Treatment sequence with knowledge of root anatomy - Courtesy ROOTS
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From: Terry Pannkuk
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
Terry, you got everything in that one post. You must have had some coffee before that one.
Great summary and nice case. - Joey D