difficult situations. From the desk of:John Stropko
From: John Coetsee Sent: Saturday, April 21, 2001 1:14 PM Try Anteos-C 0.06 SS stiff file with watch winding action, if it does not go through then nothing will. If it seems to go through then it is as Gary wrote - a deviation John Coetsee
From: Richard Schwartz Sent: Saturday, April 21, 2001 9:26 AM >>If you look closely at Ricks posted case, you'll see the apical shapes look unusual. The question is why? << Gary, When you say "unusual," please explain what you mean. - Rick
From: gary Sent: Saturday, April 21, 2001 5:44 PM Mark, You are never safe at the apex with any instrument! One wrong move at the apical 1.5 mm can ruin hours worth of work! One advantage of small patency files is that you are unlikely to make these errors with these hand files.The way to finesse this area is with #6 and #8 using the file bender with discrete curves. You can almost always find the curve with this technique, even in retreatment cases with ledges. The SEM pic is using a rotary TDP .04 taper. You can see that this file is NEVER going to make this curve but it WILL get to" length" at some point, yes? I do not believe rotary files were ever designed to manage these abrupt curvatures, nor do I know of any manufacturer or endodontist-designer who claims you should use them in this manner. If you can't get patency with a #6 or #8, you should question why in the world a rotary file would go to length. - Gary
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Photos courtesy of Gary - www.rxroots.com |
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From: "Jerry Avillion" Sent: Sunday, April 22, 2001 7:19 AM I've tried alot of different brands of #6 and #8 files. So far, my favorites are the Caulk flex-o-files. (sometimes, I'll use the regular k-flies if I want a stiffer instrument, but they dot seem to cut as well) What are yall's favorite brands? Jerry Avillion
From: DANNY O'KEEFE Sent: Sunday, April 22, 2001 12:15 AM Great photos and info. Although, I may be learning too much. It adds to the guilt. Danny
From: B. Harvey Wiener, DDS Sent: Saturday, April 21, 2001 9:36 PM Hallelujah Gary! Remember a while back I inferred that common sense should always prevail in choosing an obturation technique. Same goes for C&S. If you know and study(digital images or off-angle radiographs) the anatomy of a particular root canal system, before you begin, you must then "design" your cleansing and shaping protocol for that anatomy using "instruments" that can accomplish your goal "predictably" each and every time.Those of us that use rotaries most of the time should know that what Gary says is "the way it is". There are no quick shortcuts for negotiating curvatures in the apical 2 mm other than by placing a "gentle bend" in a 06 or 08 hand instrument and dancing and prancing your way down those canal walls until you reach home. You may think that using rotaries may work from time to time but never predictably and never without the very strong possibility of creating your own "additional" apical terminus. - Harv B.Harvey Wiener, DDS, MScD, FRCD(C) Limited To Endodontics 800 East Broward Blvd Suite 305, Fort Lauderdale, Florida 33301 Tel: 954-463-9191 - Fax:954-463-9194 E-mail: endo@bellsouth.net
From: I. Blake McKinley, Jr. Sent: Tuesday, April 24, 2001 1:57 AM Bravo! Very well put. Customizing the approach based on your pretreatment assessment of the system for predictability in the outcome is certainly key. This is true whether hand instuments are used or rotary instruments are used. - Blake Jr
From: B. Harvey Wiener, DDS Sent: Saturday, April 21, 2001 11:05 PM Harvey, you're so right, but... I have a collection of ledges (by me) in the apical last 1.5mm. which I discovered with a #10 or #15 working length file X-ray after having worked for a long time -and discarded many, many 06 -pink handle- instruments (before rotaries) and I thought I was OK. Those last two mm is what distinguishes the men from the boys, I'm ashamed to concede that in a fair number of cases I'm still a boy. On the other hand, I was associated with three fine endodontists that never used 06 and 08 files perhaps a few 10's and their cases worked. One of them, whom you know, is presently a restauranteur near Gary's territory. I have several of his cases more than 25 years in my own mouth and they are still kicking. They are all to the radiographic terminus, I hope I won't have the opportunity to look at the anatomic terminus some day soon. You probably while still in Montreal saw succesful recalls of cases of my "tocayo" (Spanish word for a person with the same name) before you slowly converted him to the "way". - Ben
From: B. Harvey Wiener, DDS Sent: Sunday, April 22, 2001 3:11 AM Ben, Boy,do you have a memory about my former partner Ben S? That was 24+ years ago. Your point is well-taken. I often have to use many Pink 06's which I often make into .07, .075's by cutting off a frayed mm etc. These are stainless instruments(Phil). I prefer them in these cases to NiTi's along with some RC Prep gently "ejected" over the orifice from a syringe. Once I negotiate through to the "terminus" I don't let go. I continue to use as many as 100, 1.0mm or so vertical strokes following that curvature so I don't lose it. I do understand what you are saying though about ledging which I hopefully avoid in doing it the above way. As I write this, it's almost as if I am actually feeling these apical machinations that I desrcibe. I think Ben, that reaching this degree of "feeling" with your fingers on the instrument is what separates the men from the boys.- Harv
From: Kachman Sent: Saturday, April 21, 2001 9:55 PM It would seem to me that a file that cannot be pre-curved (ie. NiTi) could only negotiate a terminal "wow" like we see on Gary's post if one possessed great luck... isn't NiTi's flexibility a two-edged sword?...particularly when they break in an extreme curve and then immediately straighten out and lock in there? Phil Kachanoski Peachland BC
From: Richard Schwartz Sent: Sunday, April 22, 2001 2:44 AM Phil, Actually, niti instruments can be pre-curved. I do it all the time. Niti instruments can go some pretty amazing places, and in fairly large sizes. But like everything else, they won't do everything you'd like. They have their limitations. I did the case below two days ago, entirely with rotaries once WL was established. It had 4 long, curved canals. The palatal root was 28 mm. Both the distal and palatal roots had fairly sharp curves at the end. The cement extrusion was, admittedly, a bit extensive. - Rick
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Photos courtesy of Rick - www.rxroots.com |
Bill Watson DDS, MS, FAAOMP, MBA writes......... NiTi files can certainly be curved and this technique can be helpful at times especially once working length has been established, i.e., a glide path has been established. You certainly cannot expect a precurved NiTi rotary to work the way a SS or NiTi hand file to work. My experience has show that precurving a SS or NiTi hand file to finesse a very fine curvature or 'work out' a ledge is much easier and more predictable.
From: Mark Dreyer Sent: Sunday, April 22, 2001 3:08 AM Rick, I never pre-curve niti files. I'd heard it could be done, but I've always instrumented those curved areas with pre-curved stainless steel hand files. What would be the advantage of pre-curved niti files vs. pre-curved stainless steel? Here's one I did a while back. I don't have one of those gizmos that put the curve in your k-file. I just bend the tip of the file by hand. Is the bending tool worth buying and if so, who sells it? Mark Dreyer, DMD, PA 3503 13th Street St. Cloud, Fl. 34769
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Photos courtesy of Mark - www.rxroots.com |
From: Richard Schwartz Sent: Sunday, April 22, 2001 4:28 AM Mark, I precurve them by hand also. I need to do it sometimes to get the right angle to get into a canal in a patient with limited opening, or to get past a ledge. You can certainly do it by hand with stainless steel instruments. When possible, I like to clean and shape the canals with rotaries. But there are lots of ways to do it, as you see every day on Roots. Nice case. Rick
From: Tim McManus Sent: Sunday, April 22, 2001 8:23 PM Tim McManus wrote: I taught this to a first year endo resident on a case he had "given up" on and he was quite impressed with my ability to bend an 08 file and get another two mm of length in the distal canal of tooth #19. He had instrumented the canal using an assortment of hand and rotary files but did not even consider picking up a file as small as an 08. The residents think the files stop at 10. The other remark that the student made which concerned me was that he did not think that reaching the apex was so important in this particular case since it was vital. Do we not want to clean and shape the entire root canal system whether the case is necrotic or vital? He was very excited to show me the final result and told me that this episode has really changed his approach to endo. That is the reason that I teach!
Sealing Cap Continued....
