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Inaccessible mesial canals - Courtesy ROOTS

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From: D. Kendel Garretson
Sent: Tuesday, September 27, 2005 5:07 AM
Subject: [roots] max. first bicuspid

This one  was really tough: Tooth 17 (#2US) vital case, 
emergency, 2 appointments, 4 hours total time.
Almost inaccessible mesial canals: file had to be 
inserted way from the distal side. Two seperate mb canals
that were VERY crooked. I did not not dare to prepare 
the buccals any more than Flexmaster 30/04
(40/06 in the palatal canal). mb1 was 22mm, mb2 only 20 mm 
(which I veryfied several times), palatal only 18.5mm.
Resilon/Epiphany (Real Seal cones) with System B/Obtura. 
Sorry, I screwed up the scope pics - Winfried

Beautiful case...patience, persistence and passion. - Fred Ditto to those comments! Beautiful work on a very tough case, Winnfried.- Mark Dreyer Winfried ... Great job! I can only imagine the difficulty. In a case like this, do you charge a different fee, because of the difficulty or are your fees controlled by the government? I've always faced a dilema about how you set fees for procedures, based upon the differences in how difficult they or the patient is. I guess most feel the "win" on some and lose on others. No matter, that was a very impressive endodontic treatment - Terry Hi Terry, if you want to charge a higher fee, you have to make a contract with the (private) patient PRIOR to starting your treatment. I underestimated this one. Thus it actually cost me money. (I'll charge the pt. extra for the next treatment to compensate). For social security patients, it has been ruled that such a treatment is not possible (because the roots are too crokked) and the tooth should be extracted, unless the patient pays himself - Winfried Congratulations !!!! Winfried Beautiful work !!! Thanks for sharing - Carlos Heilborn Winnie: The more I learn, the more I realize that hand filing is still the king and what separates the boys from men. specially when you pre-curve each one individually to match each canal. my only negative comment is the over-flared palatal canal , what was going on?...otherwise it is case to be proud of... clap, clap, clap - ahmad Wow, That looks tough! Nice! DougR Fantastic case Winfrie! You are nominated for the oscar for patience!! - Vipin Super! - Carlos Murgel Excellent result on a very difficult anatomy. How did you manage to get those x-rays to see the the roots so well ? On the pre-op I can't see much, is this just scanning problem ? - Thomas Hope the endo works. That will be a good one to take the tuberosity off with an extraction. Guy No problem, Guy. In a case like that I would seperate the roots, take the palatal out first and hope to get the rest out without fracturing them - Winfried beautiful! - Marcos Arenal That's some endo there. Nicely done - gary Thanks to you and all the others for your nice comments. The preop is a scanned (600dpi) Kodak insight film (from the patients complaints, the first or the second molar could be the culprit, and I can't get 2 molars on my sensor) , the others are digital x-rays (Planmeca), where I played a little with gamma and contrast to get optimal visibility of the roots and the instruments - Winfried Awesome job Winfried.....are you using Reamers or Files for the Glide path? Looks like a Reamer.! - Sachin Dear Sachin, thanks! I used 06to 15 Reamers in an M4 Handpiece for the glide path. For the X-rays, I always use hedstroem fiLes in the Lingual canals, so I can tell immediately even a hundred years later which canal is which .. Winfried Great idea. Different files in different canals. Wish I had thought of that - gary

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