Fractured lower molar: Endo restorative - Courtesy ROOTS
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From: Ahmad Tehrani
Sent: Sunday, July 26, 2009 7:20 AM
Subject: [roots] Endo/Restorative
pt presented with a fractured lower premolar, cold and hot sensitivity.
#20 responded to thermal tests w/ lingering sensation lasting 2 minutes.
#19....positive response to cold, but no lingering pain.
Plan of action--> endo premolar ( IP #20) and evaluate the molar (Rev. P.)
once the crown was removed. final x-ray was taken before cementation of
provisionals - ahmad
Nice, Ahmad, and smart use of a fiber post in a vulnerable tooth. I don'’t’
crown any more of these than I have to but with this much tooth loss, you
have to do some sort of cuspal coverage even if it is a full
crown. What are you using here. Nice build up…material in build up????? - Guy
Ahmad, Thanks for posting this. I learned something from it in reference
to the wedge trick, and will try it on my next few similar cases - Mark
Ahmad, Beautiful work and documentation. - Arturo
Hi Art....thanks for the nice words - ahmad
hi ahmad, do you normally place your build ups post endo treatment?
stephan and winni showed it before and i guess handling is much easier
than placing wood sticks. but nice results as always - Dennhardt H
Hello Ahmad I feel more comfortable, when I do the restaurative before endo -
treatment. In very few cases I do the restaur. after endo because of sight
or Instrumentation Problems. If Patient is unable to open his or her mouth
wide enough etc.
Did you search for ŕ second Canal at the vest. site? At your Pictures it
seems that there might be ŕ vest. canal. I'm surely wrong but it seems so,
that the Canal you treated is more at the lingual site, than at the Center of
the tooth. So I would have expected ŕ Second one at the vest. side. - Stefan
Hi Ahmad, nice work! Yet, as Holger mentioned, it might hve been easier
placing a pre-endodontic adhesive build up BEFORE starting the endo. I think
there are a lot of advantages:
* You can evaluate the restorability ahead of time
* placing rubber dam is a lot easier in a second appointment
* there is no more fracturing of cusps or teeth during the time of the
* there are no more bugs from caries interfering with your work it's more fun
and more predictable
to work on a restored tooth rather than on a ruin
* You get more reliable reference points for working length on a build up than
on a ruin
* There is a lot less chance of leakage while the Ca(OH)2 is in The pre-endo
build up becomes part of the post-endo build up after the endo is finished
* The adhesive pre-endo build up and the adhesive seal of the orifices and
post endo build up allow to wait for the success of the endo before doing
the final restorative because there is no concern for coronal leakage
I attached a couple of pictures of a case I did for a referral a some time ago.
Hope you like it! - Winfried
Charisma or Venus Flow (color= Baseliner) give you better contrast then Tetric flow XL
- Roman Bakowicz
I like Tetric flow bleach XL because it has a radioopacity of more than 300% AL - Winfried
Winnie: I appreciate your perspective and your work has always been awesome, but frankly,
I don't like pre-endo buildups for one step cases. what I didn't show was the dycal barrier
used for the entire length of appointment during shaping and cleaning phase. The wedge holds
the dam down and dycal completely insulates the tooth from saliva leakage and NaOCl getting
in to mouth. If I have to do a second appointment I concur with you and do a temp BU before
closing the tooth.
Yes restorability is a key and as you can see I debrided the "wound" inside out to assess it.
do you remove the entire pre-endo BU at the 2nd visit before final closure of the tooth? - ahmad
Thanks Ahmad, Sorry, I missed the fact that you one-stepped it. That way it makes sense of course.
The pre-endo BU becomes part of the post-endo BU in my cases. - Winfried
Hi Winfried........This Teflon tape tip works amazingly well. I used it in 3 cases a couple
of months ago when you had first introduced this idea here on Roots - Sachin