The text provided here is for the general information of the patient, and explains in simple language how an endodontic procedure is done. Tooth number 35 was endodontically treated in a single day procedure, and Densply’s PROTAPER system was used for a single visit root canal.
Patient had a history of pain for the past 2 years which was being managed by analgesics, and she had no significant medical history. She was avoiding the dental surgeon for the reason she had dental phobia and was afraid of the pain only.
A block was administered to numb the whole quadrant accompanied by a buccal infiltration in the area of the tooth. The block was painless and helped gain the cooperation of the patient. Most of the time, blocks for lower alveolar nerve are not so much painless, but if they are, they help in establishing a very cooperative environment. We waited for 10 mins, during which a verbal contact was established, and the patient was explained about the treatment. Since the patient was guarded about the treatment plan, she started opening up after the painless Local Anesthesia administration and she was more attentive than before, hence the treatment procedure was explained to the patient in detail.
An opening was made, which resulted in loss of the crown structure almost upto 60%. All the black lesion along with the brown lesion was removed until a clean white tooth was reached. An efficient coronal access was achieved and the canal was accessed with a #10 H-file, to check the patency of the canal. The sequence of protapr files was used along with EDTA as lubricant. 5% Sodium Hypochloride was used as an intra-canal irrigant, in between each file sequence.
After the preparation was done, endomethasone was used as a canal sealer and the protaper file of the last used file was used. Single cone obturation was done and the tip of the GP was melted until the opening of the canal level. A permanent GIC (Glass Ionomer Cement) core built-up was done, and followed by a permanent PFM crown.
Since the tooth was single rooted, and there was no active purulent discharge from the canal, it was preferred to do an endodontic treatment in the same appointment. The patient was already on antibiotics for almost one month. After the endodontic treatment, patient was recalled after a week and the tooth was evaluated for signs and symptoms of pain and infection, which were negative. Final prosthesis was loaded after 2 weeks time.
What are your thoughts of the radiolucency still present on the distal of 35? It appears to be residual caries or perhaps it is an open margin left after the final restoration was completed. Also regarding 36+37, the crowns seem overcountoured and bulbous creating areas of overhanging margins which would be difficult to clean by the patient. Thoughts?
ReplyDeleteyou would be surprised to know, that the mesial and distal margins were shorter than the preparation, and they must have been replaced, which i told the patient and she was not interested in replacing them.
ReplyDeleteabout 35, yes, it was an open margin, i had to refill it again after 2 weeks, before proceeding to the final prosthesis.