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  Thermafil obturated lower first molar with gold crown

From: senor
Sent: Tuesday, June 30, 2009 4:01 PM
To: ROOTS
Subject: [roots] FW: an 8 year history with a thermafil obturated lower first molar with gold crown

Patient presented in 2001. I have no idea (nor did the patient) how old the nsrct and crown were
at the 2001 initial visit.

The gold crown was more of an onlay type prep and the tooth ended up fracturing off the DL cusp
underneath this restoration. This, I have now witnessed occurring 2 X in my career. Previous to
these two cases of fracture under crowns, I didnít think such a thing was possible. FULL coverage
protection is now my policy on restorative now days..........
BUT conservative microscopic axial reduction.........!!!!!!!!!

About a 2 or 3 months ago, in 2009, I extracted the tooth and here is how the clear tooth results
turned out.........LOTS interesting stuff IMHO......could be good stuff for a thermafil debate at
the next AAE meeting in San Diego, if you ask me........:-) - Craig

WOW Craig......this is really nice. I really think that correlation between clinical findings (extracted teeth) and lab analysis will provide better directions for Endo. Tks for sharing ... - Gustavo Senor, thanks for very nice presentation! Where do you get all the "chemicals" from? Looks like a very good way to learn about my failures... i'm pretty interested - Dmitri Decalcifier II comes from here: http://www.surgipath.com/us-en/Products/processing-reagents-solutions-paraffins.decalcifiers/decalcifier-system Everclear comes from your local liquor store.. Wintergreen oil is methyl salycilate. The real stuff is ULTRA hard to find. So I have gone to a synthetic version from HUMCO which is in Texarkana Texas and they only have a phone number as far as I know: 1800 662 3435. you might be able to find it online somewhere else but basically you are looking for a synthetic wintergreen oil. About 2 oz is all you really need at one time.......it doesnít take much All that being said it is more fun to look at other peopleís failures than your own.... Senor I think it is a tremendous hobby and would like the formulas that you use if you donít mind, Craig. As I told you in a previous post, we end up often extracting teeth without a good understanding of exactly what is going on. Clearing would help in many cases. Iím a lot OCD and it drives me nuts to not know why I fail sometimes yes, Terry, I know Iím not good enough If you donít mind send me the formulas and Iíll get the materials from the college and then Dryer can make fun of me. Iíve extracted some very old silver points and clearing one of them would be nice. It would be nice to see how a perfectly round piece of soft metal worked when we now live and die on warm vertical - Guy W. Moorman, Jr. DDS Yep, Lottsa apical plastic :) - Terry Hey got something in higher res? - Kim Kim, it was my understanding that the Resilon on carriers was going to be better centered on the carrier than ThermaFill consistently and reduce the instances of plastic against canal walls. Is that true??? - Guy Guy - Thatís true. The obturators are injection molded and overmolded the Thermafil art dipped and therefore the carrier is almost never centered in the gutta percha, let alone in the canal. However, because the RealSeal 1 materials all bond to one another, in the unlikely case that the obturator should strip (the Resilon bonds to the polysulfone carrier) the polysulfone will bond to the RealSeal resin sealer - Kim But is that bad? That is the question!!!........ As well, not the loss/lack of apical hydraulics as noted by the unfilled main canal system...... PS....good eye...... Craig Yep, very bad especially for those who don't recapitulate and clean the apical third to begin with. :):):) The bigger question is "What's more important filling the fins or sealing POE's?" I know the answer. :):):) - Terry Very nice work senor. Thermafil, as I have stated many times, is a very impressive technique or relatively round, evenly tapered canals. Doesn't work as well on ovoid or super-ovoid systems. Regarding the plastic carrier: There is nothing special about GP, and in terms of a material, the plastic carrier is "more noble" If this was a GP case, you would see a resorbing, naked, uncondensed cone at the apex with no sealer around it instead of a non-resorbing, "jammed in," naked plastic carrier with no sealer around it. This patient was in last week for a 10mo recall before the extracoronal restoration was done. Tell me you're gonna get pluggers around those corners with those shapes and I'll show you my oceanfront property in Colorado - John A Khademy
Dear John, That was really an inspiring case...Amazing how you manged to fill those curves using a Thermafill. I was also amazed on my preclinical work with Thermafill to see a lot of fins and lateral canals filled with guttapercha, although I lack the technical skill to fill with Thermafill without having parts where the plastic core is in direct contact with the canal walls. This is why I never did any Thermafill filling in my patients. Regarding to cases where we have those curvatures and narrow spaces, I can see a Themrafill can fill them nice on the radiograph, where probably doing a warm vertical compaction will end up actually in a cold un-condensed cone (due to lack of space of penetration of the heat carrier). My big concern is how we are precitably doing our cleaning and desinfection in those cases ? We know our irrigation needle should pe WL-1, and we know that ultrasonically activated NaOCL gives better cleaning and desinfection results. In such shapes that can be filled nice with Thermafill, how can we get our irrigation where we need it , and how can we activate it ? because if we need for irrigation and desinfection a better enlargement of the canal, maybe also other filling techniques might also predictably work . thanks a lot for sharing your cases ! - Roberto Roberto, I'll post your question on TDO and we can discuss it there. I don't feel like arguing with Pannkuk and his BU BS. - John John, I am curious about your statement that Thermafil does not works on ovoid or super-ovoid systems. Can you make it clear for me - Gustavo Hi Gustavo, Well, I didn't say it "does not works" I said "Doesn't work as well...." senor nailed the reason in my opinion...the hydraulics are poor if the carrier is small in comparison to the canal... I man...try to pack off a fat central incisor with a #8 Schilder plugger... John Hi John, I am line with you that carrier's size is critical to allow the filling of anatomical complexities. I figure that it is the reason which my thermafil cross-section results are usually inconsistent. It is a problem because the technique has lower predictability. In the attached PDF you will see what I am telling. In the first slide, you will see a good filling result in oval-shaped canal (without sealer). However, in the second one, the performance was poor (also without sealer). The follow slide shows 2 examples that how thermafil usually performs middling (with sealer). I think that this is closest to our clinical reality. Only for curiosity, a look at the last one: Lateral condensation! - Gustavo Johnís point is well taken. A thermafil in an ovoid canal is like a round peg in a square hole. Difficult to develop adequate hydraulics, difficult to get predictable 3d fill. It is just that simple - gary More importantly, those who think they can machine root anatomy into a round cross-sectional form on a predictable basis so that they can predict which cases are appropriate to receive Thermafilth are grossly misguided and naive. - Terry Agreed - gary All of this makes perfect logical sense. Please refer me to an article showing that Thermafil is an inferior approach with regards to success rate - Scot White See leaked distal canal/root of case presented..........the case failed off of the distal canal coronal leakage. The canal is quite oval and a carrier is floating in the middle of the mass of gp. Most likely hydraulics and gp support from the carrier were minimal allowing for more shrinkage of gp etc and gaps etc and so on. the mesials on the other hand look like they were done yesterday.....Senor Thermafil is like a Forrest Gump box of chocolates, typically used by Forrest Gump. :) - Terry Well, maybe not a Theramfil debate, but definitely plasticized obturation materials debate. Long live the squirt! Great documentation Craig and very interesting post - Arturo Craig: Fabulous job. Whose protocol did you use? This is great stuff! - gary Thanks! And i assume you are asking which protocol I used to clear the tooth? - Craig Yes. I guess I should have been more clear. How did you do the clearing? - gary After having used Dr Carrís method and Dr. Castelucciís method, I have broke in to my own rhythm on tooth clearing. I have seen some hellaciously complex methods to do this but I am lazy...:-) ...... I have many batches of cleared teeth to waste, so I have tried many combos of methods and here is what I currently do: 24 hours in Decalcfier II (which is the hydrochloric acid mixture recommended by Dr Carr) Then 24 hours in Ever clear full strength Then 15 min +/- as much time as you need, in methyl salicylate........ie; the teeth will be clear in about 15 min but they continue to change over days and months. It is interesting as hell if you donít mind me saying. So I photograph them at different stages depending on what shows up or doesnít show up initially....... Itís really that simple .............anything else is a waste of time IMHO and can damage the teeth beyond recognition. Too long in the alcohol mixtures recommended by both Castelucci and Carr, desiccates the teeth too much and results in a volumetric change in the teeth that no longer best represents the original anatomy. I have lost some really interesting teeth early on with too long in too many alcohol concentrations. Thanks for looking at the case and asking about the clearing. It is a hobby of mine...... (Mark Dreyer makes fun of me... )........the method was born in botany and was originally used to clear plant material....(see enclosed)........if you ever have teeth you wanted cleared and presented, just mail them to me and I will do it and photograph them for you or mail them back to you for you to photograph or observe........Craig
Thanks Craig and all rooters for sharing your clearing protocols. Any of you have experience to prepare or fill teeth after clearing? If so... what is your feedback? Do you add any other step/ingredient to the protocol to make teeth workable? I always thought that all clearing process, soften the tooth and unable its use for endo demonstrations but since I saw some obturation videos, I wonder if we need an extra step. Can anyone help me on that? - Ricardo
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