Management of Blunderbuss Canals in Endodontics - A 3D Attempt
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Management of Blunderbuss Canals in Endodontics - A 3D Attempt
- 1. Management of Blunderbuss Canals in Endodontics - A 3D attempt. INDIAN DENTAL ACADEMY Leader in Continuing Dental Education www.indiandentalacademy.com
- 3. 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). www.indiandentalacademy.com
- 4. 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. www.indiandentalacademy.com
- 5. Case Report • 16 years / Male dghseyhqatga • C/o pain & discharge. • H/o apexification attempted – 2 yrs prior. www.indiandentalacademy.com
- 7. Radiograph • Incompletely formed roots – blunderbuss apex. • Peri-radicular rarifraction. • Thin fragile dentinal walls. • Apically divergent canals . • Lack of apical barrier. www.indiandentalacademy.com
- 8. 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. www.indiandentalacademy.com
- 9. 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
- 10. 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 www.indiandentalacademy.com
- 11. I Preparatory Phase www.indiandentalacademy.com
- 12. Diagnostic Radiograph • Access cavity modified. • Radiographic Working length established – 21. 5mm. www.indiandentalacademy.com
- 13. • Wax pattern taken. • Flasking - Dewaxing process – acrylizing – heat polymerization - Custom Resin Block → ENDODONTIC OBTURATOR. www.indiandentalacademy.com
- 14. 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 www.indiandentalacademy.com
- 16. 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 www.indiandentalacademy.com
- 17. Endometrics Volume of the canal space Volume of the obturator → 152.296 mm3 → 149.625 mm3 • Error % → 1. 8 % www.indiandentalacademy.com
- 25. Post-op IOPA - MTA Torabinejad M et al ; 1998 JOE www.indiandentalacademy.com
- 30. 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..!! www.indiandentalacademy.com