Blistering Case.

Dentistry January 4th, 2007

Here’s a second molar case that I finished yesterday. I did the first molar a couple of years ago and was trying out Brasseler’s Endosequence files at the time. I busted one in the distal root of the 6 around a very mild curve. This was one of the cases that led me to abort my use of the Endosequence files. They just didn’t work that well in my hands.

Anyway for the 7, I ended up working most of the apical 1/3 areas by hand because of the tightness of the canals. Curvature is obvious mesial to distal, but there was also significant curvature buccal to lingual between the mesial canals that you can’t see on the xray. I end up getting some nice blisters or callouses on my fingers when I have to work cases like this by hand.


The two pictures are scans of the same xray. Again, note the void in the chamber of the 6. This tooth was restored with a permanent crown after I finished the endo 2 years ago. I’ve asked the dentist to access the crown and remove the cotton that’s probably still in the chamber and place a proper core. Sheesh.


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  • looking_down

    The obturation on the 7….amazing. Just amazing.

  • Ameloblast

    Thanks. I thought it might be a good case to blog. Ideally I would have like to have instrumented larger apically, but I ran out of time. I had to administer 1.8 X 8cc of local to get the patient numb enough to get into the tooth.

    The risk to instrumenting larger is, of course, severe apical canal transportation.

  • Kissaki

    Your endo’s amaze and terrify me

  • Ameloblast

    Really? Why is that?

  • Dr. Mommy, D.D.S.

    nice work, really! ugh, i can just imagine how tired your hands must have been after that! my new office doesn’t have rotary and i hand filed an upper premolar to a size 40 file, and my hand was killing me. i think i’ll refer out all my molars at that place….

    as for the brasseler files, i have a seperated file in the MB canal of my own RCT-ed #46. the file was small enough and the dentist was able to push it to the side and continue instrumenting and the tooth hasn’t bothered me since. but i had one separate on me when i was practicing in new york, had to refer that case out because it broke right at the middle third.

    however, i do like the concept of the brasseler endo-EZ system, with the single cone obturation corresponding to the last file used. that new york office didn’t have an obtura machine and i was trained doing lateral, and i found that my fills were very dense and three dimensional, very easy to use. now i use obtura (which i’m still trying to master) and thermafill. what do you use and how do you feel about “single cone obturation”?

  • Kissaki

    Because looking at them gives me nightmares about transportations and perforations! I think the one of the 7 is amazing.

  • Ameloblast

    Any obturation technique works well as long as the canals are aseptic. Single cone tehniques, specifically Ketac Endo sealer with a single GP master cone, have been shown to have the same success rates as lateral condensation, which have been shown to have the same success rates as vertical.

    The one worry with single cone techniques is the possibility of faster sealer wash-out if coronal leakage occurs.

    My primary technique is vertical condensation with a non-standard cone. I use lateral with a warm vertical down pack in larger canals in order to control the gutta percha in the apical area better.

    For both techniques I backfill with Obtura.

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