Cheyenne, WY...June 15, 1994
Once in a while I'm required to dig deep into my bag of tricks and pull out an idea I haven't used in years.
While I was giving a course in Cheyenne recently Dr. Bob Hageman, an oral surgeon from Casper, WY posed an interesting question.
How to you prepare an apex for apicoectomy and fill with our technique?
Ages ago when I was still in Downers Grove, Illinois I was faced with an interesting dilemma.
A 17 year old young lady had just gotten two new PJC's (not PFM's) and one, evidently exposed, began hurting something fierce.
Since a conventional root canal would almost surely destroy the PJC it was decided to do a double apicoectomy and retro fills.
After making an incision and exposing the apices I broke off about 5mm of the tip of a file, held it in the beaks of a needle holder, inserted it through the apex and filed as far as I could reach.
Then used another longer larger file the same way until I had actually reached into the coronal portion of the tooth.
Then using a syringe full of peroxide with a 30 gauge needle, fed the needle into the canal with a hemostat as far as possible and irrigated, letting the debris bubble out.
This was followed with plain water and since it would be impossible to dry the canal with paper points anyway, I proceeded to fill the canal.
Using an endodontic syringe filled with a thick mix of PCA root canal sealer I fed the needle all the way into the crown via the apex.
I then began pouring cement into the canal, flushing water, tissue tags and debris out through the apex.
When I was convinced that nothing but pure cement was flowing through the apex, I began withdrawing the needle, continuing to extrude cement finally wiping the apex off with my finger tip.
There are a lot of advantages to this technique.
It allows much better debridement than a conventional apico.
It allows much better and more complete filling than gutta percha.
And it does not require ultrasonics.
It's an all hand operation.
Your Comments are Welcome by email.drjack@BetterEndo.com