Tuesday, April 22, 2008

Upcoming Inner Space Seminar

Our mission statement says, “…we are unconditionally committed to excellence in all we do, we are the endodontic leaders and teachers in our community.” In order to promote the specialty of endodontics and help all dentists perform the highest quality endodontic procedures, we have developed a seminar series entitled, "Inner Space Seminars".

Our upcoming seminar will be held on Thursday, May 8th, 2008. Please call or email to register.

Monday, April 14, 2008

Intentional Replantation

Replantation of an avulsed tooth is a well known and accepted treatment following a traumatic dental injury. Preservation of vital cells in the periodontal ligament allow reattachment of the tooth in the alveolar socket. Rates of success at 5 years reported in the literature ranges between 70% - 91% (1).

The main factors limiting the success of this treatment are the amount of time the tooth is out of the mouth, disruption of the periodontal ligament and bacterial contamination.

Although not common or well known, intentional removal and replantation of a tooth is an effective mode of treatment for teeth that cannot be treated with traditional endodontic surgery. This strategy can be particularly helpful in lower second molars where proximity to the mandibular nerve and thickness of the buccal bone make endodontic surgery difficult.

Intentional replantation allows the clinician to control the variables that would limit the success of a replantation following traumatic avulsion. Atraumatic extraction, minimal time out of the mouth and aseptic technique, allow a clinician to perform apical procedures that otherwise could not be performed.

Again, while not commonplace, intentional replantation is a treatment option that can be considered in special cases. It may offer your patient a final opportunity to retain a natural tooth, when endodontic surgery is not an option.

This case was actually an UNintentional, intentional replantation. Let me explain. This patient presented to our office with a bridge from #27 to #29. Significant buccal decay was present. The general dentist and the patient wanted to try and maintain this bridge.

Her dentist placed an amalgam root surface filling under the buccal margin of the bridge. A distal periapical radiolucency developed. I was then asked to complete the RCT on the tooth. Since the anterior abutment was loose, we decided that to remove the bridge, complete the endodontic treatment, and retrofit a post and core back to the bridge. Hardly an ideal restorative solution, but a solution that worked for the patient in her particular circumstance.

While attempting to remove the bridge, the entire tooth came out. At this point, this became an intentional replantation case.

Within a matter of minutes, we did a retroprep and MTA retrofill.

The anterior abutment of the bridge was then permanently cemented on and the posterior abutment replanted into the socket.

This patient returned last week for a 3 month re-evaluation. The tooth was sensitive for a while, but she now reports no sensitivity or swelling and she can now chew nuts on that side!
If you look closely you can see that the distal lesion has healed. While this is a very short term result, the healing of the apical lesion, lack of symptoms would indicate initial success. We will continue to monitor this tooth over time. Look forward to updates!


Tuesday, April 1, 2008

Gates Glidden Drills

I know that all the manufacturers are encouraging you to shape the canal oriface with their special oriface shaping files, but I still like to use the gates glidden drills to open the upper third of the root canal system.

Quick research this morning indicates a gates glidden drill costs me $3.12 and a NiTi rotary instrument costs me $7.15 (taking into account the endodontist's bulk discount).

Call me "old fashioned" but why anyone would want to pay twice as much for an instrument that takes twice as long to do the same job is beyond me. The gates is non-end cutting and also improves the direct line access into the canal, which will help prevent separation of your rotary files. The shaft of the gates is somewhat flexible and usually, if there is a separation, it will separate high on the shaft and is easily removed with a pair of cotton pliers.

If I had to guess, I would guess that nineteen out of twenty times a gates glidden drill breaks, it breaks high on the shaft. That being said, here is a case where the gates separated in the mid-shank area. When this occurs, it just the same as if a rotary file separates. It can be just as difficult and time consuming.

Pre-Op #19

Gates Glidden #3 separated in MB canal.

Technique for removal is the same as with a rotary instrument. Visualize it, ultrasonic instrumentation around the instrument until it loosens, and retrieve.

All said, I would much rather use a gates glidden to open the upper third of the canal for all the reasons described above. Can anyone give me a better reason to use a rotary file to do the same thing?