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To squirt or not to squirt - Courtesy ROOTS
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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. - www.rxroots.com |
From: Jörg Schröder To: ROOTS Sent: Tuesday, May 16, 2006 5:04 AM Subject: [roots] To squirt or not to squirt this one has been a referral case. Tooth 48 (international) is the distal abutment of a bridge. Patient complained about tenderness to percussion for 8 month. Then she was told to look for a specialist. Previous dentist didn't know, that a instrument was separeted. Just could not negotiate the mesial canal. The instrument came out very quick using US (Endosonore file ISO 25, prebended). A lot of prebended handfiles to get around the curvatureand the ledge in the mesial canal. Patency mesial but not in the distal. Also no EFL reading distal. The 2. wire film shows why. A severe curvature to the db . Managed to get around this with SS files prebended and at the end I used GT handfiles and ruined them with my endobender. No rotary files would enter the last 2 mm. So I enlarged with NiTi-rotaries until the curvature and ended with a SS ISO 30 at WL and a 08/20 GT handfile prebended around the curvature. Conefit mesial 06/30 and distal 08/25. I was very disappointed when I looked at downpack. A lot of voids. At the end I did not like the result. A void in the mesial and not a continous tapered shape, and it seems, that I straightened the distal curvature. OK, a bad look does not mean it won't heal ( patient is free of symptoms), but would this have been a case to squirt? - Jörg Schröder
Jorg, awesome work as always. What a great save for this patient. I have used the same techniques you used here to negotiate ledges/abrupt curves. Also, you can pre-bend a niti, position it around the curve, and rotate it with a handpiece. I have done this a few times with success. Rosenberg had a nice video of this in his presentation this weekend. I think the choice to use a cone or not is not so important. But if you choose to not use cones, and inject from the Obtura or similar device, make sure you know the preparation very well apically. If the size of your p.o.e. is too great, you may want to use a cone, or MTA. Also, the more I use the 'no cone' technique, the more I like it, and my results are getting more consistent. I'll try to get one from today in the computer to show you - Kendel Thanks Kendel, to exactly know what I did at the apex seems to be the point. I am afraid of pushing GP beyond the foramen. So I have to work on my shape - Jorg i was a dye in the wool pacmac user until mark and some others started talking about getting around severe dilacerations. but what converted me was that monster canine i posted of my nephew a few months back. like an idiot, i took all kinds of time gathering instrumentation that would reach into the netherworld, but when it cam time to obturate, i didn't have a point long enough, so we ended up squirting my default. it was so simple and the fill so nice we started doing it more according to hoyle and with few exceptions (read that to be gary the apical barbarian) the results have been favorable. but mark's words about getting a pacmac or other rotary around a curve i've spent a few hours navigating with hand instrumentation made good sense to me, and by and large squirting would seem to be the technique of choice in those cases. i do go back to a cone on big apical preps however. joey can probably do it, but i don't have the brass ones for that yet. - gary Thank you Gary, it seems that I have to take a course with J. Dovgan to learn how to do it. Maybe he is giving one in march/april 2007 as I will be at UPenn for 2 weeks - Jörg Joey usually places MTA in the canals with larger apical diameters. - Mark Dear Jorg stop pointing small details on your superb case and documentation. Your cases are world class and a small void is nothing - Carlos Murgel Carlos, just searching for the perfect case and trying to improve my technique. - Jörg Look at the details and do not be content with every result you get even though your cases are very good already. Be the best you can be! BTW: According to the voids: Make a further radiograph after you tried to resolve voids with your SysB or doing the backfill and do your post endo only if that control is OK! - Carsten Hi Carsten, thank you for the input. ( see my answer to Carlos). Would have been squirting, even if it is a more operator sensitive technique, the preferable way to obturate this kind of curvatures? - Jörg To your question: You know what’s my obturation technique, so I do not have to answer, what I would have done. ;-)) According to that kind of curvature I believe that it should not be a problem to do this in Schilder technique or with CW - Carsten Yep...and Gary...it's easy...probably easier then placing cones...especially if you have the right instruments...like the Dovgan pluggers and Dovgan Carriers...making a little MTA plug is a snap. - Joey D Yes, I understand that, and also do it all the time, and you and I have corresponded privately on the subject. But how are you defining big? I assume if apical size is 40 or below, you squirt. Most of us agree that above an 80, place an mta plug. What about the middle ground? What do you do in the 40-80 range? - gary I'm putting in MTA plugs at 50...I can do them as small as 40..but usually that's just a squirt with less pressure...it depends on the anatomy ...if there are vital structures.. it's get's a plug at 40 - Joey D Thanks joey. That’s very helpful info - gary
