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  Necrotic lateral : apical hook

The opinions and photographs within this web page are not ours. Authors have been credited
for the individual posts where they are. - Photos courtesy of Ahmad
From: Ahmad Tehrani
Sent: Monday, April 09, 2007 9:50 PM
Subject: [roots] lateral

22 y.o. Female. She just wanted this tooth filled. I told her it would be 
no problem as long as I extended the filling to the apex..-:) So to make 
my point, we started with pulp responsive testing first against her 
adjacent teeth.

EPT, ice and hot test....all negative.

Necrotic lateral....Totally asymptomatic....No sinus tract. I am always 
fearful of causing a flare up with these "dormant" CAP cases. So I always 
explain in detail (till I am blue in the face ) during consultation, 
not to make "excuses" afterwards.. Started cleaning out the caries, accessed
the pulp and filed to a size 25 with pre-curved tip. Projected the canal 
and built up the tooth temporarily with composite. CH and closed with cavit.

My question is how do you maintain the natural canal curvature with larger 
files? The wire film is a size 25 which looks like itis straighteneing the 
canal already. bending bigger files is a laborious task for me, so I probably
follow the mantra of keep it small as practical I am afraid to strip perf
the thin areas around the bend and wrecking it. All laterals have an apical 
hook that is easily mismanaged with blind rotary files.

Been there , done that.....)) - Ahmad

lateral Ahmad, I don't think you can maintain that natural curvature if you are going to clean the apex. This one has more than one curve so bending a file is not going to prevent straightening. So you straighten it out a little. Do you think that hurts the case? I'm betting you will get a great result. You are right about that little apical hook. We are going to screw those up sometimes. Why not one step this one? The ones I worry about are the ones with the well formed lesions. They are the ones that blow on me and lower bi's seem to live to screw with me. Guy Ah. Another anterior elastic anterior rubber dam clamp fan! I hate those big honkin things that are always in the way. This is so much easier - Gary
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