Apical periodontitis : Restoration in glassionomer : Two molars
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From: RafaŽl Michiels
Sent: Wednesday, March 25, 2009 2:17 AM
Subject: [roots] Today's cases
Diagnosis: 3.6 with apical periodontitis on both roots. Pulp in the
chamber was removed by the referring dentist. At the lingual side a
piece of the enamel had broken off. Also alot of chipping
on the other teeth. It is correlated with the tongue piercing she has.
Treatment: RCT, 1 visit. Protapers and Profiles, NaOCl, EDTA, PUI,
obturation with Gutta condensors. Temp. Restoration in glassionomer
Future: The dentist will restore it with a definitive composite
Extra advise to the patient: replace the metal ball of the piercing
with a plastic one.
Diagnosis: 1.7 was opened by the referring dentist, due to caries
into the pulp. The temporary restoration he made, was with glass
ionomer and is well.... not so good, but it doesn't leak.
Tooth is also periodontally compromised, but patient wants to keep
it at any cost. Treatment: RCT, 1 visit. Protapers and flexofiles,
NaOCl, EDTA, PUI, obturation with Gutta condensors. Temp. Restoration
in glassionomer, I did not remove the distal part of the previous
glass ionomer, since there were no signs of leakage AND, the patient
has an appointment with his dentist to replace the temporary filling
with a definitive one, this friday. Future: friday a definitive
restoration will be placed.
The MB1 and MB2 are very close to each other, which was rather
difficult to shape - RafaŽl
Rafael.............unless I'm missing something, no Ca(OH)2 was used............
The RCT's are amazing as always, but I do have one question.............
even if you're not the person doing the restorative, should we as endudes,
NOT BE AT LEAST pre-prepping the tooth - pseudo-transitionalizing it to
hasten the timing for restoration, to get the patient committed 110% to
proper therapy, to make the restorative lad aware of CLP issues et al....
What can I say? Excellent work!!! Beautiful cases, hat is off, etc.etc.
Rafael, thanks for sharing!
No comments... Only questions :-)
Could you please tell how do you manage apical part of the canal?
Why i ask i that i often have problems with working length control and as
a consequence - gross puffs or underfilled areas... so, it's the question
for everybody - tell the secrets of apical instrumentation and obturation
control :-) I would be more than grateful to get your view on this - Dmitri
Dmitri, if you use rotaries, never take them to the full working length,
at least 1 mm short of it. Keep in mind that as you are cleaning and shaping
the canal, any curvatures in this are going to become straighter therefore
your length is now going to be shorter. Always after each rotary instrument
check for patency with a 10 file. Finish your apex to 20 or 25 file
and then step back 0.5 mm for every higher file. The final instrument will
also depend on the original size of the canal as you know, if it is a central
on a young pt. your last file to the apex will have to be bigger but the
principle is the same. Getting puffs at the end of the canal, not a big thing,
do not worry about it. Keep in mind that this is the protocol that
I use for my warm vertical condensation tech. Hope it works for you, let me
know - Jose
Now the main question is what should we call a working length? I know....
it's back to basics type of question and look goofy asking this :-))
I take my EAL and substract 1mm from... call it estimated working
length. Then after shaping to that est.length approx to 20/.06) i start
to explore apical part... if i can i take paper point measurment
and substract 0.5mm from red dot (or whatever colour is it). Instrument
to the final shape and start irrigation, PUI etc... Now there is the catch
- i still sometimes end being short (as viewed on x-ray after obturation)
or being too long as seen on conefit x-ray - and then it's a PITA to fit
the cone). If not, then i sometimes push through the constriction while
doing waves of condensation... Where do i go wrong? - Dmitri
Sounds dumb, but no one ever taught me that simple notion of not taking rotaries
to full wl. I had to find it out for myself the hard way with some pretty good ,
what shall we call them, oh yeah, puffs. I canít agree more. I am an apical hand
finishing guy also. No way to create a proper capture zone in my estimation
otherwise - gary
Thanks Jose and Dmitri,
As for the apical instrumentation, I mostly do the same which is. Protaper F1
at about 0.5mm of the constriction and I finish with K-flexofiles, handfiles,
mostly until a size 30, unless I need more obviously. I almost never (maybe I
did it 3 times in 3 years) finish with a size smaller than 30. (This is my
protocol, it is not for a warm technique, but for Cold lateral condensation or
obturation with the guttacondensors, hence the reason why I have a bigger MAF)
Hope it helps, but Jose pretty much said everything - RafaŽl
Constriction.. do you mean 0.5 short of EAL measurment?
Could you please laborate on what is the benefit of instrumenting to at least
#30 for cold lateral condensation?
When i did cold lateral i oftentimes left canal instrumented to F1 or F2
depending on the case and went obturation... But if you instrument to #30 with
hand files, then what master cone do you use - still ProTaper one or
conventional ISO .02 cone? - Dmitri