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Distal root : Extra anatomy : filling technique

From: "Scot White" To: "ROOTS" Sent: Monday, January 19, 2009 7:59 PM Subject: [roots] Speaking of healing Marga posted a healed case earlier and after I looked at it this morning, I had this patient in the office. I too like the look of the healing going on here but I would like opinions on the "extra" anatomy that I see at the end of the arrow that I labeled "A" in the lower left photo. And while this healing is obviously pleasant and the patient is asymptomatic, do you think the distal root is a success? - Scot White

Scot, what a fantastic case, great job! - Jose Scott, What sealer and filling technique did you use on this case? Very nice work.- Mike Scot,it looks like a deep split to me, and perhaps incomplete healing. Tough call, frustrating situation. If asymptomatic, and patient is good about recall, why not inform the patient of what you see, and if they agree, recall it again in 6mos/ 1yr. I have been cursing distal roots of lower molars lately. Here's one I did. A retreat with carriers removed on the first visit. Do you think I missed a distal canal? I worked hard troughing and looking , only to see this on the film later. Not sure....frustrating - Kendel

you bought Dexis? Oh, cool case...what files did you use?..))) - ahmad Kendel, great job! I do not think you missed a thing, what I think you are looking at could be overlapping of the anatomy of the mesial root, my guess. With the quality of the endo that you are delivering if there was a second distal canal at least you should have gotten a hint of sealer into it. Do not get frustrated over it, we are too demanding on ourselves, you can still do an apico if there is a problem. Take care. - Jose Kendel, Interesting. My guess is that the angle of the film, combined with an unusually wide shape on the mesial root has created an overlap and so the edge of the mesial root is "charading" as a missed canal. I'd like, if you have a moment, to hear in your own words what constitutes "troughing". I feel like my ability to locate hidden canals is not so good, so I'd like to hear what instruments you use and what goes on in your head when you are searching. I've been having more luck lately, it seems, using an ultrasonic as opposed to a bur. Thoughts? - Scot no, i used dexis, but didn't buy it. files? the really cool ones with gold and black, real shiny.....when i use them, what do you think...missed a d canal? i'm gonna talk to referring doc tomorrow, see if we can get more images. - Scott Thanks Scot. I'm going to check some other images if I can, and perhaps ask the referring doc to put this in a long term temp, if I decide not to go back in at this time. I had a similar case about a month or two ago, and went back and found the missed canal----I'll see if I can get it and send it along. The images weren't real good, but it may be of interest nonetheless. Troughing----yes, u.s. is the gold standard, and if you are developing comfort with that, stick with it. But having said that I will admit to using Munce Discovery burs of late----they provide excellent visibility under the scope, they leave a very readable surface, they are inexpensive relative to u.s.tips, I am comfortable with the feel/feedback since it is a bur, and they come in many sizes, and two lengths---the shallow troughers are the ones I use most for routine MB roots of max molars, and clearing isthmuses like we find in upper bi's and M roots of lower molars. The deep troughers can be used for accessing deeper splits and dealing with obstructions. What goes on in my head? Depends on the situation of course. I try to only follow color/texture cues ---in other words, I don't trough blindly. The color map should be dictating my efforts. I've learned to decipher the subtle white lines/dots/color variations, but that doesn't mean I can't be fooled. So you also have to think about anatomy, use tooth contours as clues, look for asymmetry, etc. There is an excellent article published in the JOE a few years ago---Laws of Canal Location----something like that--- I can look it up if you like. It's a good read. Hope some of that helped,- Kendel Scot, I found that case (attached). On the first visit, I removed the carriers and sealed the wide open margin---actually had gp to the margin!. This is a RESTORATIVE failure, likely called an "endo" failure by most that would see this ;-) Sorry about the scratchy phosphor plates. If you look at the first "final", you can see sealer tracing into the missed D canal. I called the patient back for a third visit and found the missed anatomy. Made me feel like an idiot for missing it.....oh well, glad I went back in, this is a humbling game we play - Kendel

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