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Endo tips    Better Endo    Endo abstracts    Endo discussions

  Restoration of access opening

The opinions within this web page are not ours
Authors have been credited
for the individual posts where they are. - ROOTS

From: Marga Ree
Sent: Tuesday, February 01, 2011 2:03 AM
Subject: [roots] Restoration of access opening

When thereZer is a PFM crown, it's always a challenge to 
mask the metal when closing the access opening with 
composite. This one was easy, because it was an 
all-ceramic crown. Thermafil was removed using hedstrom 
files and hemostat. Treatment was completed in 2 sessions.
-  Marga

Great case Marga, the RCT and restoration are beautiful. In other cases that you've posted in roots, you were sandblasting the pulp chamber. Are you still doing that? Do you known some paper that studied this procedure in endodontics? - Patrick Baltieri Thanks Marga, I will buy a sandblast device and test in extracted teeth, to understand how to use it. - Patrick Baltieri Thanks Patrick, Yes I always sandblast the pulp floor after finishing the root canal treatment. It's very effective to clean up the floor. - Marga Oper Dent. 2008 Sep-Oct;33(5):556-63. The effects of tooth preparation cleansing protocols on the bond strength of self-adhesive resin luting cement to contaminated dentin. Chaiyabutr Y, Kois JC. Department of Restorative Dentistry, University of Washington, Kois Center, Seattle, WA, USA. Abstract This in vitro study evaluated the bond strength of a self-adhesive luting cement after using four different techniques to remove surface contamination on dentin. Extracted human molars were flattened to expose the dentin surface and prepared for full crown preparation. Acrylic temporary crowns were fabricated and placed using temporary cement. The specimens were stored at room temperature with 100% relative humidity for seven days. Following removal of the temporary crowns, the specimens were randomly divided into four groups, and excess provisional cement was removed with (1) a hand instrument (excavator), (2) prophy with a mixture of flour pumice and water (3) aluminous oxide abrasion with a particle size of 27 microm at 40 psi and (4) aluminous oxide abrasion with a particle size of 50 microm at 40 psi. The microstructure morphology of the tooth surface was evaluated and residual materials were detected using SEM and EDS analysis of randomly selected specimens. The ceramics were treated with 9.5% hydrofluoric acid-etch and silanized to the prepared dentin prior to cementing with self-adhesive resin cement (RelyX Unicem, 3M ESPE). he shear bond strength was determined at a crosshead speed of 0.5 mm/minute. The results were analyzed with one-way ANOVA, followed by Tukey's test. Particle abrasion treatment of dentin with an aluminous oxide particle provided the highest values of bond strength, while hand instrument excavation was the lowest (p < 0.05). Aluminous oxide particle size did not significantly influence the bond strength at 40 psi. The use of low pressure and small particle abrasion treated dentin as a mechanical cleansing protocol prior to definitive cementation increased the bond strength of self-adhesive resin-luting cement to dentin following eugenol-containing temporary cement. PMID: 18833862 [PubMed - indexed for MEDLINE] Excellent work as always Marga. Please can you summarise what file sequence you used. Thank you for your posting. - Stephen Day Thanks Stephen, I used Mtwo files in this case, the usual sequence: 10/04, 15/05, 20/06, 25/06, 30/05 and finally 35/04. And of course handfiles to obtain patency. - Marga Hi Marga real nice work. can u pl tell what burs did u use to go through the (probably) zirconia core of the all ceramic crown thanks - Abhinav Misra Thanks Abhinav, I use very sharp long diamonds in a high speed handpiece. - Marga Hello, Marga! Marvelous case as always! Thaks for sharing! I have one question: How did you manage to restore so beautifully the access opening? What was your bonding protocol? Do you use hidrofluoric acid to etch the porcelain? I guess I had some questions!:) Thank you again for sharing this lovely case! - Bojidar Thanks Bojidar, here is the technique: 1. Clean the internal surfaces with a micro-brush or cotton pellet containing a solvent such as alcohol. 2. Use air abrasion to clean the cavity and ceramic 3. Acid-etch the ceramic material with 10% hydrofluoric acid for 1 min (I use porcelain etch by Ultradent) 4. Rinse and dry, the porcelain should have a frosty appearance after drying 5. Acid-etch the dentin with 37% phosphoric acid for 15 s. This step cleans the porcelain and enhances the silane adaptation 6. Thoroughly rinse and dry and then rewet the dentin with a micro-brush soaked in CHX (CHX has a beneficial effect on degradation of the hybrid layer). 7. Apply a 4th generation primer to the dentin (I use Clearfil SA primer ) and gently air-dry 8. Apply a 4th generation adhesive to the dentin ( I use Clearfil Photobond) Because the Photobond bonding system is dual cure, you need to mix one drop of each bottle (universal and catalyst). Gently air-dry 9. Mix 1 drop of Clearfil porcelain activator ( a pre-silane) with 1 drop of each bottle of Clearfil photobond dual cure, apply to the ceramic, gently air-dry and light cure for 15 secs. 10.Bulk-fill with a dual or self-cure composite to within 2 to 3 mm of the cavo-surface margin and light-cure (I use LuxaCore self-cure). 11. Cover the core material with a hybrid or nanohybrid light-cure composite can be used as a top layer 12. Contour and adjust the occlusion. 13. Finish and polish the restoration. It looks time consuming, but it takes approx. 10-15 minutes. - Marga Marga you simply rock!! Great endo and restaurative skills!! I read your article from the Dental Clinics of North America "The Endo-Restorative Interface: Current Concepts" and it explains that placing a post after endodontic treatment in a tooth with a crown may improve retention and increase fracture resistence. Please could you explain why did you choose not to place a post in the distal canals? Thanks for share (and care) :)) Kind regards Javier Thanks Javier! I place posts routinely in crowned teeth with small roots (premolars and front teeth). In general, it 's not necessary to place posts in molars, because of amount of sound tooth structure that is left. Having said that, I don't think there is a drawback of placing a fiber post, provided you don't remove additional tooth structure to accomodate the post. When I am in doubt about the remaining dentin, I will typically place a post. - Marga

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