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From: Marga Ree
To: ROOTS
Sent: Tuesday, December 20, 2005 2:32 AM
Subject: [roots] Took me hours to instrument this one
Once in a while I get a case referred that is not a retreatment. Tooth 26, irreversible pulpitis.
The canals were all very narrow, especially mb 1 en 2 were very curved and difficult to negotiate.
In these cases I love to use the K3 02 tapers, and then switch to 04 tapers for the final shape.
Mb1 and 2 were separate canals, although on the rads it looks if they join. - Marga
Wow , look at those curves. I always always always learn a ton from
your posts.
Do you get it up to a 20 handfile in this case.......
I use K3 as well and like the 04 and now have ordered 02 taper as well.
What sizes do you have up to in the 02
Marga, clap , clap , clap.....well done , beautifully treated case.- Glenn
Thanks Glenn. I have the sizes #15-40 in K3 taper 02 in my set-up.
My file sequence in these kind of cases:
Gates #4, 3, 2 till resistance, K3 shaper 12, 10 and 8 to resistance,
sometimes I repeat this sequence in a later stage of the instrumentation,
dependent on the canal shape.
Establish a glide path with handfile # 10 or #15
K3 #15/02T
K3 #20/02T
K3 #25/02T
(K3 #30/02T), not always, dependent on canal shape
K3 #15/04T
K3 #20/04T
K3 #25/04T
(K3 #30/04T)
If I have problems to get an 25/04 or 30/04 taper to length, or I notice
that there is significant resistance to cutting, then I throw in more 02
tapers. I have learned this sequence of Bill Watson, and it is a very safe
way of instrumentation.
Gauge the foramen, and shape back accordingly. - Marga
Marga...thanks for that, it was sent to work (your email) for me to
print out and keep for the next tough case.
Why the GG 4,3,2 first, does the K3 12,10 not open it up enough
coronally. I am not doing this but perhaps in these curved cases it
helps to get better access to the deeper parts .
I am always fearful if I don't get to a 20 handfile patent first
......but you are the boss, and if I can get my results to look half as
good as yours or Bills that would be great.
PS is Bill still on TDO , if so tell him I said hi and that I miss his
teachings.......he was awesome. - Glenn
Glenn, The reason why I use GG's is to make room in the coronal half of the canal,
and to move the orifice somewhat away from the furcation. I do like GG's,
they're cheap and efficient, and when they separate, you can easily take
them out wtih a pair of tweezers. I use then in a brushing motion, on 2000
rpm at the max. I work a lot with GG # 2, which is equivalent with a # 70
hand file.
Using rotaries taper 02 is much more predictable in very curved canals than
working with hand files, regardless how skillful you are. Give it a try, and
you will love it. - Marga
Marga, your work is always nice.
But I have a question:
Can we honestly expect the average clinician to stock that many files in
their sponge to do a case?
IE/ 15, 20, 25, 30, 35, 40 in .02 taper
15, 20, 25, 30 in .04 taper
Shaper files in 12, 10 and 08 tapers
GGs and hand files?
For you and me, it's not a problem - those kind of overhead costs are part
of what we do. But when guys like Steve B. and John W. suggest that
clinicians toss files after a single use...does anyone honestly think that
an average practitioner will:
A: Lay out this number of files for a case?
B: Toss after a single use?
C: Understand how this method works?
I know the Kerr guys sell a VTVT package, but I'd be interested to know what
their sales are like with this assortment vs. buying them by size/taper. I'm
not sure that the VTVT technique is that well understood by many Dentists.
There reaches a point where a Dentist (who probably doesn't do several endo
cases on a daily basis) has got to wonder just how many instruments and how
much "stuff" does it take to do a case properly? Ultrasonics, MTAD etc etc.
And can we, as specialists, expect this from them as the current endo
"standard of care"?
Rob (who regretfully has NOT invented/patented an endo instrument yet)
Rob,
You have a point here. Let me first make clear that I don't toss my files
after a single use.
Usually I dont use so many different files, in many cases a use the VTVT
sequence, which consists of 2 shapers and 35/06, 30/04, 25/06 and 20/04, so
6 files in total. Usually I need an extra 35/04, but that's about it. And of
course handfiles.
I agree that it is difficult to understand the VTVT sequence, for me it was
also a learning curve to master this technique.
Moreover, it takes some time till you know what a system or specific
sequence can do for you. I have experienced this with the use of Profiles,
ProTapers, System GT etc.
I am not the kind of person who is telling the audience that is attending
my courses that endo is easy. It is NOT. It never will be. Doing endo
properly not only requires skill and experience, but also the 3 P's of Fred
B: PASSION, PERSISTENCE and PATIENCE. Endo can be damned difficult (nice
alliteration...:-))
I don't expect from an average clinician that he will do such a case, and
that's one of the reasons why we introduced the difficulty assessment forms
in the Netherlands. Assess the grade of difficulty before starting a
treatment, and refer if the treatment is beyond your level of expertise. For
some clinicians this means that they refer every molar endo, which is fine.
If you treat only easy cases, than you armamentarium can be limited. If you
treat complicated cases, then you have to be prepared, and that means that
you not only need the skills and experience, but you also need more stuff - Marga
You guys don't even want to know how many files I have laying around here,
but we are in agreement that good endo ain't easy. Sometimes, mediocre endo
for me is a real butt buster.
But for the average g.p. doing recreational endo, we do need to follow the
kiss principle. Keep it simple stupid. - gary
Gary, If we can have SS files, why not an SS protaper which we can use in
staight canals and mulitple cases thereby reducing the cost factor. The
Niti is only good for curved ones! We can even have files made of Elgiloy
or TMA which wil have more cutting efficiency than the Niti's.??? I once
asked james L Guttman while he was touring Kerala (India) and he said it
is purely market ( business oriented. Unless you throw the files no one
will buy them!!! ) - Vipin
Nice, Marga. Beautiful shapes. DougR
Marga, another beautiful case, very intresting discussion, as always .
In the lihgt of McSpadden's lecture, this sequence involves every next
instrument by whole surface, but it's difficult to find "the one" which
doesn't.
IMHO there is no safe sequence at all in such curved canals.
Minimizing the set of files always provided me to separation in curved
canals.
Have you tried S-Apex?
This one, is nasty curved molar..Race S-Apex case.
Very, very sensitive and difficult patient, but very grateful too.
Greatings from Poland - Marek Korzan
Fantastic job Marga ....very nice handling of the mesial curve - sachin
Tooth 26, irreversible pulpitis
