Case of the month of February/09

[Khaled Balto]

Thanks to Dr. Najeeb for his valuable contribution. I am sure this case will generate lots of discussion. As you all noted, I am experiencing technical difficulty in uploading quality images...but I promise it will be resolved in the coming few days....until then; let's all admire the peace of art Dr. Najeeb is sharing with us.

[bakkarm]

Hello,
Yeah i agree excellent case by Dr.Khayat . My question is did he bypass the ledge by exploring with the finger spreaders? ... If so what would be the difference between k-file vs finger spreaders.

Also, what type of ultrasconics did he use? ( endo tips?)

Thank You

[Najeeb Khayyat]

Thank you Dr.Bakkarm for your complement.
Regarding your question,the ledge wasn't really bad to bypass,the real problem was to open the obliteration apically.Finger spreader,because it has no flutes, are more stiff and doesn't bend as easy as the K-file of the same size,and the smooth rounded non cutting tip of the spreader makes it (under pressure) dig only apically at the least resistant area,which is the occluding dentin chips or the calcified pulpal tissue.Provided that the part of the canal coronal to the obliteration is well prepared or flared,to remove coronal interferences,the finger spreader tip create a pathway for the next subsequent smaller nstrument,which is usually,size 8 or 10 K-file.So,the use of the finger spreader does not rule out the need to use the K-files as an important tools to negotiate obliterated canals.
Thanks to Prof.Madiha Gomaa,who taught me this valuable technique which I have been using for a year
successfully almost all of the time in cases of obliterated canals.
Regarding your 2nd question,Proultra Ultrasonic Endo. Tip#4 was used in this case.