ENDODONTIC RETREATMENT

                       28yr/ M with poorly obturated 36.

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

                           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.

 

 

                                  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.

 

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