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
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 ?
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
Great idea. Different files in different canals.
Wish I had thought of that - gary