The case I’m showing you today was referred to me for a re-treatment, as you can observe in the picture, there was a broken file on the distal canal with a big apical periodontitis. The treatment was planned to be done in two appointments. In the first one I removed the broken file, and placed calcium hydroxide for 25 days; In the second appointment the tooth was symptomless and I completed the treatment.
After 4 months the patient came for a review and the PA showed new bone formation, so the infection was healing.
I usually like to finish the treatments in a single appointment but is not a rule, time management has to be consider as another variable in root canals treatments and sometimes, is better to do it in two appointments and some others we need even three appointments.
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time.
In this post I’m going to talk about how important is to work ergonomically in dentistry and endodontics.
I like to think that modern dentistry is about details, patients nowadays are more conscious about the differences between good and bad jobs, Internet (Facebook, Youtube, Blogs…) has resulted in a great tool that has impacted on dentistry significally giving the oportunity to patients to check and investigate the perfomance of dentists before attending their practices. Patients not only research and compare differents jobs, they tend to discard all those professionals with no history on internet or those afraid to show their work fearing to be compare to other colleagues. Today, if you don’t show your work, you don’t exist.
I don’t want to deviate my topic “4 handed dentistry” whit that short reflextion. Dentistry is about details and there is only one way where we’ll be able to work on it, we need to bring the object we are working with closer, that means MAGNIFICATION. “Traditional” magnification is to bend our back over the patient 90 degrees. Our eyes have some limitations to focus objects to a certain distance, more closer doesn’t mean that we see things bigger. So to be able to work on details we need to see things bigger, and there is only two solutions: 1) the use of loupes or, even better, 2) the surgical microscope. I’m not going to talk about the differences between loupes and microscopes because again that’s another topic, “Microscope is better of course :D”.
Going back to the topic, what I want to talk about is about 4 handed dentistry which, if you are able to implement little by little training your assistant, your work will radically change, letting you be more focused and relaxed doing your job, meaning, better treatments and happy patients.
So the first question we should ask ourselves is, ¿Do we need as a dentist any instrument in our side? no we don’t or at least as minimum as possible. A surgeon in an operating theatre never picks up his own instruments, the nurse do it for him, I do microsurgeries and I like to be as focused as possible on my operating field.
With the next two videos I want to show you, in a very basic way, how to pass instruments with your assistant and how you can work after some training. There is more than one technique and the location of your instruments and nurse will vary depending on your surgery setup. I hope you start and benefit implementing 4 handed dentistry in your practice.
Make it a point to do something every day that you don’t want to do. This is the golden rule for acquiring the habit of doing your duty without pain.
In this case, I found a pulp stone inside of a mandibular second molar. Dental pulp tissue can form dentin or osteodentin in the reaction to the homeostasis induced either by surgical or chemical stimulation, and the activity of pulp cells regulates the calcification of pulp tissue.
Pulp stones are calcified bodies in the dental pulps of the teeth, which can be seen in the pulps of healthy, diseased, and even un-erupted teeth in the primary and permanent dentition. Dental pulp stones may be free, attached, or embedded in the coronal or radicular pulp. They are considerably more common in the pulp chamber than in the root canal and may occur in a single tooth or several teeth.
Although pulp stones have no clinical significance, they lead to complications when endodontic therapy is needed.
As you can see in the video, their large size in pulp chamber may block access to canal orifices and alter the internal anatomy, and attached stones may deflect or engage the tip of exploring instruments, preventing their easy passage down the canal. In this kind of situation the use of the surgicalmicroscope is mandatory.
One of the most important things in Endodontics is planification, for that, we need to have an excellent knowledge of the pulp chamber anatomy as well as the different variants in configurations of the root canal system anatomy. Nowadays, and according to the American Association of Endodontists, the use of the CBCT is a standard in our field. This tool, allow us to see the tooth in a 3D model, and check the anatomy from every angle.
On the next case, I completed a root canal treatment in a second maxillary molar, almost the last tooth! the complexity of the case was the minimal mouth aperture of the patient and the tricky root canal anatomy with this 4 canals. Planning the cases before, allow me to do the treatments in a shorter and safer way.
This is a re-treatment of an upper second molar #27 through an Emax crown . These kinds of treatments are difficult. However, sometimes they can be easy, and other times they can be impossible. The re-treatment of the tooth depends a lot on the work carried out by the previous dentist therefore, I endeavour to be honest with my patients, as sometimes I am not able to fix everything.
In the following case I had to re-treat a tooth filled with Thermafil. Although Thermafil is a great system and works very well in the hands of some endodontist, it doesn’t work for me. I feel that I can’t control the obturation in 3D and the plastic carrier can be easily exposed without guttapercha around.
For that reason, I feel much more comfortable and secure using vertical condensation with System B, it requires maybe more training under the microscope but is worth it and works really well for me.
– Tooth #27
– K-Files #10 #15 #20
– Wave One Gold
– Bioceramics + System B
Dr. Pablo Salmeron.
“Never give up, because when you think it’s all over, is the moment where everything starts.” — Jim Morrison.