Torturous apical anatomy
Simple retreatment
Periapical access
Irreversible pulpitis
Implant #30
Angled Xray
K3 and LS
Twisted files
Acute pulpitis
Int Vs Ext resorption
Triple retreatment
Radiolucency
MB2 joined with ML
Fun with tricuspid
Very large lesion
Implant case III
Implant case I
Implant case II
Chewing sensitivity
Missing ML Canal
Ledges and perfs
Simple canal
Crack or mesial canal
Mesial system
Upper right cuspid
Upper molar
Necrotic and restoration
Bent file stuck
CaOH2 Case
Necrotic cases
Dentin and pulp space
PA child case
Furcation in class III
3 roots bicuspid
Ankylos case
Deep furcation
Crown access cores
Distal part of crown
Middle mesial canal
Missed anatomy

rss feed for dental india
website
Endo tips    Better Endo    New additions    Endo abstracts    Back to home page    Endo discussions

Treatment sequence with knowledge of root anatomy - Courtesy ROOTS

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: Terry Pannkuk
To: ROOTS
Sent: Tuesday, August 25, 2009 9:48 AM
Subject: [roots] Didn't want to argue gp deformation?

When someone says they don't want to argue something, I immediately sense philosophical/scientific/logical weakness.
I will bluntly and unrelentingly state the opinion that the concept of continuous wave warm gp compaction is a significantly
inferior technique appealing only in convenience and speed. The challenge goes to someone who can demonstrate that it is not.

Having to use flexible NiTi Pluggers, maintaining conservative access in the name of "Biomimetics", and espousing that one
can't cleaning secondary, tertiary, quaternary, nanoanatomy is just plain clinical defeatism. Clearly, "excellent" is better
than "good" which is better than "fair" which is better than "poor" which is better than "feces".  When one can attain "perfect",
a quality absent from the natural world, one shouldn't settle for "poor" or "feces" when "excellent" or "good" is possible.

Many techniques are promoted for speed, convenience, and simplicity. The Classic Schilder Technique is not.  If some better
technique comes along that demonstrates superiority and an unequivocally improved outcome,  The Classic will cease to maintain
favor in the same way the gold foil technique has become antiquated. It is bound to happen at some point in the near future.

Here is a vital case I treated in one visit last week.  Negotiation of the confluent MB2, debridement of the MB2, cone-fitting
of the MB2, and the hydraulic dense "packing" of the MB1-MB2 system demonstrating the irregular apical "bulging" was only
possilbe by starting the treatment sequence with a knowledge of root anatomy, convenience form, and "SEE" access design,
without it, apical cleaning and proper conefitting would have been impossible.

Important highlights of this focus:

1. No continual "bombarding" with ultrasonics along a mesiolingual groove (in fact no ultrasonics were used).

2. No biometic conservation of restrictive overhanging dentin that would prevent direct visualization down the root canal
   system to the first major curve.

3. No frustrating attempt to minimize shaping through inadequate access restricted and directed toward the inside curve
   predisposing to strip perforation (In fact the referring dentist had taken final impressions for a crown which I had no
   intention of considering if direct line access required altering the mesial margin and axial wall of the prep).

4. Beware that compromises in classic fundamentals

   a.  predisposes to overuse of rotaries and risk of separation,
   b.  results in failure to negoticate MB2's,
   c.  results in failure to find deeper secondary, tertiary, and quaternary root canal system anatomy,
   d.  results in failure to adequately debride, secondary, tertiary, and quaternary root canal system anatomy,
   e.  fosters an inability to idealize the material properties of gutta percha and express excess resorbable sealer
       (via heat transfer and plugger compaction dynamics),
   f.  predisposes to blockage, ledging, and false paths, and ultimately
   g.  results in failure to debride, clinically seal, and prevent recurrent endodontic disease that typically manifests at a
       later time in the patient's life, failing at a much longer horizon than the standard routinely recommended short-term
       recall period.

-  Terry

Terry, you got everything in that one post. You must have had some coffee before that one. Great summary and nice case. - Joey D
Protaper flaring
6 yr old Empress
Cvek pulpotomy
Middle mesial
Endo misdiagnosis
MTA retrofill
Resin core
BW importance
Bicuspid tooth

Necrotic #8 treatment
Finding MB2 / MB3
Deep in a canal
Broken file retrieval
Molar cases
Pushed over apex
MB2 and palatal canal
Long lower third
Veneer cases
CT Implant surgury

Weird Anatomy
Apical trifurcation
Canal and Ultrasonics
Cotton stuffed chamber
Pulp floor sandblasting
Silver point removal
Difficult acute curve
Marked swelling
5 canaled premolar

Sealer overextension
Complex anatomy
Secondary caries
Zygomatic arch
Confluent mesials
LL 1st molar (#19)
Shaping vs Cleaning
First bicuspid
In Vivo mesial view
Inaccesible canals

Premolar 45
Ortho and implant
Radioluscency
Lateral incisor
Obturation
Churning irrigant
Cold lateral
Tipped to lingual
Acute pulpitis images

Middle distal canal
Silver point
Crown preparation
Epiphany healing
Weird anatomy
Dual Xenon
Looking for MB2
Upper molar resorption
Acute apical abcess
Finding MB2

Gingival inflammation
Irreversible pulpitis
AG BU ortho band
TF Files
using TF files
Broken bur
Warm technique
Restorative prognosis
Tooth # 20 and #30

Apical third
3 canal premolar
Severe curvature
Interesting anatomy
Chamber floor
Zirconia crown
Dycal matrix
Cracked tooth
Tooth structure loss
Multiplanar curves

Check Page Ranking