This is the type of case that I would like to have day-in and day-out as is a straightforward ‘virgin’ endodontic case that can be treated in a single visit. With Niti. alloy, curvatures such as this MB root are no problem.
Another ‘routine’ lower molar case with 4 canals (2 distals).
Removal of Canal Blockages
Of course, as an endodontist, nothing in life is that simple and we often have to retrieve an impending disaster by re-negotiating blocked root canals, especially those with separated instruments!
……..…If you can see it……you can get it!!...........
And of course dismantling old post-retained cores can be fun!
And the majority of my work is of course rectifying previous endodontic treatments that have not worked for various reasons,
and, usually I have to treat them over more than one appointment to settle the infection, such as this failed Thermafil case:
With the introduction of Mineral Trioxide Aggregate (MTA), we have one of the most biocompatible materials at our disposal. This has revolutionised the treatment of immature or open-apex cases:
This young lady had an extensively carious lower premolar that had died before complete root maturation. Thus, over 2 visits, application of orthograde MTA to internally ‘apexify’ the root end provided an immediate barrier against which g.p. obturation could be performed. Unusual Cases
And of course, to make the endodontist’s life interesting, there’s always a few odd cases thrown in!
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Where? identify the tooth concerned, does it radiate to other sites
What? Is there anything that triggers or exacerbates the pain
How? How does it start, instantly, growing to a peak
If it is 'pulpitic' and lingers or is spontaneous, or triggered by heat, then an irreversible pulpitis is likely.
Rx: Perform a coronal pulpotomy and dress with a sedative pulp dressing (e.g. Ledermix or Ca(OH)2. Relieve the bite off the tooth, and advise a suitable anti-inflammatory/painkiller, based on the patient's medical history.
Check the associated teeth for pulp death. If localised and fluctuant, suggesting a dentoalveoler abscess.
Rx: If possible obtain drainage through the tooth by endodontic access. Leave open for 24 hours, then root-treat and dress with Ca(OH)2 until symptoms have settled, prior to final obturation. Relieve the occlusion on the tooth concerned
- If a swelling then treat as above.
- If acute pain and no swelling, Prescribe an NSAIDs (or suitable alternative if patient's medical history contraindicates this type of pain relief)
- If a swelling, then treat as above
- If acute pain, relieve the occlusion off the root-filled tooth, and prescribe appropriate painkillers (as above)
- If acute symptoms persist, and you have exhausted all the other treatment approaches, then prescribe antibiotics (unless other medical contraindications/interactions)
a. 200mg Metronidazole 1 t.d.s. for 5 days (tell patient to avoid alcohol)
b. 150mg Clindamycin 1 q.d.s. for 5 days (tell patient to stop immediately if they experience any gastric/intestinal irritation/diarrhoea, and contact their medical doctor and yourself)
- NSAIDs or suitable alternative painkillers if medical contraindications
- Warm salt water mouth rinses in the area of the surgery
- If swelling, then 200mg Metronidazole tablets, 1 t.d.s. for 5 days
ANY CONCERNS THEN REFER TO YOUR LOCAL SPECIALIST ENDODONTIST
Once the root-filling has been placed in the tooth, the tooth will normally be left with at least a secure cement base to seal the canal orifices and gutta percha.
Upon request or if the Endodontist feels that it will secure the immediate coronal seal of the tooth, a core-build-up will be provided for a small extra fee.
Upon request, post-preparations within the canals can also be provided.
We recommend that posterior teeth that have lost one or both marginal ridges be restored with an indirect onlay or crown. In smaller access cavities, an adhesive material (resin-modified glass ionomer, or resin-composite) are recommended for the core/seal. Please do not hesitate to contact us for any assistance or advice.
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