endodoncia

Vertical Root Fracture

casos, Endodontics, odontología Pablo Salmeron

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.

There are three factors that determine the distribution and direction of forces, a) the anatomy of the root canal, b) the anatomy of the root, c) the thickness of the dentin. The canal anatomy seems to be the most important factor determining the distribution of forces.

The vertical fractures most often occur in premolars, both maxillary and mandibular, followed by fractures on the mesial root of mandibular molars and central incisors.

One of the biggest problems we find in cases of vertical fractures is that they aren’t easy to diagnose. Most symptoms usually appear years after the fracture. We may well find, sensitivity to percussion and vertical palpation, presence of fistula, or a large and isolated periodontal pocket that doesn’t correspond to a general periodontitis. Radiologically we can observe a radiolucent area with horizontal bone loss along the affected root.

fractura verticalDiagnosis 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.

PhD. MSc. Dr. Pablo Salmeron.

The importance of an accessory screen in endodontics

casos, endodoncia, odontología, Reflexiones Pablo Salmeron

20150924_161013_resized In this post I would like to talk about why an accessory screen, as much bigger the better, is very important for me on a root canal treatment.

Documentation: An accessory screen allows you to take better photos and videos. One disadvantage of microscopes that do not have built in cameras and need an accessory camera is the difficulty of “pairing” what you see through the eyepieces and what your camera captures through the beam splitter. That image you want to capture and document, should be the same focused image through your eyes and through the camera, but requires a perfect configuration thereof, and the correct setting of the diopter correction of the eyepieces. The camera captures the image of one eye, either the right or left depending in which side of the microscope the camera is. When we look through the microscope we have stereoscopic vision, we see with both eyes at the same time, and is our brain with his own corrections who made a sharp image in the end. The problem here is that without that perfect “pairing” between camera, eyepieces, eyes and brain if we need to document the most tiny detail, that is only focused in one particular millimeter depth of field, we may find that the image of the detail that we wanted to document is not focused at all.

One of the options is trying to focus through the LCD of the camera, the problem is that the size of the LCD is small and usually is in a position that is not comfortable to focus through it.
For me the solution was to connect the microscope to a 55″ screen that I have in front of me. Through that screen it is very easy to document every detail and get good quality photos and videos with the details that I want to show totally focused.

Assistants: Working with a large screen allows my assistant see what I see so she can help me better. Your assistants are part of the treatment, involve them and show what you see motivates them to work. Another advantage is that they can avoid look directly to the work field for more time. This prevents from suffering headaches and vision problems as the light source of the microscope is very bright and brings all these problems after a long work session.

Education: A large screen allow me to teach and train other dentists who want to learn about endodontics.

These are the three reasons why I love working with a large accessory screen.

PhD. MSc. Dr. Pablo Salmeron.

A second palatal canal or a centred MB2?

casos, endodoncia, odontología Pablo Salmeron

Successful root canal therapy requires an excellent knowledge of both the external and internal anatomy of root and its canal morphology. Extra roots or root canals, if not detected, are a major reason for endodontic failure. Maxillary molars show considerable anatomic variation and abnormalities with respect to the number of roots and root canals. Traditionally, the maxillary second molar has been described to have 3 roots with 3 or 4 root canals, with the fourth canal commonly being found in the mesiobuccal root (MB2). Several authors have reported of maxillary second molars presenting with 4 roots with the accessory root being the second palatal.

In this case, an upper second molar, I found a 4th canal in an unsual location.

A second palatal canal or a centered MB2? Watch it in HD 1080p.

YouTube player

– Second upper molar with an unusual 4th canal.

– Labomed microscope.

– MTwo + Reciproc files.

PhD. MSc. Dr. Pablo Salmeron.