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.
Today’s case is a 11 year old patient with a big caries on the second maxillary molar referred to me to save the tooth. My duty as endodontist is not only providing root canal treatments but also preserving teeth from them too.
In this particularly case I performed a pulp horn amputation.
These are the steps taken:
– Rubber dam isolation.
– Microscope magnification.
– Manual removal of the soft dentin with excavator.
– Pulp horn amputation.
– Disinfected and rinsed with NaOCl from “outside” to achieve haemostasis.
– Dried with sterile cotton pellets.
– Bioceramic capping.
– Direct glass ionomer as temporally filling on top.
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.
Last month I gave a lecture at The 9th Palestinian International Dental Conference. I have to start this post thanking particularly to the BAIRD Academy and the Palestine Dentistry Society for inviting me to the congress and make me feel like I was at home. I want to thank especially Dr. Hassan Maghaireh, Dr. Raed Junaidy, Dr. Anan Amro, and Dr. Ahmad Abd El-Ghani for all their help and for showing me the most beautiful areas of Jordan, Palestine and Jerusalem.
The topic I covered was about Magnification, Cumulative Trauma Disorders (CTDs), Ergonomics and 4 Handed Workflow. For me, all those 4 concepts, are intimately related.
Our manual capacity is limited by our own eyes. It’s because of that why we can not be more precise, simple as that. To be able to see fine details, we have to bring the object closer to the eye. This is why dentists have to bend down over the patient’s mouth, and this is why dentist have back problems.
The use of magnification is the way to overcome our eye’s limitations. This will also make us work in a neutral and healthy position resulting in long lasting professional career.
4 handed work flow is the master piece which completes the ergonomic puzzle. Here you have a couple of videos where I show basic movements which you can start using till you develope your own technique. The first video has been recorded in 30 minutes with an assistant with no previous experience at all; and the second one with a new assistant after one month training. Watch in HD.
“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.” Mark Twain.