Sharing Passion for Fixing Teeth With Endo
We recently finished up this 3 rooted premolar. I considered using amalgam on this one due to the caries rate. Also considered deeper Markley wires. However, since the furcal floor was 3-4 mm below the bone level, I opted for a larger fiber post.
The porcelain crown attempted to correct the spacing caused by a peg lateral and as such the center of the canal was located pretty far distal to the crown. Using the imaging to guide the therapy (Image Guided Therapy or IGT) the access was planned for this particular tooth extending through the incisal edge along the long axis of the tooth. A thin fiber place was placed. The tooth was left in CaOH until there was evidence of radiographic healing.
The patient presented with pain on the distal abutment of the bridge. Clinical examination revealed caries and that the bridge was loose on the mesial abutment. The patient wasn’t interested in implant therapy due to a prior bad experience and chose to have the bridge remade. The premolar was retreated (Thermafill carrier removed with hedstroms) and the molar treated endodontically. Due to the wide short chamber present on the molar we chose to make a dual access leaving a dentin truss for support. The premolar was restored with a fiber post for rehabilitation purposes. We opted to use custom resin matrices for restorative purposes. The 1 year followup shows a good fitting bridge, and a functional asymptomatic restoration.
Some daily work. An example of image guided access and root-form appropriate instrumentation.
We opaqued the silver to achieve an esthetic access closure.
One year followup. Pretty typical instrumentation for a maxillary molar.
-Trudeau
Kind of rare to see these wide open canals on a 60 year old. The patient initially presented with buccal probings to the apex on this second molar. I used some pre-bent 10 and 15 files on the distal, mesial lingual, and mesiobuccal canals. I used a 7.04 rotary file on the mid-mesial canal. Instrumenting large canals takes a little more time. Continuous taper shaping of these canals would have likely perforated it coronally. So for these large canals, this is root-form appropriate instrumentation of the internal aspect of the root. Looks like there were 3 POE’s on the MB root. The lateral canal evident on the postop may have contributed to the furcal blowout.
-Trudeau
Measurements had it it over 12mm preoperatively.
-Trudeau
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