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vicious curvacious tooth # 15

From: Rajiv Patel To: ROOTS Sent: Friday, August 26, 2011 9:43 PM Subject: [roots] Got Carrier? 34 yof had a vicious curvacious # 15 This case could have been a good indication for using a carrier based system. Comments?? The constant fear of losing patency and prematurely sinking titanic titanium in the abyss of these curved roots kept looming in the background. Fire On! Rajiv Patel Flower Mound/Denton,TX

Amazing rajiv your. Shaping protocol and obturation protocol kindly explain regards - Raghu Nasty curves well managed! Is that carrier based obturation? What about your shaping protocol Of the mb-U turned canal? Thumbs up - Antonis What a beauty! (I have screwed some of these in the past :-( ) - Maarten If the case could have been a good indication for a carrier based system, then I have to ask, what technique you used now? I find it a beautiful case. - RafaŽl Raghunandana, Antonis and RafaŽl - here you go Instrumentation protocol here - scouting with 6,8,10ís, crown down with hand insts. and Protapers crown down ( I destroy quite a few Protapers by prebending them), glide path to a # 20 hand file, finished with 30/0.06 Twisted on the mesial/distal roots short of the curve and hand instrumented with the Twisted rotaries - 25/0.04 and 30/0.06. Palatal was shaped to 35/0.06. WL check and patency checks several times. Obturation - warm vertical gutta percha, but I suspect there was limited to none deformation of gp in the mesial canals due to access for the .04 system B/touch and heat tip, Hence the question - Got carrier? whether that could be better alternative, but by the time the carrier progressed that far apically it would be "naked" of the gutta percha. Gary - I am glad you could read between the lines.....(: endodontic and other wise.....Rajiv Patel Thank you rajiv Bending protaper do you mean rotary or hand held protaper How often you would check the glide path Before you could take .20. File for glide path how did you give the curvature for the file. Finaly how did you maintain the curvature. Of gp - Raghu I meant Hand held Protaper or any other rotary inst you are comfortable with,can be prebend. On cases like these there is no count of the number of times you need to go though a series of 6,8,10's and interspersed with C files of the same sizes. All this after preflaring the coronal third. Slowly advance with K files in crown down and ultimately access the apical third with a 20 K. All stiffer files were prebend. In this case the gutta percha followed the path relatively easily, some other cases you can use endo-ice refrigerant spray to stiffen and slightly bend your cone. - Rajiv Got Carrier?=Got Failure and no chance of nonsurgical retreatment? I suspect that a SEE access would have made this case a little simpler with better apical access, more efficient apical cleaning/churning of irrigant/flushing out of debris, better/more appropriate cone fit , better apical level of plugger depth and more favorable heat transfer to the apical gp resulting in deformation of the cone to a deeper level and very good chance of showing a radiograph with demonstrably filled complex apical anatomy. ..but then I guess thatís just me. Itís still an expertly handled case given the unnecessary restrictions placed upon clinical performance. - Terry P.S. Pointless dialogue?.....I beg to differ. FYI. Iím now up to 194 uninterrupted long term recalls (120 CBCTís). 8 months to go working backwards from July 31, 2010 to November 1, 2009 when I started this using the Kodak. It will likely exceed 300 recalls and 200 CBCTís when Iím done in the near future. Terry. Thank you for taking time to give your perspective. I respect your perspective, expertise, experience and knowledge and constantly learn from you and whole bunch others daily. I still think the Yin and Yang can and need to co-exist, Let every individual be their own judge....some mistakes or judgments have to self-experienced and experimented with. Semantics can tend to pollute the clear waters of creativity and understanding. Thank you once again for the compliment, even though it was slightly backhanded....< Good points Rajiv, no one deserves a free pass from objective science and logically derived self-evident truths, especially me because I am by nature very opinionated. get it? :):):)- Terry P.S. Screw the vendors for interfering with clinical truths. What s "SEE access".........are u refering to more straight line access? - Jim Hung Strategically Extended Endodontic access so that a canal orifice can be accessed in a direct line to the first curve in a root. - Terry Excellent case Rajiv! how much time did this take? - siju Thanks Siju, Time - approx 3.5 hrs over 2 appts. - Rajiv

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