Case of the week part 24

This is one of the most difficult case I have made. Young Pt, upper first molar, typical anatomic situation with 4 canals. Look at abrupt curvature of mesio - buccal root! MB and MB1 merged in curvature. Spend two visits to complete this case. MB and MB1 prepared with ProTaper Universal S1 and S2 to curvature, then hand files and NiTi Two (Poldent) up to size 30.02. DB and P with ProTaper Next to X2 and X3. ///// To jeden z najtrudniejszych przypadków z jakimi się mierzyłem. Młoda pacjentka, górny pierwszy trzonowiec, typowy układ 4 kanałów. Zobaczcie na kształt kanału przedsionkowego-bliższego! Kanały MB i MB1 łączą się dokładnie w największej krzywiźnie. Opracowanie zajeło mi 2 wizyty. Kanały MB i MB1 opracowane ProTaper Universal S1 i S2  do zakrętu, następnie dogięte pilniki ręczne i narzędzia rotacyjne NiTi Two (Poldent) aż do rozmiaru 30.02. Kanały DB i P opracowane ProTaper Next do X2 i X3.

HyFlex fresh case

Todays fresh case - first challenging one shaped with HyFlec CM files. One visit, simple shaping protocol, and warm gutta-percha compaction. I think i am gonna love that files!///// Dzisiejszy świeży przypadek - pierwszy wymagający i opracowany narzędziami HyFlex CM. Jednowizytowo, proste opracowanie, wypełnienie gutaperką na gorąco. Chyba się zakocham w tych narzędziach!

Case of the week part 23

Fresh 2 yr follow up. There were problems with patency in distal canal. I tried to locate canal with US, but i couldn't find "catch feeling" with #08 k-file. Also there were furcation lesions but without communication with pocket. Probing was normal. I put fiber post in distal and reconstruct crown with composite. After 2 yrs bone looks great even in furcation, the time for overlay has come.

Case of the week part 22.

https://vimeo.com/113400228
Short movie about broken file removal with modificated injection needle.

Case of the week part 21

Single visit management of false route in tooth #22. Red arrow indicates false route made by general dentist. Left RVG is initial one made in my office. Green arrow shows where exactly canal lumen is. Canal prepared to size 30.04 (Endostar five) and then apical part enlarged to seize 40.02 (NiTi Two rotary system). Citric acid, hypo, again citric acid, destilated water and CHX as a final irrigant. Note apical delta after CWO.

Case of the week part 20.

I love to see such a healing progress in such difficult case. PT came to my office with pain on percussion of tooth 46. Initial RVG shows that tooth was already RCT and have big lesion nearby apex of medial root. It also shows that probably there is zip in apical part of medial canals, and apical surgery will be the option. I decided to try reendo - two visit approach with calcium hydroxide in between. I had huge problems during shaping protocol - no apical patency both in messiahs and distal one. I used a lot of hypo, US, and citric acid. Then I obturate. Third RVG is one year recall -despite technical problems lesion is gone!!!! You don't always need a patency to properly clean root canals!

Endo Tip

During broken file removing procedure it is extremely important to block canal orifices. After You locate broken file in canal, close other canals orifices. Once I forgot about it and that gives me additional work. File jump out from one canal directly to another one. I used to do it with cotton pellet but teflon tape is much more comfortable. It is easy to remove after procedure. You can buy it in plumbers shop, divide to small portions and autoclave it. It is brilliant!