Doug Kase
Did You Know?
The surgical masks that we wear lose their
effectiveness in 30 minutes under normal use.
According to New York State’s mandated
guidelines for infection control, autoclaves should be tested weekly with
a spore test and a permanent record should be maintained.
Packaged autoclaved instruments should
be resterilized every six months and unwrapped instruments every six days.
Even one complaint from a patient about
your office can cause an O.S.H.A. investigation (informal or formal).
You must supply four pieces of personal
protective equipment (gloves, eye protection, mask, and garment) to all
employees in contact with blood and saliva.
Sodium hypochlorite is a good hard-surface
disinfectant? A 1 : 10 ratio of bleach to water will disinfect in three
minutes; however, it can eventually cause damage to the item you are disinfecting.
Doug Kase
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 S
JERRY SEINFELD would say, did you ever wonder what’s the deal with the
word blunderbuss? Oh, I know that a blunderbuss was a short
musket with a wide bore, but how often do you run across one of those nowadays?
Now if I were on the corner of 57th Street and 7th Avenue, waiting for
the downtown bus, but accidentally boarded the crosstown bus, I might consider
that
a blunderbuss. However, in the world of endodontics, a canal so wide
apically that you may not even have the instrumentation to obturate it
would be called a blunderbuss. That kind of canal certainly can evoke
feelings of helplessness. You might even turn to immediate unnecessary
apical surgery in order to correct any overfill of gutta-percha and sealer
that comes spilling out of an uncontrolled apical foramen.
This is the case of a 28-year-old male patient with
a history of trauma to tooth number 8 when he was a child. As Figure
1 clearly shows, there was incomplete root formation including the absence
of apical closure. There was also evidence of a periapical radiolucency.
The patient came in with symptoms of abscess, including pain and periapical
swelling. I placed him on antibiotics and analgesics to control the
acute symptoms and we scheduled another appointment for treatment.
Initially, it looked as if it would be a cut-and-dried case of obturation
and immediate apicoectomy.
When he returned in two weeks, the acute symptoms had abated,
and I initiated treatment. I opened the access as wide as possible
without compromising the crown, achieved measurement control with an apex
locater, confirmed it by radiograph (Figure 2), and accomplished instrumentation
with instruments as wide as a #140 reamer. I utilized large-diameter
hedstrom files along the canal walls to check for tissue and debris.
Now, how in blazes was I going obturate? I
was able to dry the canal and then pack MTA cement to the apical measurement,
using the reverse side of a coarse paper point until there was some apical
resistance, thus creating a stop. Using cotton wrapped around a large
diameter file, I cleaned the excess cement from the canal walls.
I then placed EZ-Fill cement, using the bi-directional spiral, and thus
the canal was flooded with sealer.
I reversed a large gutta-percha cone, dipped it
into solvent for three seconds, and placed it to measurement control.
Using a spreader with no apical pressure, I laterally condensed the mass
of gutta-percha, then coated a second large cone with sealer and placed
it into the canal in the normal direction.
Since research has shown that AH-26 based EZ-Fill
sealer alone would be good enough to seal the canal, the gutta-percha core
only helps to force the sealer against the MTA stop and the canal walls,
leading to the final result seen in Figure 3.
Immediate surgery was not necessary, and the patient
walked out very happy. The dentist also felt satisfied with the result,
but only time will decide the ultimate success in the case of this blunderbuss.
May-June 2001
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Figure 1: The blunderbuss.
Figure 2: Verifying measurement
control.
Figure 3: The final result.
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