Houston Dentistry Volume 5 Issue 1 - Page 12

SMILES in the SPOTLIGHT

LEADERS IN HOUSTON DENTISTRY CREATING UNFORGETTABLE SMILES
Enhanced visualization is critical to a successful outcome , especially in retreatment and surgical procedures . The surgical operating microscope greatly enhances magnification and illumination of the operating field . It allows the clinician to observe in detail the anatomy of the pulp chamber , locate canals , remove previously placed dental materials and detect micro fractures . With the help of microscopes and ultrasonic instruments , together , they both help remove foreign objects , canal obstruction , and help keep the reduction of tooth structure removal to a minimum .
With all the advancements of the endodontic armamentarium to improve treatment care , another crucial determinant of a successful outcome is case selection . Most endodontic procedures are performed by general dentist . When difficulties arise or are identified , a referral to an endodontist is the appropriate course of action . There are many factors that can increase the difficulties of endodontic treatment . The American Association of Endodontist ( AAE ) has tools to help evaluate a patient ’ s clinical condition , gauge the clinician ’ s treatment capabilities and help overcome case assessment pitfalls . These tools are available on the AAE website ( www . AAE . org ) or download EndoCase on iTunes or Google Play .
With all the advancements in the Endodontic Armamentarium and with careful case selection , a more predictable and favorable endodontic outcome is achieved .
CASE 1 : Calcified case with lateral canal - Microscope , ultrasonic , and CBCT help locate calcified canals
THE MODERN ENDODONTIC ARMAMENTARIUM by David S . Wan , DDS , MS
The modern endodontic procedure has been revolutionized exponentially in the last two decades . There have been drastic improvements from the way canals are cleaned and shaped to the way teeth are visualized radiographically and clinically . From this article , we hope to briefly go over current advancements in the endodontic armamentarium that have helped support improved care for root canal therapy .
PRE-OP Radiolucent lesion between roots
POST-OP Lateral canal was feeding lesion
The instrumentation of the canals was previously done with stainless steel files . In the 90s , a major advancement occurred in endodontic therapy . The new nickel-titanium ( NiTi ) files were introduced to the dental field . NiTi ’ s flexibility , combined with the blades cutting edge and taper design were much more superior compared to their stainless steel counterpart . The NiTi material has been improved even more in the last decade , allowing more flexibility directly related to better cleaning efficiencies , fewer procedural errors and a more successful predictable prognosis .
Digital radiography has improved drastically over the years . Reduced radiation and improved image quality are just some of the few continued advancements with digital radiography . The most recent breakthrough was implementing the use of Cone Beam Computed Tomography ( CBCT ) with endodontic therapy . Using the CBCT , in conjunction with our many technological advancements , we are able to visualize the field in question in 3D , which directly impacts the formulation of better treatment options . The CBCT aids in determining potential differential diagnosis , while properly assessing the root canal anatomy , and creating a more defined blueprint for endodontic retreatment or surgery . In some instances , CBCT can also assist in determining the location and extent of root fractures .
CASE 2 : Retreatment - New improved NiTi retreatment files help with removal of previous obturation material
PRE-OP
Failing root canal with draining sinus tract
POST-OP 1 week - sinus tract has healed
CASE 3 : CBCT taken on retreatments helps locate previously obturated canals and missed canals
Electronic apex locators continue to improve and evolve a higher accuracy of root canal length . Together , with improved digital radiographic imaging software that assist in measuring root canal length , the length of the root can be determined in a more accurate manner . Because of these two improvements , the number of radiographs taken can be greatly reduced which will decrease the amount of radiation a patient is exposed to , thus reducing treatment time .
PRE-OP Poorly obturated symptomatic # 19
Patient was asymptomatic
POST-OP
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