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Lateral incisor::Dr.Kossev's method of MTA filling - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are -
From: Valeri Stefanov
Sent: Saturday, June 12, 2010 7:54 PM
Subject: [roots] Re: [roots] after Marga´s lecture I want more and more and more...

Javier, Marga already wrote about conventional/classic treatment for a case like yours.

Let me give you an alternative approach which is easier to perform and not so technically 
sensistive while having the same predictability and chances for success.

One would fill the canal and area of resorption inside it at one and  the same time
by using bioceramic sealer - iRootSP. It is much more easier to do compared to filling 
with MTA Marga's way. You can fill totally the canal also with MTA using
Dr.Kossev's method. The difference is that with pure bioceramic it can be done much 
more easily and for shorter time. With this method there is no need for wet cotton pellet 
to be left over the material.

Afterwards wait for at least 24 or preferably 48 hours. On next visit drill out bioceramics 
with long neck round diamond bur up to the end of resorption deffect. Take care not to remove 
a sound dentin from the walls.Then etch with the liquid of phosphate cement the walls of the 
"hole" you have created for at least one minute. Rinse with water and then prime and
bond the routine way. Then pack the canal "hole" with very strong fiber re-inforced composite
Nulite F (see attached files ) placing it in small portions and light curing each portion 
before adding a new one. Packing the canal and making a core/build up is done at the same time 
- i.e. you make something similar to cast metal core, but this is done "ex tempore" with
very strong composite in one visit. ( see the photo of lateral incisor I have done although 
I have not got that deep into the canal )

Finally take impression and make a crown or send the patient to a GP/prosthodontist to make it.

I am using Nulite F since 2004 with great success in similar cases where canal diameter is 
very big and also for posterior MOD fillings. If you want additional re-inforcement you can 
use fiber glass or polyalken tape instead of big size FG root post. This will give you more 
even distribution of stress under load compared to using stiffer fiber post instead.

My 2 cents. - Valeri Stefanov

3096 Fatigue failure of teeth restored with composite resin post/cores
C. DOTCHIN, Otago University, Dunedin, New Zealand, and J. HOOD, Otago University, Dunedin,
New Zealand Impact fracture has frequently been used to study the failure of various post/core 
restoration supporting cast metal crowns. An alternative clinical failure mode is by fatigue. 
Objectives: The advent of high modulus, high fracture toughness fibre composites (Nulite F, 
SDI Australia) raises the question whether these materials alone could be used for post/cores 
supporting crowns. This study seeks to answer this.

Methods: Sixteen central  incisors were decoronated and root canals opened to 1.5mm. 
Cast metal post/cores and cast crowns were prepared  for eight teeth. Post/cores and crowns 
were cemented with zinc phosphate cement (Shofu Hy Bond). Root canals of  the remainder were 
treated with 3M Single-Bond and packed with Nulite-F composite to form post and core.  
Metal crowns were then fabricated and cemented. Strain gauges were cemented across the 
tooth-crown junction on  the palatal and connected to an electronic strain gauge digital 
read-out. Teeth were supported in resin 30 degrees to the horizontal and loaded at 
37cycles/minute under 100 N force until failure or a maximum of 300,000 cycles.

Results: The mean cycles to failure for crowns with cast metal post/cores was 57047 ± 19381. 
No crowns with composite cores failed by the "cut off" point of 300,000 cycles. A t-test gave
a probability of p=0.0000.

Conclusion: This technique provides a simple, but time consuming method for the study of the 
failure of crowns with varying modes of support, under fatigue loading.
Seq #334 - Restoration of Endodontically Treated Teeth
10:15 AM-11:30 AM, Saturday, 13 March 2004 Hawaii Convention Center Exhibit Hall 1-2
Back to the Prosthodontics Research Program Back to the IADR/AADR/CADR 82nd General Session 
(March 10-13, 2004)

Comparison study of two posterior composites  in endodonticaly treated maxillary premolar with
mesio-ocluso- distal cavity before and after mounting in an artificial mouth

* k Amiri, F Zakavi, T Omidi pour, Z Jalali
SMJ 2009; 8(1):23-23
ICID: 889423 Article type: Original article IC Value: 4.81

Objective: There are many restorative designs for root canal treated maxillary premolars that 
each of which have their own advantages and disadvantages. One of this treatments is composite 
inlay restoration with fiber-reinforced composite which has sufficient retention, strength and 
acceptable apearence,as well as more compatibibility and less leakage than cast-metal restoration.

Material sand Methods: In this -experimental study, after calculating a sample groups, 72 sound 
maxillary premolar teeth with the same size were chosen and fixed in acrylic resin so that the 
CEJ was 2 mm upper than the level of resin . the sample were randomly divided in to six groups of 12 .

Group 1(positive control) : intact teeth. Group 2 (negative control): root canal treated with 
MOD cavity preparation that had been extended 1 mm below CEJ . Group 3 and 4:root canal treated 
teeth with MOD cavity preparation for fiber- reinforced (Nulite F) composite inlay using Nulite 
F2 liner . Group 5 and 6: these groups were prepared in the same way as groups 3 and 4, differing 
in that , this specimens were restored by 3MP60 composite instead of Nulite F . Following restoration , 
all specimens was termocycled 500 times. Specimens of groups 1,2,3,5 were loaded by the universal 
testing machine (Zwick z020,Germany) at speed of 0.5 mm/min. specimens in groups 4& 6 onset were
loaded by artificial mouth 1000,000 times then loaded by universal testing machine . 
Finally the results was analyzed using ANOVA test and comparison multiple tests.
Results: average fracture resistance for first group was 2.091 killo nioton,(kn) second group
was 0.862kn, third group was 1.577 kn, fourth group was 1.431 kn , fifth group was 1.296 kn and 
sixth group was 1.170 kn. According to data analysis the deference between first and secovd groups 
to other groups was significant. Fracture resistance of 3th group with 5 &6 groups and 4 th group
with 6 group have significant deference.

Conclusion: because of increasing of the fracture resistance in endodontically treated teeth that 
restorated with fiber-reinforced composite (Nulite F) and their significant diference in comparison 
with conventional posterior composite (3MP60) as well as their other properties , can say that
we can use fiber reinforced composite as an acceptable method for reconstruction of endodontically 
treated maxillary pre molar.
Protaper flaring
6 yr old Empress
Cvek pulpotomy
Middle mesial
Endo misdiagnosis
MTA retrofill
Resin core
BW importance
Bicuspid tooth

Necrotic #8 treatment
Finding MB2 / MB3
Deep in a canal
Broken file retrieval
Molar cases
Pushed over apex
MB2 and palatal canal
Long lower third
Veneer cases
CT Implant surgury

Weird Anatomy
Apical trifurcation
Canal and Ultrasonics
Cotton stuffed chamber
Pulp floor sandblasting
Silver point removal
Difficult acute curve
Marked swelling
5 canaled premolar

Sealer overextension
Complex anatomy
Secondary caries
Zygomatic arch
Confluent mesials
LL 1st molar (#19)
Shaping vs Cleaning
First bicuspid
In Vivo mesial view
Inaccesible canals

Premolar 45
Ortho and implant
Lateral incisor
Churning irrigant
Cold lateral
Tipped to lingual
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Middle distal canal
Silver point
Crown preparation
Epiphany healing
Weird anatomy
Dual Xenon
Looking for MB2
Upper molar resorption
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Finding MB2

Gingival inflammation
Irreversible pulpitis
AG BU ortho band
TF Files
using TF files
Broken bur
Warm technique
Restorative prognosis
Tooth # 20 and #30

Apical third
3 canal premolar
Severe curvature
Interesting anatomy
Chamber floor
Zirconia crown
Dycal matrix
Cracked tooth
Tooth structure loss
Multiplanar curves