Do Not Try This Root Canal at Home.
Morphology March 18th, 2008
Although this case was a tough one for me, I’m glad it was referred here. I’m not sure how it would have turned out in the hands of the patient’s regular dentist.
The complication is the DB root (besides the fact that the patient was very anxious and fidgety and couldn’t open very wide). It’s got a nice s-curve to it with the end of the S being at the last 3-4mm of the root. The curve at the apex of the root is difficult to see on the xray scan, click on the picture for an enlargement. It’s a tough deal for endodontic files to negotiate these types of curves, even if you are using nickel-titanium instruments.
Anyway, I’m heading home for the day now. Don’t worry though, I’m still working on my upcoming post about my misadventures with cockroach blood…
March 18th, 2008 at 7:00 pm
Nice – show me the picture in a year
You know I would’ve had it on the table.
Ian.
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March 18th, 2008 at 9:34 pm
Uh oh… I beginning to remember that you’re a dentist.. and how I don’t like dentists because all they ever do is hurt me. Now I’m afraid of you… eeeeeeeeee!
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March 18th, 2008 at 9:49 pm
Ian: I don’t know what you’re talking about (LOL), it’s not even infected. Even if the GP did the endo and screwed it up the tooth would probably survive. Here’s a link to modern day endodontics’ watershed study.
You OMFS people must walk around with elevators and forceps in your pockets
fragileheart: The same could be said for ex’s…
March 19th, 2008 at 9:30 am
i’m curious – obviously you had to hand instrument the apical 1/2, but did you use rotary to open up the orifice? how does the solution get all the way down there when it’s that curved?
some day i’ll show you the botched endo that someone i know did, not an endodontist….
March 19th, 2008 at 9:31 am
oh, and it wasn’t me, either!
March 19th, 2008 at 12:25 pm
Hand instrumented the apical 1/3, I was able to get rotaries about 4 mm short of working length.
I used my full set of rotaries to that length very carefully (and I also use gates gliddens). The small apical size is actually the limiting factor for irrigation, not the curvature. As long as instruments are able to get to WL and you’re irrigating frequently enough, irrigant will get down (up). The question is whether there’s enough volume that gets to the apex to be effective. That’s why the fact that the case isn’t infected is a major bonus.
We’ve all botched endos at some point in the past…
March 19th, 2008 at 12:30 pm
hehehe that’s true Peri, I’m not afraid of you anymore. Though I still shiver a little whenever you post xrays of teeth.