Retreating endo

[DancingKoala]

Hi guys
I did root canal tx today and it was about 3 mm short from the apex.
I am thinking about doing it again (retreatment?)
My plan is to use endosequence and clean the canal with the 2 size smaller from the largest one.
Do you guys think that would be enough to clean the canal and put the mastercone back in?
or any other advice?
Working length was 21mm.


Also, what happens when the canal is 3mm short from the apex? What are the possible complications that can happen to my patient?
Sealer went all the way to the apex but the actual master cone was 3mm away from the apex. I think what happened was that the tip of the master cone got bent.

---

Members don't see this ad.

 

[DentinBond]

Are you using Resilon or gutta percha? If Resilon, the sealer is the same substance as the master cone. Aside from some concern over shrinkage, sealer and Resilon itself (bonded to the dentin walls) are pretty much equivalent.

Missing the apical 3mm increases the odds of reinfection. Actually, from what my endo academic colleagues tell me, filling to length with a .30 tip size increases the odds of reinfection over filling with a .40. Have a look at some cross sections and review the intense network of lateral canals in the area.

Chloroform irrigation dissolves both gutta percha and Resilon. I used to resist using it, but it's really the only way to get out all of the prior fill, even if it's recent. And it's best to irrigate with NaOCl again. We should take any chance we can get to eliminate bacteria. And then with Resilon, one must not let NaOCl be the last substance in the canal; make sure to irrigate with "Smear Clear" (Sybron) as a final step.

Just started using the EndoVac from Sybron, by the way. It rocks. Irrigating from the apex up! Who knew.

 

[DancingKoala]

Are you using Resilon or gutta percha? If Resilon, the sealer is the same substance as the master cone. Aside from some concern over shrinkage, sealer and Resilon itself (bonded to the dentin walls) are pretty much equivalent.

Missing the apical 3mm increases the odds of reinfection. Actually, from what my endo academic colleagues tell me, filling to length with a .30 tip size increases the odds of reinfection over filling with a .40. Have a look at some cross sections and review the intense network of lateral canals in the area.

Chloroform irrigation dissolves both gutta percha and Resilon. I used to resist using it, but it's really the only way to get out all of the prior fill, even if it's recent. And it's best to irrigate with NaOCl again. We should take any chance we can get to eliminate bacteria. And then with Resilon, one must not let NaOCl be the last substance in the canal; make sure to irrigate with "Smear Clear" (Sybron) as a final step.

Just started using the EndoVac from Sybron, by the way. It rocks. Irrigating from the apex up! Who knew.

Actually, I haven't used obtura gutta purcha yet. I melted the master cone w/ system B and took an X ray and stopped before I used obtura. I am hoping that I can pull out the entire master cone in one piece when I melt more with system B and pull it out. My next plan is to go down there with series 29 bur using endosequence (this is the biggest bur and the last bur before I tried the master cone in). I hope that takes care of the tip of the master cone and the sealer.

I am not sure if we got chlorform. We only got EDTA and NaOCl for irrigation.

 

[Luonghd]

Thanks for your recent endo insights Doctor, I hope you are teaching clinical endo somewhere out there. If you are not, you should.

 

[DancingKoala]

I was just wondering....
if I use endo-sequence (NiTi instrument) wouldn't it also be possible that the master cone gets pushed thru the apex due to apical pressure that the instrument is applying?
And isn't there also a chance of root fracture?

 

[Wax n Relax]

You need to use chloroform to dissolve the gutta percha.

 

[DancingKoala]

You need to use chloroform to dissolve the gutta percha.

Can I remove the gutta percha without using chloroform? The tooth had two canals and I don't want the chloroform to touch the other canal and dissolve it.

And if I use chloroform, is it safe for the periapical tissues and nerves down there? Does it only affect the gutta percha?

 

[Genemyers]

Better rate of success is obtained when root canal is includes obstruction short of apex. Does your root canal follows above criteria ? If yes then there are good chances of root canal success.

 

[BingDent]

Te best time to retreat a root canal is immediately after you obturated. At this point, cement is not set hard and gotta percha is still soft. If you took a final film and you noticed it is short, simple use a rotary file at 450rpm to remove the gotta percha. Reinsert your master cone and verify length, then obturate. It will add about extra 30 min. to the procedure though.

 

[manybirdme]

you are right,I hope you are teaching clinical endo somewhere out there. If you are not, you should.