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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 Marga -
 Separated instrument

From: Terry Pannkuk
Sent: Wed 2/1/2006 17:46
Subject: [roots] Separated instrument: The Ghost

This was a freaky instrument separation I had yesterday.  Itís been
a long while since Iíve had this happen and Iíve never had one break 
like this.  I think Herb Schilderís ghost caused it to separate since 
he hated rotary files. J  This male patient had a somewhat challenging 
maxillary second molar with two separate MB1 and MB2 systems with a 
long sweeping 90 curve.  The MB2 was way out into the mesial marginal 
ridge and the dentist who just made this crown 2 weeks ago didnít
have a chance of this not being an exposure.  After extending the 
access, finding the canals and performing initial coronal flaring, 
I began some mid-enlargement with the rotaries.  When removing the 
S1 Protaper from the access I noticed it looked shorter.  I pressed 
the tip with my thumb and noticed it was also stiffer.  I then looked 
at it under the scope and sure enough, the tip was gone.

I couldnít believe it because I never felt it separate and I wasnít 
even sure which canal it could have been, since I went through all 
four canals briefly just to create space to place files for radiographic 
measurement.  I then went through some recapitulations and thought for 
a moment it could have been in the MB2 but the 10 K-file was eventually
placed to length without any sense of an obstruction.  I recapitulated 
to the estimated working lengths on all four canal systems
and felt nothing.  I then figured it has separated outside the tooth at 
some point during the assistant transfer and didnít worry about it.  
In a few minutes I placed the files in the MB1 and DB canals to get a 
radiographic measurement.  I was shocked to see the separated instrument 
in the apical third of the palatal root.  It confirmed my theory that files
just donít break on their own outside the tooth.   I went back, flared 
and recapitulated a series of files in the palatal again and felt nothing.  
I then placed a purple Ultradent tip down the canal and saw nothing sucked 
up with the flooded irrigant.  I went through a series of Hedstrom files 
15-60 sizes, felt nothing, and nothing seemed to come out.   I placed
files in the palatal and MB2 to get the final working lengths and the 
file was directly next to the separated instrument in the palatal apex.   
I continued to completely clean and shape the case with no sense of 
obstruction and finally took a cone fit film and it was mysteriously 
gone.   It was a ghost.  I finished the case, never told the patient 
about the mysterious apparition and figure I wonít bother mentioning my 
paranormal experience to the general dentist either.

I probably sucked it out of the canal at some point after loosening it 
with the Hedstroms.   - Terry

C00l case, good to know that even you have seperated files ;-) - Thomas Terry, it is interesting that Dr Schilder hated rotaries. I thought so too, but then today, in lit, we reviewed a paper by Shafer & Lau 1999, about the Series 29 concept. They quoted two references by Dr Schilder from the early nineties on this topic where thay say he praised these files, and I think I either heard or read that he even designed the ProFile Series 29. Did he? - Marcos Arenal They weren't rotaries. He didn't like NiTi either but realized that Tulsa was going to design them the way they could sell them. NiTi and rotaries were the fad and that's what was going to sell. There's a definite disconnect between what achieves quality and what is popular. Rob wrote an excellent detailed description of the issue from Schilder's perspective.- Terry Series 29 was Schilders' attempt to correct the "jump" that occurred when going from 6 to 8 to10 to 15 to 20. You often see this when your #10 file goes to length but the 15 doesn't. Same with 15 going to length and 20 not going. Look at the size difference between #10 and 15 or between a 15 and 20! Compare that to the minor difference between 30 and 35. Most of us understand that for tough cases you need MORE files in the smaller range and less files once you get up above 20 or 25. Another prpblem that he often quoted was that according to ISO standard of allowed .02 variation in size manufacture - this could actually cause you to use a "thin" #10 file ( which is actuallymanufactured as an 8)and then follow it with a "fat" 15 - which is actually a 17. That's why that "supposed 15 file" won't go.( Conversely - you can have a situation where you are using a "fat 10 - actually a 12 and then following it with a "thin 15" - which is in reality a #13. THAT file will go easily.) Some have tried to address the problem by having "in between sizes" 17, 19 etc. That just sells more files!! Others have suggested actually cutting the file ends off to make a "file of in-between size". I've never understood that - the tips would be dangerous and sharp.. Schilder's Series 29 was how he envisioned a file system with a consisted constant difference in file size - which actually translated to less instruments. For those of us who new him well - Herb actually preferred the old carbon steel files and reamers with used the old "0,1,2 3" size system - before Ingle started the move to ISO standards. The funeral is tomorrow. Rest in Peace Dr. Schilder. Your legacy lives on - Rob Kaufmann thank you Rob, since this makes so much sense, I wonder why the S29 has not made the ISO standards obsolete in relation to endod instruments; or has it? - Marcos Nice description! For years we've dealt with inadequate files and adjusted them to our needs. They still suck; just suck less, or more or less depending upon the case. .:):):) I hope to see you there tomorrow bro! I'm at LAX about to board the red eye as we speak. - Terry have solved the 10-15-20 sizing problems in my practice by adding just 2 files to my set up. I added a #12 and #17 Flex- O-file. I use 06, 08, and 10 K-files followed by 12, 15, & 17 Flex-O-files before proceeding to rotaries. Flex-O files have safe tips to reduce ledging. I tore up the ligaments in my "endodontic thumb" in a snow skiing accident in 98-99 and had to have reconstructive ligament surgery a year later when it didn't heal. I probably would not be able to practice without #12 & 17 files and rotary instrumentation - Randy Hedrick

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