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Roots Digest 2
From: kendo
To: ROOTS
Sent: Monday, July 06, 2009 3:32 AM
Subject: [roots] Uh oh.........the smell of napalm Part 2
Continued from Page 1
| Fig 4a Panel of anatomic preparations from the classic work by
Professor Walter Hess of Zurich The Anatomy of the root canals of teeth of the permanent dentition, London, 1925,
John Bale, Sons & Danielsson. |
| Fig 4b - Vertucci FJ 1984.Two thousand four hundred human permanent
teeth were decalcified, injected with dye, and cleared in order to determine the number of root canals and their
different morphology, the ramifications of the main root canals, the location of apical foramena and transverse
anastomoses, and the frequency of apical deltas |
| Table I and II derived from Antibiotics and the Treatment of
Endodontic Infections Summer 2006 American Association of Endodontics Colleagues for Excellence |
| Figs 5a, 5b Flat field sensors provide a sense of the extent of
osseous pathology; however, the periapical radiographic image corresponds to a two-dimensional aspect of a three
dimensional structure. Periapical lesions confined within the cancellous bone are usually not detected.
Thus a lesion of a certain size can be detected in a region covered by a thin cortex, whereas the same size lesion
cannot be detected in a region covered by thicker cortex |
| Fig 6 All cone beam tomography units provide correlated axial,
coronal and sagittal multiplanar volume reformations. Basic enhancements include zoom or magnification and visual
adjustments to narrow the range of grey-scale, in addition to the capability to add annotation and cursor-driven
measurement. |
| Fig 7 Strategic extension of the access perimeter is too often
undervalued in terms of successful endodontic treatment outcomes. The shape of the chamber must be regressed to
its native state to ensure that axial interference is negated as an instrument traverses the length of the root
canal space. |
| Fig 8a Dystrophic calcification confounds even the most experienced
clinician. The key to identification of the orifices is to regress the inner space using the continuum, cusp tip,
pulp horn, canal orifice. In lieu of an ultrasonic tip which tends to chop the stone and scatter debris, gross removal
is best done with a diamond bur in a high speed handpiece. The fine removal of residue can be done with a multi-fluted
carbide bur to trace the fusion lines |
| Fig 8b Keeping the chamber wet with alcohol improves optics and
highlights colour differential. The most important tool for orifice identification in addition to dyes is a micro-etcher.
The satin finish produced highlights the disparity between the natural tooth structure of the floor and the secondary and
tertiary dentin of the calcified orifice. |
| Fig 9 Micro-etching ensures the removal of oils and debris as well as
eliminating the residue in fusion lines and fissures. Routine dentin bonding is then performed. The composite chosen
in this instance is Permaflo® Purple (UPI, South Jordan, UT) which enables differentiation of restoration and tooth
structure should re-entry be necessary. |
| Fig 10 A vast array of equipment exists in the marketplace to optimize
irrigation protocols. Radical change may well be in the offing, however, R&D on bio-active obturating materials may prove
to be the defining variable in total asepsis. |
| Fig 11 Numerous investigators have shown that the concept of keeping
the apical foramen foramen as small as practical does not mean a size 20 or 25 file. This Schilderian concept should
read as small as the apical morphology permits in order to ensure that the free flow of irrigant to the apical terminus
enables more definitive cleaning of the apical segment of the root canal space. |
| Fig 12 The artist/clinician recognizes that negative space surrounding
an object is equally important as the object itself. In the case of root canal therapy, the positive space is alterable,
but must be created in balance with the encompassing negative space to ensure morphologic integrity. |
Contd....Page 3
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