From: Mark Dreyer
To: ROOTS
Sent: Friday, August 14, 2009 4:01 AM
Subject: [roots] Separated file case

I'm just about to finish a crazy busy day (after no pts yesterday) when my assistant comes in at 4pm and says
"Dr. X has separated a file in the mb canal and wants to know if he can send the pt right over?"  For a second
I ponder telling him to take a hike given that he has only sent me problem cases so far.  (He also has relayed
to my staff that he wants me to teach him how to find mb2's).  Anyhow after a second or two of thinking about
what I'd really like to say given my great love for separated files, I said, sure send him right over!

I didn't feel like spending an hour or two doing the Rosenberg twisted file technique given that this tooth was
vital pre-op (confirmed with pt that cold drinks drove him nuts) and also given the fact that both canals
drained together and I was able to bypass the segment.

I feel lucky that I haven't attracted too many of these type referrals.  Rosenberg always used to say not to
let it get out that you can handle these type cases because they are always money losers.  He developed his
technique to retrieve his own broken files -  Mark Dreyer, DMD






Mark, Can you summarise Dave's technique for us ... or post a .doc file if there is one/
many thanks - Simon

Simon, Summed up, you bypass the separated file on two separate locations, work up to patency with a 20 then
twist the files counter clockwise til tight and pull out.  This could easily require a couple hours of time
and 100 small hand files.  I've done it a few times, but have been unsuccessful a few other times.
It is very tedious but for the doctor with the right combination of patience and skill it is ingenious - Mark

Mark, Did you take rotories in canal with the separated inst. Just curious - Brent

Good question, not normally a good idea to take rotaries past a separated file segment, but since this file was
out of the way, I was able to take the rotaries to length with no problem - Mark

Nice Bypass Mark.......your pics are real high quality.
What was your MAF in the canal with the sep. instrument.....I feel that as we increase the file size the files
get stiffer and it gets difficult to get them across the separated instrument....well this is with me ...
what do u feel and suggest? - Sachin

Sachin, Thanks.  I did my normal 20/08 a mm long and noted the flutes were loaded so I imagine the MAF was
about a 30 - Mark

Good work , could you please describe how did you manage to by pass this apical 1/3rd separated file? - Mayank

Mayank, Quite frankly this was an easy bypass, probably the easiest I've ever encountered.   Somehow or another
the file separated in a fin or isthmus  because all I had to do was find the right path and I bypassed quite easily.
- Mark

You couldn’t get that sucker out of there?  In a hurry to get home? J  since you function like an endodude and
I do not, I’d like to see what others have to say about taking that kind of referral.  My thought is you provided
a service, showed you could handle the tough stuff, you most certainly can handle the more routine.  Now if he
made a habit out of it, might be time for a pow wow.

That’s why gp’s shouldn’t do endo! - gary