Case Study Number 497935
Patient has already been treated on an emergency basis for an acute apical periodontitis with an irreversible pulpitis on second mandibular premolar. Access opening through bridge abutment allowed for pulpectomy and calcium hydroxide insertion at a specialist office. A provisional filling sealed the opening on occlusal. Still, as it happens often, huge leakage occurred from second bicuspid abutment margin although molar abutment was still rock hard cemented.
On pre operative Xray dental film, molar abutment shows a canal system filled with calcification and a PDL widening on its mesial root, this tooth is asymptomatic. Patient wanted to save her bridge, she understood that in order to do so, her bridge had to be removed with minimum damage in order to cement it back. By the same token, molar endodontic condition could be assessed prior to the final bridge re-cementation.
Bicuspid bridge abutment cement has been washed out for a long time now. Existing bridge has been safely removed with minimum damage in a matter of minutes using Metalift crown and bridge removal systemTM on molar. An endodontic procedure has been performed on the bicuspid. After removal of deciduous occlusal glass ionomer filling on molar abutment, a recurrent tooth decay reaching the pulp justified a second endodontic procedure. Opmi PROergo dental operative microscope has been usefull in denticles safe removal. Endodontic procedures have been performed using the ProTaper system endodontic files from Maillefer, root canal systems have been filled with Pulp Canal Sealer (Kerr) and gutta percha.
X ray dental film on the right shows a post endodontic outcome with existing bridge back in its original position (not cemented), that fixed prosthesis has been autoclaved and had its inner part sandblasted. Referring dentist will cement it back on abutments once he will be done with posts and cores build up of his choice. Not having to bore a large hole in the bridge abutments will definitly contribute a lot in rescuing it.
To look at a video on Metalift removing a PFM restoration please go to: http://www.metalift.com/video_downloads.html