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File separated in MB canal
From: Mark Dreyer
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 till
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.
You couldn’t get that sucker out of there? In a hurry to get home?
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