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Removal of fractured US tip
From: Marga Ree
To: ROOTS
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 don’t 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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