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Lower Third Molar & Apical Curvature

If patient is not willing for a dental implant, it may be necessary to save wisdom teeth so that it can be used as abutment for a bridge. 46 years male patient referred to our practice to save lower left wisdom tooth with large buccal caries.

C/E: Carious #38, caries mainly involving buccal side. Cold test: +ve

R/E: N/S periapical changes, Something bad happened to my x ray device, so the X-rays in this case are not very clear. Apologies for that.

Tx plan: Slow caries excavation, if pulp exposure then #root_canal_treatment, if no pulp exposure then direct restoration.

Buccal caries was subgingival and very deep leading to pulp exposure.

#TCS (Coltene) used to trim the tissue and to expose the margin where definitive restoration can be placed.

Looking at the tissue around the cavity, planned to place #GIC as interim restoration later to be replaced with #silver_amalgam.

After #pre_endo_BU with #GIC, tooth was isolated and access cavity made.

Any costly file you use, root canal preparation is incomplete without K files. Bent K files are best to scout curvatures and for initial canal preparation i.e., #Glide_path.

#Edge_endo files with K files and #Hero_shapers used for mechanical preparation.

I prefer to use 2% paper point for drying root canals, it helps me confirming working length and avoiding errors.

There was apical curvature and 2 canals merging into 1 canal looking like C shaped canal anatomy. So, decided to use squirting technique for obturation. We do not use GP cones in this technique. Warm GP is directly injected to the canal and compacted with pluggers. We apply sealer with paper points or GP cones prior to GP injection.

There are broadly two types of devices available for warm GP. One is cartridge type extruder, here warm GP comes out with a press of button through motorized mechanism. These devices are comparatively costly. Second is backfill gun, where warm GP comes out from tip with our fingers pressure on the trigger. Here the whole control is in our hands so it becomes more technique sensitive.

Warm GP is then packed with hand pluggers. Hand plugger should be loose fit in the canal so that it should not exert excess pressure on root walls.

A confirmatory radio graph is must after first round of warm GP pack to avoid any error. In this stage if GP is short of apex, we can correct it. Later after complete obturation it is comparatively difficult.

According to canal length, squirting can be completed in 2 steps or 3 steps.

Packing warm GP with hand pluggers. Hold the plugger gently onto the warm GP till GP cools down, it will compensate shrinkage of warm GP.

A layer of colored composite even I had to do amalgam core because after this root canal will be sealed and we can do amalgam even if there is some breach in isolation.

Notice the apical fills, it would not be possible with cold lateral technique.

After amalgam core patient was sent back to referral dr. for the further work.

I'm firm believer of concept, "what you take out from canal matters more than what you put in". But obturation shows the efforts we put in cleaning the canal anatomy and there are some cases which are not possible to obturate properly without warm GP. I"ll share more cases with #squirting technique video for better understanding.

Thank you for your valuable time and apologies for poor quality X-rays.

Your comments and suggestions are welcome.

Dr. Neeraj Narang

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