Dycal matrix
Search for MB2
Difficult canals
Tear drop shaped MB
Separated file
Red hair gingivitis
Cone pumping
Central incisor
Trauma case
Trauma case followup
Trauma case II
Light into the canal
Astra implant
Split maxillary molar
MB2 and MB1 merger
Endo buildup
Fractured molar
Use of antibiotics
Sick upper molar
Buccal sinus tract
Crown preservation
Resilon
Buccal and lingual
Immediate Implant
Implantologist
Endo is dead
Cervical resorption
Distal translucency
Healing
Fractured vital #10
Strip Perf
Dentin deep crack
Fibrous hyperplasia
CAP
Tight molar
Silver point recall
Wiry and curvy
Damage control
Liquids surface tension
Thermafil case

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

Advantages of warm technique: RCT of tooth 3.6 (#19) - 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: RafaŽl Michiels
To: ROOTS
Sent: Tuesday, June 23, 2009 11:11 PM
Subject: [roots] The advantage of a warm technique. (and full sequence of treatment)

Here is my last case of the day.

On may 5th, the patient came in the office for a RCT of tooth 3.6 (#19). The referring dentist had done an expulp
and a temporary restoration. In the first visit, I made a new temporary restoration in glass ionomer (Ketac Fil).
I tried to get patency in the canals, but had problems in the distal. I could not get to length. The distal was
very wide. So I expected two POE's or even more. I placed calciumhydroxide, a cotton pellet and sealed the cavity
with glass ionomer. As anaesthetic ArticaÔne with adrenaline was used (septanest special). Rinsing was done with
NaOCl 3% and a final rinse before the calciumhydroxide with EDTA 17%.

In the second visit today, I could get patency in all canals, but the distal was pretty though.
In the apical part I continuously felt irregularities and alot of files 0.06 and 0.08 were needed to get down.
In the end, I prepared the canals until a protaper F1 and finished apically with a size 0.25 K-file.
Normally I end up with a bigger MAF, but in this case this was not necessary, I believe, since I had to start
active filing from a 0.15 onwards. Length was 26mm in all canals. Rinsing with NaOCl 3% and EDTA 17%.
Anaesthetic was mepivacaine in the second visit (scandonest)

Then I dried the canals and filled them with the Elements obturation unit. First an apical plug of 4mm then
backfill with light body guttapercha in little layers. As sealer I used AH+. Afterwards I sealed the cavity with
glass ionomer. In the distal you can see the apical delta, being filled. Maybe it is even a missed canal or a
big lateral. Anyway it is filled. :) This would not be possible with a cold technique, which I mostly use.
Critique and comments welcome as always (I'll start myself: The distal edge of the temporary filling should
have been better.) - RafaŽl

for my critique, i felt this Gutta Percha irregularities around distal apex is caused by material extrusion overlapping the apex on x ray; as vertical condensation tech. had been used. anyhow nice work - Ahmed Jamleh I think it is only sealer which has been extruded. This is indeed difficult to control. But practice makes perfect. So I'll practice some more ;-). - RafaŽl Hi Rafael! Thanks for sharing your case and sequence. Regarding that, what is your rational for choosing your MAF? What size is your irrigation needle? The distal box is quite tricky when we work so near the bone level. Have you considered crown lengthening before final restoration? - Ricardo Hello Ricardo, The rationale for choosing this size of MAF was the following. Getting a 0.06 to length, was not possible passively. So I needed to file already with this small size. Consequently I needed to file with all the ones I used. With a size 0.25 I got white dentine debris. Meaning I was creating an apical box with this size already. So, I believed this size was sufficient to stop. As for the irrigation needle The size is comparable to a size 40, if you know that the taper in this case is 7. This means that I can put the needle at approximately 2mm ( a little more) from the apex. Not sufficient, that is when the Irrisafe comes into place and in some cases I do cone pumping (not in this one, though, maybe should have done this.) I am not a fan of such small MAF, but in this case I thought it was sufficient. Though it is subjective. - RafaŽl Hi Rafael, Thanks for the answer. You were very clear about the procedure. My question was what is your guide-lines/rational in general for MAF determination? And regarding that Iím not sure yet if I get it. (maybe my answer was not that evident) Is it dependent on the size of your negotiation files? - Ricardo No - RafaŽl Pre or post coronal flare? Is the first rotary that cuts dentine form there first flutes? (is this Dr. Buchanan, isnít it?:-) or Minimum box size that guarantee a good apical stop to pack? Yes. In this case the 25 was the file that actively cuts dentine from the apical part. So this was indeed the rationale for this - RafaŽl With a F1 and an ISO40 needle, I wouldnít get it so deep (3mm). Although mathematically possible it will engage easily, and shit happens. What I try do is enlarge a bit more, and use a narrow tip 30G side-vented. 1mm short of WL and loose - Ricardo Thanks for the tip - RafaŽl Rafael you endo is excellent but your rxs are very bad...just joking. Very nice filing and looks like the distal has some apical colateral canal - Carlos Murgel CD, Dr.
Silver point removal
Sealer extrusion
Double vision
Tooth #19 NSRCT
Class V restoration
3 distals
Root fracture
Crowns
Bicuspids
Implant #3
Implant #30
Missed MB2
Hand filing
Implant management
3 Canal premolar
Palatal swelling
Tooth #32
Unusual MB2
Microscopes
MB2
Endo cases
Trauma slow burn
Alvelor bone
Disposable RD
File retrieval
K3 out of apex
Apical resorption
Apical resorption II
Fatiguing case
Dry prophy cup
Reynolds protocol
Multiple teeth
Lateral condensation
Endodontist
Root canals anatomy
Endo programmes
Apical Delta
No MTA, no polyester
Implants in Endodontics
Best Articles
Check Page Ranking