"C" shape case

The opinions within this web page are not ours. Authors have been credited for the individual posts and images where they are. Photos courtesy Terry Pannkuk

From: Terry Pannkuk
To: ROOTS
Sent: Saturday, September 02, 2006 2:33 AM
Subject: [roots] Smoothing out some previous "monkeying" around wih the access

I completed this “C” shape case today.  I decided to take some sequence pics of the cone-fit and two-handed compaction.
The referral had previously accessed the tooth and went a little wide at the MB line angle.  I sandblasted the pulp chamber
and placed a bonded core at the end.  All three systems were confluent with the ML smoothing into the D after coronal
flaring - Terry





Terry:
very nice ...your obturation flow always looks so smooth.
I noticed that you removed the mesial isthmus connector, so why not remove the thin wall between the merging canals for better cleaning?
Is that unnecessary and leads to weakening the tooth more?
But I understand about keeping it there, so they don't ask for discount since you only did "one" canal???...)))
Thanks for the kudos on my pictures, but yours are much better than mine. I am working on it. - Ahmad 

You don’t want to get carried away on a “C” shape.  The furcation invaginates into the “C” and getting carried way with
troughing the thin isthmus can lead to big trouble (i.e. perforation).  When I visualize the confluence apically and note
that it is clearly flowing and clean in the apical third I leave the isthmus (….and well enough) alone - Terry

I couldn’t agree more with that philosophy Terry.  The isthmus is a bacterial harbor, but mechanical removal, although
tempting at times when we’re armed with high mag and an U/S, could weaken or even be catastrophic to the structural
integrity of the tooth.  Here’s a case I did a couple weeks ago. - Rod Tatayn




Middle distal connected a common isthmus from buccal to lingual





Tempting to open up the entire fin, but WL films show apical confluence of canals to a single distal POE.




Cleaned and shaped canals individually focusing on cleansing the confluent apical third pack





Awesome pictures! I agree, coronal flaring facilitates apical enlargement  ;-)) - Fred