Management of Blunderbuss canals in endodontics /certified fixed orthodontic courses by Indian dental academy

Management of Blunderbuss Canals in
Endodontics - A 3D attempt.

INDIAN DENTAL ACADEMY
Leader in Continuing Dental Education

www.indiandentalacademy.com

Blunderbuss canals – Wider alternatives

• Apexification.
• Custom GP roll.
• Radicular rehabilitation using resin posts - monobloc
concept.
• Placement of barrier materials like MTA, Tricalcium
phosphate in conjunction with customized post system or
backfill technique (Obtura, Flowable resin).


Apexification – Not always…!

• Presence of periapical pathology - periapical abscess – destruction
of Hertwigs epithelial root sheath.
• Repeated sinus tract formation.
• Downgrowth of granulomatous tissue - Bleeding manifested when
files placed short of apex.
• Penetration of the cortical plate by apex.
• Defective access seal.
• Environmental contamination during procedure.
• Inadequate cleaning and sanitizing wide open canals.
• Closure not occurred within 2yrs – Failure.
• Non-compliant patient.

Case Report

• 16 years / Male
dghseyhqatga
• C/o pain & discharge.
• H/o apexification
attempted – 2 yrs prior.


Clinical Examination


Radiograph

• Incompletely formed roots –

blunderbuss apex.

• Peri-radicular rarifraction.

• Thin fragile dentinal walls.

• Apically divergent canals .

• Lack of apical barrier.


Ultrasound – To continue apexification or not…??

• Provides 3 dimensional impression of

the space.

• Exact assessment of the nature of the

peri-radicular tissues.

• Information on the size of the lesion,

its content & its vascularity.

• Differentiates between lesions of

endodontic origin.

E. Cotti et al ; IEJ 2002 ; 148 – 151.

Ultrasound
• Hypoechoic lesion - 6.5 x 5.6 mm with
posterior acoustic enhancement
consistent with fluid collection - near
the root tip of right central incisor.
• Few mobile internal echoes consistent
with particulate debris - seen within
the fluid collection.
• Hypoechoic fluid loculation - focal
erosion of anterior wall of
corresponding alveolar socket -
suggestive periapical abscess of right
central incisor.
Dr. M. Venkatesan, Cons. Radiologist,
Bharat Scans. www.indiandentalacademy.com

Treatment plan

I. Preparatory Phase II. Surgical Phase III. Obturation Phase
• Radiograph • MTA as barrier • Tailor-made resin
• Wax pattern (2 step tech). obturator cemented
• Heat polymerized – Gary D Matt et al ; with dual cure resin
Endodontic obturator. JOE 2004 cement.
• Spiral CT • LC Composite built-up

I Preparatory Phase


Diagnostic
Radiograph

• Access cavity modified.
• Radiographic Working length
established – 21. 5mm.


• Wax pattern taken.
• Flasking - Dewaxing process – acrylizing – heat polymerization
- Custom Resin Block → ENDODONTIC OBTURATOR.

Volume of Obturator

• The resin block is divided into different segments each
measuring 3mm in length and the width of these segments
are measured.
• The computation of volume to the total length is done by
integrating the entire segments of the resin block →
SEGMENTAL INTEGRATION TECHNIQUE.

• Volume of the Obturator → 149.625 mm3


Spiral CT


Volume of the canal space

• The values obtained in the CT scan are calibrated
& scaled down to the required normal size and the
volume is calculated from the different segments
by scaling technique using Engineering scaling
principle.

• Volume of the canal space → 152.296 mm3


Endometrics

Volume of the canal space Volume of the obturator
→ 152.296 mm3 → 149.625 mm3

• Error % → 1. 8 %

II Surgical Phase


h qatga
Dg hsey


Post-op IOPA
- MTA

Torabinejad M et al ; 1998 JOE


III Obturation Phase


Dghseyhqatga


To Conclude…

• Wax pattern – Endodontic obturator fabrication with
Resin.
• Segmental integration technique – Volume of the
Obturator.
• Spiral CT – Volume of the canal space.
• Canal volume = Obturator volume → ENDOMETRICS
• MTA barrier – apically.
• Obturator cemented with dual cure cement.

- 3D SEAL..!!

Thank You


Management of Blunderbuss canals in endodontics /certified fixed orthodontic courses by Indian dental academy

Recommandé

Recommandé

Contenu connexe

Tendances

Tendances (20)

En vedette

En vedette (20)

Similaire à Management of Blunderbuss canals in endodontics /certified fixed orthodontic courses by Indian dental academy

Similaire à Management of Blunderbuss canals in endodontics /certified fixed orthodontic courses by Indian dental academy (20)

Plus de Indian dental academy

Plus de Indian dental academy (20)

Dernier

Dernier (20)

Management of Blunderbuss canals in endodontics /certified fixed orthodontic courses by Indian dental academy