root treatments forum

sclerosed canals- what now?

2008-11-26T13:17:00.000-08:00

I often encounter sclerosed canals, or what appears to be sclerosed on x-ray. On opening the tooth I mind-map the positions of the canals and with the use of LN -burs am able to negotiate or access the canals and then to complete with filing. Some sclerosed canals need a bit more confidence and courage to work further up the canals until access is managed. And some are just not patent. Today I had such a case. It was an upper right second molar. The disto-buccal canal was sclerosed. I completed the palatal and mesio-buccal and then left the DB canal. Closed the tooth with a hard temporary filling and asked my patient to return after 4 months for a review. I will decide after 4 months whether I will need to prejudice the tooth in order to try and find the calcified canal. I will weigh up the patients' symptoms (if he has any) and make that decision. If the patient has symptoms before 4 months, of course I will deal with the tooth!

I think this is the responsible way to tackle this case. Don't you agree?

ps. look at the first premolar!- seems like I'm going to see the patient for this tooth too!

patient is a gagger

2008-09-17T14:05:00.000-07:00

one of our challenging procedures is working on a patient who is a gagger. the patient is usually tense and anxious and often embarrased. be empathetic, have time to deal with the patient and try and convince them that working together will help alleviate some of the stress and worry. they need to be reassured that gagging is often a reflex they cannot control and they should not be embarrased about their actions.
there are a number of ways to help with dealing with a gagger: medication (tranquilisers), nitrous oxide inhalation, sedation (intravenous), hypnosis (distraction techniques)
a simple way that i would like to remind everyone is just the use of the rubber dam!!
keeps everything out of the way including saliva and the roving tongue. what a help!!
easy and comfortable for the patient.
i had a patient today who was a gagger. i had to root treat his upper wisdom tooth!!
it took about 20 minutes to convince him to try and 'wear' the rubber dam. finally he did and i managed to save his tooth. just by the way - the patient was almost sitting upright!! i was nearly doing a somersault in my chair trying to see into his mouth.
by the way- did i get a big thank you for struggling so hard?
you guessed right, not even a small thanks for my trouble, just a moan about how difficult it was for the patient and how he hated people working in his mouth!!

post removal in ten minutes

2008-08-26T14:16:00.000-07:00

the BDA conference in Manchester was great. i really enjoyed presenting my technique and got a lot of positive feedback. it's really simple! a post will dislodge when a space has been provided for it to move in. a very fine latch-grip bur with a long neck (16mm) and round end (06) is used to drill along-side and around the post to about 2-3mm. the post is then vibrated out the root with an old blunted or broken scaling tip. the bur is called an LN bur (by Maillefer, Dentsply) ask for D0205. you may have to remove the collar of the core filling to see the post so that you minimise removal of dentine. the bur can also be used for sclerosed canal location. any perforation is easily sealed. if you require more in depth information, please write an email to gary.zolty@gmail.com and I'm sure i could send you a copy of my powerpoint presentation.

post removal in ten minutes

2008-03-24T14:27:00.000-07:00

Hi
I will be speaking at the BDA conference here in Manchester this year in May.
I will present a very simple technique on how to remove posts in an atraumatic fashion that is quick and easy to master. I hope you will be there to hear me speak- should be fun!
If you can't make it I will jot down some of the main points in this blogg (after 2 May) for your perusal.
bye
Gary Zolty

perio-endo relationship

2008-02-12T15:10:00.000-08:00

I have recently completed a root treatment on a lower incisor which has a buccal apical fenestration. The root treatment was completed or obturated with MTA due to the apical resorption with concurrent apical foramen widening and also since the patient will have apical surgery to correct the defect. The MTA has excellent sealing properties and is able to seal even under controlled 'soft' apical pressure. I have coronally lined the MTA with glass ionomer and temporarily sealed the access in case the tooth may require internal bleaching in the future. I will review this case after 6 months to follow up the healing.

I welcome any questions

my tooth ache

2008-01-15T12:39:00.000-08:00

i did not think that my first real posting would be about me!! i developed tooth ache in one of my central incisors. i would describe the pain as intermittent cold pain, sharp and localised to the tooth. the pain was exacerbated with hot and relieved by cold. after a few days of self medication with anti-inflammmatories the pain began to refer to my lower teeth. even i began to be confused and had second thoughts of the origin of the pain. percussion, though identifies the source clearly. one or two days later the pain almost diminshed and i hoped that the nerve experienced a spasm and would settle completely. that was okay the whole day until i drove home from work and suddenly the tooth upped the antics and clearly identified itself with a serious pressure pain. the pressure was felt within the tooth. there was no mistaking the source and the urgency now. the following day i managed to have the tooth extirpated. the tooth was still very tender for 2 days after the pulp extirpation. cold compresses helped relieve the pain somewhat.
the tooth has been finally root treated and is settling down.
why do i write this, what can we learn: always listen to your patient as they can tell you what the problem is and how to treat it.
don't rely on their localisation of the source of pain as referred pain is very confusing
root treatment is a humbling experience for someone who does it
it is very gratifying to help another person who suffers from tooth ache

WELLCOME!!

2007-12-25T07:58:00.000-08:00

Hi
Thanks for joining MY BLOGG on root treatments. I hope you find some use and enjoyment. If you have any questions please feel free to post on MY BLOGG or alternatively you can email, if you want to keep it private.
I will try and keep it practical, useful and light. It will be about day to day treatments- what were the difficulties and how I managed them.
Right now its holidays, so I'll write again in a few days
Gary