Re root canal treatment upper second molar
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
– Microscope
– K-Files #10 #15 #20
– Wave One Gold
– Bioceramics + System B.
“Never give up, because when you think it’s all over, is the moment where everything starts.” — Jim Morrison.
PhD. MSc. Dr. Pablo Salmeron.
B.
Our manual capacity is limited by our own eyes. It’s because of that why we cannot 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.
In this post I’m going to talk about vertical fractures regarding a case I had a few months ago, the one on the right picture. This maxillary first premolar was ready to get a root canal therapy but presented a mesiodistally vertical coronal fracture that continued to the furca which divided the tooth in two roots, bucal and palatal. The tooth had an old restoration on the distal side that was not in occlusion and that probably let the fracture appear on the mesial area where you can see the line fracture. The tooth was also sensitive to vertical percussion and had some mobility, however, there wasn’t significant evidence or bone loss on the radiographic tests.
Most of the vertical fractures are due to excessive concentration of loading over some areas of the root canal. Studies have shown that the curvature of the root canal seems more important than the external morphology of the root, in terms of stress concentration, the remaining thin dentin increases the magnitude but not the direction of the stress generated by forces. In fact as thinner the mesiodistal dentin walls are, the concentration of forces on the lingual and bucal walls increase the risk of fracture in this direction contrary to what one might think at first, more dentin thickness the harder it is to break in that direction, well… it is not like that.
Diagnosis vertical fractures are a challenge for the dentist because the symptoms are similar to a failed root canal treatment and usually radiographic test doesn’t show evidence of a fracture clearly. Another problem in endodontically treated teeth is often the filling materials doesn’t allow us to see the fracture line on the radiograph as they’re in the same plane. Patients may experience anxiety to thinking that the endodontic treatment is not working when, in fact, the problem is a fracture prior or post to the root canal treatment.
Discipline is any training intended to produce a specific character or pattern of behaviour. Discipline is nothing but point a goal and achieve it through a protocol, discipline is consistency, discipline is hit the stone always in the same place, always with a good guidance of course.