Apical split has been cleaned and shaped with precurved stainless steel Mani endodontic K files. Passive ultrasonic irrigation with NaOCl 5%. Filled with gutta and NeoMTA Plus from Avalon Biomed
Preserving teeth with Endodontics and Post and Core Build up.
Case Study Number 504046
“according to the current way of thinking, the most important factors against tooth fractures are the preservation of as much as possible sound tooth structure as well as the use of full coverage. The amalgam coronal-radicular dowel and core technique…has been tested successfully in recent studies, both in vitro and in vivo. Its advantages are that it requires less sound tooth structure removal, involves uniform material for both the dowel and the core, is accomplished in a single chair side session and can be easily removed. It can accordingly be used as a complete crown build up in cases where prosthetic treatment has to be postponed for various reasons.”
“This study compared the fracture resistance of coronal-radicular restorations made from three different direct restorative materials. Sixty human premolars were selected, 45 of which were root treated and decoronated. Fifteen of these premolars were restored using amalgam, 15 with composite and 15 using resin-modified glass ionomer. The 15 unrestored teeth were used as a control group… The force required to fracture each core specimen was recorded as well as the proportion of core lost due to failure. The results showed dental amalgam as having the highest fracture resistance (mean 1.93kN, sd 0.22) followed by resin-modified glass ionomer (mean 1.05kN, sd 0.20), sound tooth (mean 0.79kN, sd 0.20) and composite (mean 0.75kN, sd 0.11). The differences among all groups were significant. These results demonstrate that, although resin-modified glass ionomer is significantly weaker than amalgam, these restorations were stronger than unrestored teeth and failed at forces in excess of those encountered in normal mastication. Amalgam cores, along with resin-modified glass ionomer, tended to fail less catastrophically than the other materials and, given their strength, would remain the material of choice in situations where abnormally high forces are expected.”
A study of the fracture resistance of nyyar cores of three restorative materials. Ferrier S, Sekhon BS, Brunton PA. Oper Dent. 2008 May-Jun;33(3):305-11.
Microendodontic. Calcified canals. Case Study Number 506846
Patient referred for endodontic treatment on this mandibular first molar. Coronal-radicular access was already done but canal entries are embedded in a mass of calcified dentine and could not be found.
Preoperative X ray dental film shows a complete mineralization of both mesial and distal canals coronal third. This is an intricate root canal procedure, because this pre operative condition involves dealing with complete canal stenosis caused by dystrophic calcifications.
Dental operative microscope (Opmi Proergo from Carl Zeiss) and ultrasonic tips where most helpful in locating both mesial and distal canal entries.
Once located, our first instrument in four canals were K files number 06 (second X ray dental film). Then, mesial and distal canals have been shaped and cleaned with the Pro Taper system (Maillefer) and lots of RC PrepTM. They were subsequently filled with gutta percha (lateral and vertical condensation) and Pulp Canal Sealer EWT TM
Third X ray dental film (Clark’s rule) shows all four treated canals.
Amalgam corono apical core build up is shown in last post operative X ray dental film. A crown is planned by patient regular dentist.
Endodontic Procedure. Case Study Number 449927
To treat such a tooth in endodontics we needed to deal with:
- Difficult access
- Long tooth (24 mm)
- Calcified canals (root canal system with dystrophic calcifications) to locate, shape clean and fill
- Second mesiovestibular (Mb2) to strive for with the help of a dental operative microscope
- Canal curvature with an “S” form (Bayonet shaped root canal)
PRO Taper endodontic files from Dentsply, OPMI PROergo dental operative microscope from Carl Zeiss, Gutta Percha from META, Pulp Canal Sealer from KERR
MicroEndodontic. Case Study Number 500047
Canal curvatures are a challenge to preparation and can be the origin of many technical complications leading to failure of treatment. Canals that curve in the mesio-distal direction are usually readily detected in radiographic dental films. However, as it is the case here, many canals curve also in the bucco lingual direction. The bucco lingual aspect of this sharp curvature has been displayed using a mesio distal angulation of our X ray cone beam.
Root Canal Procedure. Case Study Number 492626
Patient is having an AAA with a necrotic pulp, an extensive deciduous restoration and a huge tooh decay on distal aspect of this first maxillary molar (Some of us might think: “you don’t have to worry it is dead”).
Dystrophic calcifications are obliterating the root canal system and we can expect to strive for a second mesiovestibular too. An extreme curvature is also present in distovestibular root canal.
Prior to the initiation of treatment, an estimate should be made as to the degree of curvature of the canal to be treated. For making this determination merely view the curved canal as having two segments, one extending from the floor of the chamber down the long axis of much of the coronal two thirds of the root and the second from the apex of the root extending back to the occlusal through the apical third of the root. These two lines will intersect and form four angles. The interior angle is the estimate of the degree of the canal curvature. In this specific case, distovestibular root degree of curvature has an estimated 120 degree. Such an estimate is of mesiodistal curvature only and does not take into consideration any buccolingual curvature. The method for making this determination has ben first described by Schneider and then Jungman et al.
This present description of Schneider method is from Franklin S. Weine in his book: “Endodontic therapy” Fourth edition pp 314-315
Carl Zeiss Opmi Proergo dental operative microscope was of a big help in locating both mesiovestibular and distovestibular canals entries, I am using the Pro Taper Endodontic files System from Maillefer for preparation of canals as they are doing very nicely in extremely curved canals. Intracanals treatment procedure is a calcium hydroxide as a medicament (Third x ray from left) since there is a lot of intracanal exudation. Canal filling method: master gutta-percha cone, lateral condensation for the first wave, warm gutta percha for the second wave. Pulp Canal Sealer as the root canal sealer. Amalgam filling has been replaced by a composite filling, because patient wanted to wait a bit for his dental insurance to kick back in. Patients regular dentist will do crowning as soon as possible after that.
Calcified Canals. Case Study Number 487445
Clinical examination: Sinus tract, mobility: 0, deciduous amalgam restoration.
Radiographic examination: Alveolar bone with circumscribed lucency, apical root canal split, hypertaurodontism (bull’s tooth), apical root canal split branches not visible on X ray dental film, hypercementosis
Diagnosis: pulpal necrosis with chronic periapical infection,
Etiology: marginal leakage, caries
Root canal procedure:
First appointment: gaining access to the split, locating entries, shaping and cleaning apical root canal branches inserting intracanal medication for 8 days.
Second appointment: intracanal medication retrieval, copious CHX 2% irrigation, drying canals and permanent root canal obturation with Pulp Canal Sealer and gutta percha (lateral and vertical condensation).
In that specific case, microscope was most helpful during all the following steps necessary to insure a better prognosis for this patient:
1) Locating and gaining access to buccal and lingual root canal entries (apical split was clearly visible under magnified observation)
2) Striving to find a third branch in apical split minimizing the chances of omitting an untreated canal
3) Aiming at the right root canal orifice when:
- Inserting the two first endodontic files to confirm canal lengths
- inserting a file sequence to shape and clean each canal
- Positioning irrigating syringe needle tip and calcium hydroxide syringe tip toward the right canal entry
- Inserting absorbent paper points in both canals when drying canals
- Inserting master, accessory gutta percha cones and finger plugger when doing final obturation with lateral and vertical condensation
4) Checking for pulpal tissue remnants prior to final obturation to minimise the chances of pushing them back into the apical area
Root Canal Procedure on Calcified Canals.
Case Study Number 317736
Patient referred for pre prosthetic endodontic treatment on mandibular first molar.
Preoperative X ray dental film shows a complete mineralization of both mesial part of pulp chamber and mesial canals as well as a complete stenosis of distal canal(s?)
Dental operative microscope and ultrasonic tips where most helpful in locating both mesial and distal canal entries. First instrument in four canals are K files number 06 (second X ray dental film)
Third X ray dental film (Clark’s rule) shows all four treated canals.
Amalgam corono apical core build up (no post) is planned plus a crown.
Case study number 485946
Symptomatic mandibular molar, patient can’t chew on that side. Referred to us for endodontic revision.
First appointment intervention steps:
Coronal-radicular access (access through PFM crown, access through coronal build up) taking great care not to perforate the previously weakened pulpal floor, gutta percha removal, locating DB, regaining patency in calcified distal canals to the apex without perforation or deviation, correcting step in apical third of mesiolingual canal, negotiation of mesial canals, CHX 2% irrigation, CHX 2% left in canal system for one minute, drying canals, insertion of calcium hydroxide dressing, provisional obturation (Cavit)
Second appointment intervention steps:
Removal of Ca(OH)2, CHX 2% for one minute, dry canals, cone fit checking and final obturation with Pulp Canal Sealer and Gutta Percha.
Small sealer overflow is a good warrant of apical seal.
Referring dentist is planning a fixed bridge 37, 36, 35 X. (Patient did not want an implant to replace missing #34)