Restorative Dentistry & Endodontics

Endodontic treatment of Geminated Canine

2012-09-15T00:28:00.001-07:00

An unusual presentation of a Canine (13) with periapical pathology showing an extra tooth structure on the mesial side.

On closer inspection, the pulp chambers seem connected. Since there is no missing tooth in the area, it looks like a case of Gemination.

After access opening, length determination of primary root is carried out.

Attempt is made to negotiate the additional root canal but the double curvature does not yield. The tooth is unlikely to heal unless the additional root is endontically treated or resected.

Surgical intervention is planned. A flap is raised and the additional root resected. The resulting perforation is sealed off with GIC.

Master cone placed.

Post Obturation radiograph.

The bony defect is expected to fill up in time.

To be reviewed in 3 & 6 months.....

On the MB2 trail

2012-05-28T09:47:00.000-07:00

A carious exposed 16 requiring Endodontic treatment.

Initial working length determination using hand files.

Closer inspection of pulpal floor reveals another Mesiobuccal orifice. A faint canal can also be seen on radiograph.

The incidence of MB2 canal in Maxillary Ist & 2nd Molars is quite high and time should be devoted to to its location and treatment.

Both MB canals have been located. It exibits a Type III canal anatomy.

Post obturation radiograph .Protaper rotary files were used for canal preparation.

Post obturation radiograph taken from another angle to see better separation of canals.

Wrong turn !

2012-05-01T09:08:00.000-07:00

A patient reports with symptoms of pulpitis and apical periodontitis in 47. The tooth has a # filling.

An obstruction is encountered in the apical third of distal canal.

A precurved file and tactile feeling help negotiate a sharp distal bend in the apical third.

The distal canal is prepared by hand filing in the apical third and Protaper rotary in coronal and middle third.

Mesial root has a Type II canal anatomy and is prepared with Protaper rotary files.

After final Obturation using 6% G.P.as master cone and lateral condensation technique.

Pegged for Crown

2012-04-24T11:18:00.000-07:00

A 26 yr. old girl is unhappy with the dark shadows in between her front teeth. She wants crowns on her peg laterals to fill up the gaps.

Minor preps are done on her laterals and impressions are sent for fabrication of 3M Lava crowns.

3M Lava crowns on dental cast.

Crown after cementation with resin cement.

Final appearance after crown cementation.

Midline diastema closure is planned for Composite build-up.

2011-03-20T07:31:00.000-07:00

Ceramic veneers

34 year old Female presents with generalized fluorosis and multiple restorations in posterior teeth. tooth # 35 is RC treated with a "gold" crown.

Patient wants 'caps on all teeth' to change her look. She also complains of sensitivity particularly in back teeth.

Clinical Assessment:

1. Fluorosis (Yellow- brown teeth).
2. Mild Attrition.
3. Inverse smile line.
4. Multiple restorations in Posterior teeth.
5. Sensitivity.

Treatment Plan:

1. Intentional RCT for posterior teeth and Lower Incisors followed by PFM Crowns.
2. Ceramic Veneers for Upper Anteriors.

PFM Crowns have been placed on 3 quadrants and crown preps can be seen in the first quadrant. The Crowns were placed one quadrant at a time.

The Lower anteriors have been prepared.

Occlusal view of Lower Anteriors after crown preparation.

After placement of Lower temporaries.

The Lower PFM Crowns.

Upper Veneer preparation has been done.

Upper anteriors with gingival cord in place to refine margins and before taking impressions.Lower PFM crowns have been cemented.

Upper temps in place.

E max veneers have been cemented.

The final visibility and smile line.

2010-02-24T12:02:00.001-08:00

DIRECT COMPOSITE VENEERS

23 yr./M with fluorosis further compounded by gutkha stains. The stains are intrinsic in nature.

Preparation of 11 & 21 for veneering. All teeth from 13 to 23 were prepared in a similar fashion.

13 to 23 with direct composite veneers in place.

2010-02-24T11:20:00.001-08:00

ANTERIOR COMPOSITES

35 yr./M with deep abrasion/erosion lesion on 11. 21 is also affected.

a layer of Dycal followed by GIC has been applied.

The surface is etched.

Bonding agent is applied and cured.

after completion of final restoration. 21 has also been restored.

# 11 & 21. teeth respond normally to vitality testing.

After restoration with composites.

2010-02-24T11:05:00.000-08:00

A FINE LINE

26 yr./F with discolored composite (mesio-incisal) on 21 and a gap between 11 & 21.

21 after removal and re-restoration with composite. 11 was treated in a similar fashion.

2010-02-24T10:48:00.001-08:00

PERIAPICAL CYST

15 yr./F with H/O trauma to anterior teeth and PA cyst in relation to 22. Non-vital 23.

Endodontic treatment carried out in 22 & 23. root end surgery was carried out and cyst enucleation done.

radiograph taken 1 yr. later shows complete healing of bone.

Occlusal radiograph shows complete bone healing around 22 & 23.

2010-02-23T11:29:00.000-08:00

LOWER 1st MOLAR WITH 3 ROOTS (RADIX ENTOMOLARIS)

carious exposed 36 with 2 distinct distal roots(Radix Entomolaris)

post obturation radiograph.

2010-02-23T10:55:00.000-08:00

ENDODONTIC RETREATMENT

28yr/ M with poorly obturated 36.

after Endodontic retreatment. 2 distal canals can be clearly seen.

2010-02-23T05:28:00.000-08:00

PROTAPER ROTARY ENDODONTICS

16 yr. old female with large restoration over exposed pulp in 26. She has symptoms of apical periodontitis( tenderness to percussion and difficulty in biting). Periapical changes can be seen over disto-buccal root.

Biomechanical preparation is achieved with Protaper(rotary) and copious irrigation.

The tooth is obturated when it is asymptomatic.

28 yr. old male with incomplete RCT in 36. The restoration sealing access cavity is broken. Remaining caries can also be seen.

After completion of endodontic treatment.

18 yr./F with amalgam restoration in 26. The restoration was done on exposed pulp chamber and the cement base can be seen extruding into it.

After completion of Endodontic treatment with Protaper(rotary).

25 yr./F with carious exposure of 36.

After obturation.

36 with PA radiolucency.

After Endodontic treatment. 2 distal canals can be seen.

2010-02-22T07:21:00.000-08:00

PROCERA Bridge

30 yr. old female reports with existing bridge from 13 to 23. History reveals congenitally missing Upper lateral incisors. Metal Ceramic bridge was used to replace missing teeth. Patient has the following problems with existing bridge:

It is bulky.
It is loose.
The metal shows through and teeth do not have translucence.
The shade is too white.
Teeth seem to be joined together.
Chipped ceramic.

There is spacing distal to upper left canine which has not been addressed.

Additionally she had swelling in upper lips a month ago.

Patient requests replacement with Zirconia crowns (she read about them on the internet).

IOPA radiograph reveals a improper RCT on 11 and PA radiolucency on 21. A single GP point can be seen in 11. It also seems to be over-filed.

Removal of the bridge reveals grossly over-reduced teeth, particularly canines. The margins are not smooth.

Endodontics is completed on 11 & 21. The existing bridge is being used for temporization in between appointments.

After completion of RCT's, the margins are improved. Impressions are taken and sent to the lab. Zirconia cores are checked for fit and margins and returned to the lab.

The Procera bridges are back from the lab. They are intentionally constructed in two parts.

The white Zirconia cores can be seen.

A tooth has been added distal to 23. It serves only aesthetic purpose and is not in function.

The new bridge is cemented in place using RelyX Unicem. The gingival contours will gradually adapt to the new bridge. Problems of shape, size, colour and contour have been addressed. The incisal edges follow the lower lip contour(smile line). The teeth do not appear joined together.

Space closure has been achieved distal to 23.

The patient is visibly happy with her new bridge in place.

2006-03-30T03:03:00.000-08:00

Class I Cavity preparation on Maxillary I st Molar

Figure 1
Occlusal view of Maxillary I st molar(16) .
Figure 2
Showing extent of cavity
Fissure extensions extend halfway(red dot) from pit to occlusal surface outline.
Dovetails are kept 1mm inside the Marginal ridge (green line).
Figure 3
Class 1 cavity outline based on above landmarks.

Figure 4
Initial depth cuts
Initial depth cuts are made with a small round bur to a depth of 1mm
Location : Central , Mesial and Distal fossa
Figure 5
Initial Cavity preparation
Depth : 2mm
Note : Bur is kept perpendicular to long axis of tooth .

Figure 6
Final cavity preparation with cavity walls having tapers and inverse tapers.
See Fig 7 also .

Figure 7
Cavity Walls marked in Black are kept parallel to each other and perpendicular to floor of Cavity
Cavity Walls marked in Green have been prepared with Taper.
Cavity Walls marked in Red have been prepared with Inverse taper.
Figure 8
Base Application
Zinc Phosphate cement base of thickness 0.5 mm has been applied to Floor of the cavity.
Note: Care is taken to remove traces of cement from cavity walls.

Figure 9
Properly triturated Amalgam .
Note the shiny surface

Figure 10
Amalgam being condensed into cavity with Amalgam condenser.
Note the serrations of the Amalgam condenser on the surface.

Figure 11
Appearance of Filling after Burnishing and Carving to the appropriate occlusal form.
Note :Amalgam does not extend beyond cavity outline.

Figure 12
Final appearance of filling after finishing and polishing