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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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