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Endo tips    Better Endo    Endo abstracts    Endo discussions

Removal of fractured US tip

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From: Marga Ree
Sent: Wednesday, April 26, 2006 10:43 PM
Subject: [roots] Removal of fractured US tip

Yesterday I saw the patient back with the C-shaped 47,
in which I separated a US tip last week.

I was lucky and  managed to remove the fractured tip
(combination of bypassing it with 2 hand files and US
activation with a # 15 file) from the distal canal,
and was surprised to see the black discoloration of it,
probably caused by corrosion? The filling is too long,
with a huge puff, apparantly I was not able to create
a capture zone in the very apical part of the canal.
Size of foramen was gauged with lightspeed, # 50. What
about the sealer trace on the angled rad? I think this
is part of a fin. Should I have gone back? I was in
doubt, I find it very difficult to visualize these type
of canal configurations three dimensionally.
I decided to leave it. What do you think? - Marga

I think you are fine with it. i'm familiar as we've discussed before with the two bypass in two locations and twist technique, but can you expand on what you did with a #15 file and activating it with us - Gary Gary, I use ultrasonic files # 15 in my Satelec unit to activate NaOCl at the end of the shaping procedure. These US files are also very nice to bypass obstructions. After I bypassed the fractured instrument with handfiles, I was able to use a US file # 15 on low power next to fragment to loose it. - Marga I donít think I can do that with my nsk unless there is an adapter of some kind to thread on the piezo end, but I do have an old sonic hp and endo files from a long while back that might be useful for just this purpose. Thanks for the idea marga - gary Marga, so the fragment is visibly loose, bypassed, now what? Suction to remove it? braiding to remove it? or just out stroke with hand file?- Kendel Kendel, No I could not see the fragment, it was too deep, I could only feel that I had bypassed it. In these cases, there is no recipe that always works. Sometimes you just rinse it out with the irrigation solution, sometimes you can braid it, sometimes it disappears in your high suction before you even notice, and yes, it happened to me once that I already had given up, and the fragment was sticking at my gutta-percha cone after cone fitting. Moral of the story: don't give up when 1 trick doesn't work, try a variety of tricks, and think of the 3 P's of Fred: Passion, Patience and Persistence. That's what I keep in mind:-)) In this case, it came out after I had bypassed it with hand files and subsequently activated the US file # 15 with NaOCl while bypassing the fragment. - Marga Thanks you Marga. I think this is an important lesson --- that often some of these results may take tremendous effort, time and as you say, persistence, patience. - Kendel Great job, Marga! I had shared your posting with Cliff and he had some tips for you, but you beat me to it. (Still in my pile of things to-do!)I enjoy seeing your cases - really nice work.- Phyllis Marga, you did it again! Great job and thanks for sharing - Winfried You go Marga!!! Excellent job!!! - Hani Great work Marga, I was sure you will remove that tip. The black color is kinda weird. Corosion so fast ? Maybe, but aren't those tips stainless steel ? About that streak, it may be a fin or another canal. Seems it goes into the main canal, so probably no worry. - Thomas clap, clap, clap... there was no doubt in my mind! how about some hair splitting? how deep did you trough the mesial isthmus? The distal orifice is well prepared, since you paid more attention to it because of Sep. Inst..... but in comparison,the mesial looks constricted. It looks under-extended to the lingual. But I wasn't there... so I could be wrong - ahmad Hi Ahmad, I love splitting hairs. Yes, you have a point here. How deep do you go? When do you stop? You are right, in retrospect, I probably could have prepped the mesial orifice more to the buccal, the trace you see at the rad is the representing a part of the buccal isthmus. I always want to see 360 degrees of the canal wall, which I could in the distal as well as in the mesial canal in this case. I have treated a modest quantity of C-shaped molars, and I posted some in the past on Roots and TDO. I remember a case in which I was treating two distal canals and one mesial, connected by a large fin/groove. I troughed the groove for a fourth canal, but didn't find one. I decided to fill, but after seeing the obturation film, I decided to remove the filling in the groove because I noticed, what I thought was, a cement trace. After troughing deeper, I was still not able to find a canal. Also after the second fill I saw a cement trace. I removed the filling again, and since I was running late, I rescheduled the patient for a third visit. I was wondering whether I was just making my own canal in this fin. Then Gary Carr replied that the danger in these cases is the severe invagination these teeth can have and that you can't detect. So the risk of a "furcal" or mid-root perforation is high. He had done a number of these at the bench to try to understand the anatomy better and it was suprising how easy it was to perforate thru the root invagination. Hence my reluctance to trough too far. The problem is that you only know afterwards if it was too far indeed. - Marga Thanks for sharing Marga. Your passion for quality work and patient care is amazing - venkat

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