From: Ahmad Tehrani
To: ROOTS
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 à second Canal at the vest. site? At your Pictures it seems that there might be à 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 à 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 intermediate dressing
* 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

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