Full debridement, minimal loss of tooth structrue

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Full debridement, minimal loss of tooth structrue

Postby BarryMusikant on Fri Aug 07, 2015 8:35 am

A video that shows us how to accomplish full debridement while preserving tooth structure:

https://www.youtube.com/watch?v=B0JwqFUCrzY

The intent of this video is to display an instrumentation technique that addresses the removal of all the tissue and the bacteria nourished by it with the least loss of supportive dentin. Another intent is to show how instrumentation that reflects the original complex pulpal anatomy can then be entirely obturated with a combination of room temperature epoxy resin flooding the individual canals as well as the common isthmus space shared by both canals using one well-coated prefitted gutta percha point for each canal. Given the concavities present on the furcal side of the root is would be an insurmountable challenge to create and obturate this space without endangering the integrity of the roots if significant straightening of the glide path, preflaring and crown-down preparations were a requirement. In short, the keys to conservative, but effective instrumentation lies in the use of lesser-tapered instruments that are virtually free of separation that result from the small arcs of motion generated in a 30-45º reciprocating handpiece.

Note the minimal taper in the mesio-distal plane coupled to the wide taper in the bucco-lingual plane. In both situations, the instrumentation is adapting to the original configuration of the pulpal tissue that reflects the external diameter of the root. In endodontics, we cannot dissociate internal shaping with external anatomy. One is a reflection of the other and must be respected. Instrumentation systems that don’t respect this relationship based on their own vulnerability do not imo pass the first requirement of maximizing the integrity of the remaining root structure.

A good deal of marketing has gone into the development of ever more flexible instruments, introducing NiTi in ever-smaller tapers. Highly flexible NiTi used in full rotation continuous or interrupted has little “body” to work against the lateral canals when they are highly oval. I would submit that stainless steel relieved reamers in thin dimensions are not only more than adequate to negotiate highly curved canals, but retain the ability to remove dentin quite efficiently in the buccal and lingual planes when the instruments are vigorously applied to these walls, something the dentist is more than willing to do, knowing they are virtually invulnerable to breakage when used in a 30-45º reciprocating handpiece oscillating at 3000-4000 cycles per minute. Furthermore, the soft flexible metallurgy of NiTi instruments have been shown to lose 60% of their cutting efficiency after a single use. That is not the case for stainless steel due to its far more robust structure. The 30-45º reciprocating movement of stainless steel relieved reamers encourages their use in multiple canals before replacement saving money and reducing procedural stress.

Regards, Barry
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Re: Full debridement, minimal loss of tooth structrue

Postby ASHOK on Fri Aug 07, 2015 9:47 am

Hi Dr.Barry, hope you are doing good.

Iam not able to upload any pics, from long time, can you please tell me or inform your technical people , how to fix that. Iam not getting that up load sign in my tool bar. Thanks and best regards Ashok.
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Re: Full debridement, minimal loss of tooth structrue

Postby BarryMusikant on Fri Aug 07, 2015 8:58 pm

ASHOK wrote:Hi Dr.Barry, hope you are doing good.

Iam not able to upload any pics, from long time, can you please tell me or inform your technical people , how to fix that. Iam not getting that up load sign in my tool bar. Thanks and best regards Ashok.


Ashok,

On Monday, I'll ask Dave, our computer guru to see if he can correct the problem.

Hope all other things are well with you.

Warm regards, Barry
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Re: Full debridement, minimal loss of tooth structrue

Postby Dr.Mathew Thomas on Sat Aug 08, 2015 1:57 pm

Hello Dr.Barry,
Well it would be nice of you if you using clear tooth , by Dr.Buchanan. if you dont mind can you take a  maxillary premolar with two separate thin  roots,joined at furcal area, and do root canal treatment with rotary 8or 6percent taper, and other with EDS, so that we can show three dimensionally  the root dentine removed by both systems on the furcal areas, which i feel can give a better result than an Xray or cross-sectional image shows. I dont know how far we can go with artificial tooth. it is my suggestion, you are more experienced than me,and you are in better position to judge whether it will serve any good using this and making a vedio.
Thanking you
Dr.Mathew
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Re: Full debridement, minimal loss of tooth structrue

Postby BarryMusikant on Mon Aug 10, 2015 10:41 am

Dr.Mathew Thomas wrote:Hello Dr.Barry,
Well it would be nice of you if you using clear tooth , by Dr.Buchanan. if you dont mind can you take a  maxillary premolar with two separate thin  roots,joined at furcal area, and do root canal treatment with rotary 8or 6percent taper, and other with EDS, so that we can show three dimensionally  the root dentine removed by both systems on the furcal areas, which i feel can give a better result than an Xray or cross-sectional image shows. I dont know how far we can go with artificial tooth. it is my suggestion, you are more experienced than me,and you are in better position to judge whether it will serve any good using this and making a vedio.
Thanking you
Dr.Mathew


Dear Dr. Mathew,

Below is a photo of a replica maxillary 2 rooted biscupid that Dr. Buchanan makes. We could prepare one canal with lesser-tapered reciprocating instruments and the other with greater tapered (06 or 08) rotary NiTi and then look at the results. Is this what you are looking for? If it is, let me know and I'll order the teeth and then prepare them.



Hope all else is well with you.

Warm regards, Barry
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Re: Full debridement, minimal loss of tooth structrue

Postby Dr.Mathew Thomas on Mon Aug 10, 2015 2:04 pm

Hello Dr.Barry,
Well we are all fine, well that is what i exactly i needed.
After reparation please obturate it as you do, so we can se in all planes the amount of damage to the furcal wall area , as it  is proven beyond doubt in Rotoary Niiti.
Thankyou for the reply.
Tahnkingyou
Dr.Mathew
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Re: Full debridement, minimal loss of tooth structrue

Postby BarryMusikant on Mon Aug 10, 2015 3:02 pm

Dr.Mathew Thomas wrote:Hello Dr.Barry,
Well we are all fine, well that is what i exactly i needed.
After reparation please obturate it as you do, so we can se in all planes the amount of damage to the furcal wall area , as it  is proven beyond doubt in Rotoary Niiti.
Thankyou for the reply.
Tahnkingyou
Dr.Mathew


Dr. Mathew,

It may take a little bit of time. I have to order the tooth and I don't know how quickly it will be delivered, probably not more than a week. Then I'll prepare them and obturate as you suggested and we'll see how they compare.

Warm regards again, Barry
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Re: Full debridement, minimal loss of tooth structrue

Postby Dr.Mathew Thomas on Tue Aug 11, 2015 12:33 pm

Hello Dr.Barry,
Well thankyou so much for considering my suggestion, i am not in a hurry.
Thanking you
Dr.Mathew
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