my first molar rct

[datsit]

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hi
well, i did my very first molar rct today n againt my wishes, i was pretty nervous about it. it was a non vital 46(mandibular first molar), grossly decayed tooth. i opened the access 4 days ago n had the patient under antibiotic coverage.
anyway, the mesial root was curved n as the canals were narrow i had a hard time negotiating them. however i did manage to establish the correct working lenght. i used precurved k files.
the post operative radiograph revealed that i was 1 mm short of apex in the mesial root but the distal canal was perfect. there was no periapical radiolucency. what prognosis can i expect. also, what should i do to get the perfect seal in curved canals even if use only hand instruments

 

[armorshell]

A big worry will be transporting the canals, especially if there's a large curve and you'r using hand files. Do you use the balanced forces technique for hand filing?

 

[OceanDMD]

The key is opening those orifices up nice and wide (coronal third of canal) were you have wiggle room and straight line access. This will help keep the hand file from making more than one bend (which causes transportation, separation, binding, ledging, all the bad things). Gates work nicely for this , which I assume you should be allowed to use. Also, never forget to re-capitulate. My first cases I recall losing patency, and sometimes you never get it back (unless you make your own POE).

 

[aphistis]

The key is opening those orifices up nice and wide (coronal third of canal) were you have wiggle room and straight line access. This will help keep the hand file from making more than one bend (which causes transportation, separation, binding, ledging, all the bad things). Gates work nicely for this , which I assume you should be allowed to use. Also, never forget to re-capitulate. My first cases I recall losing patency, and sometimes you never get it back (unless you make your own POE).

Been there. Groan.

 

[jmick101]

+1 on the Gates Glidden for opening up the coronal third. Just remember to fill the canals with EDTA or glide, work the 2,3,4 sequentially nice and easy and swipe on the upstroke towards the cusp tip of the canal you are working on (gates only cut on the pull stroke anyways). Remember though, if you use the GG and you are not careful you can strip perf a tooth easily.

As far as getting a good seal, you are just going to have to carefully use finger spreaders that correspond with your files/working lengths.

 

[DrJeff]

Been there. Groan.

Anyone who hasn't just plain and simple hasn't done enough endo. For those of us who like to, and regularly do endo, it's not a question if if you'll make your own POE one day, but when🙁

 

[teeth63a]

If you properly reached the working length on that mesial root and irrigated well, the prognosis of the tooth is still good, despite being radiographically short 1 mm.

Being radiographically short 1 mm obviously does not translate to an actual shortage, some studies show that radiographs can be inaccurate (I don't have the studies available). IE, PAX angulation can be different between takes.

I use an apex locator to determine canal length, and even with that, my fill can be short radiographically...due to tooth orientation, xray orientation, apex location.

Don't sweat it, you're probably ok.

 

[KOM]

Anyone who hasn't just plain and simple hasn't done enough endo. For those of us who like to, and regularly do endo, it's not a question if if you'll make your own POE one day, but when🙁

POE? Perf. something or other?

 

[jmick101]

POE? Perf. something or other?

Point Of Exit.

 

[aphistis]

Point Of Exit.

Or alternately, Pissed-Off Endodontist.