calcified canals Flashcards
How does a surgical operating microscope (SOM) help the clinician locate calcified canals within a root?
The SOM provides the clinician with superior illumination and magnification when compared to dental loupes, an overhead light source, or the naked eye. Calcified canals can easily be addressed by utilizing the SOM (Carr & Murgel 2010). Astute clinicians can learn visual skills required to discern dentin from calcified pulp, relying on dentinal color changes, translucency, and refractive properties to help locate remnants of calcified pulpal tissue. Previously, perforations or over‐enlargement of accesses have resulted in decreasing the lifespan of a calcified tooth; however, the SOM makes these types of cases routine and more predictable.
How can a CBCT scan help guide a clinician to locate deep calcified canals within a root?
A PA radiograph shows structures in 2-D, whereas a CBCT shows structures in 3-D. When carefully drilling down a root to locate a deep canal, a 2-D radiograph will help guide the clinician in a mesial to distal direction only. Although this information is helpful, it tells the clinician nothing about the buccal– palatal orientation. Although the clinician may think he or she is nearing the canal on a PA radiographic, the clinician may in fact be close to perforating the root, usually towards the buccal. Also, CBCT soft- ware frequently has “measuring tools” to help estimate distances from the incisal edge reference point to the deep canal orifice. A sagittal or axial slice taken during the procedure can often help guide the clinician safely towards the deep canal within the confines of the root (Nallapati 2015).
What are some indications for internal bleaching?
Despite some historically bad press in the litera- ture, if done properly, internal bleaching can be a safe and effective procedure for improving the aesthetic outcome of a darkened anterior tooth. Use of unheated bleach is recommended, as well as the use of a protective barrier a few millimeters thick of restorative material at the CEJ level within the tooth and root. Indications for internal bleaching can include intrinsic staining from blood breakdown products, restorative materials, excessive fluoride, certain medications, and pulp canal obliteration post trauma (Abbott & Heah 2009). Various types of staining respond well to internal bleaching and can remain stable for years.
Why is it important to recall endodontic cases after more than six months to one year?
Historically, recall rates in endodontic private practices tend to be low. Most endodontists tend to recall cases at six months, and possibly one year, if they recall patients at all. However, the clinician should make every effort to obtain “long‐term” recalls.This case displays a four‐year recall at the time of publication, and although not quite “long term,” it can be considered “intermediate term.” A six‐month or one‐year recall can help the clinician evaluate apical healing on a given case (Orstavik 1996); however, endodontists should be concerned about tooth survivability after endodontics. A short‐ term recall will help the clinician discern whether a case may be successfully working from a process‐ centered point of view; however, a long‐term recall is required for properly assessing the outcomes from a patient‐centered perspective.
Explain why pulp canal obliteration (PCO) can be a challenge for the clinician treating a given tooth, and list some tools and instruments that may help make treatment possible.
PCO presents a challenge to treatment on several levels (McCabe & Dummer 2012). Roughly 4–24% of teeth can display some form of PCO post trauma. It may be difficult to rely on sensibility testing with teeth that have undergone PCO, and technically, these teeth may be difficult to treat as locating the actual canal can often be challenging. From a treatment planning angle, knowing when to treat may also pose a challenge to the clinician, i.e., treat at the first sign of PCO although the tooth is completely asymptomatic? It is recommended that treatment for teeth with PCO only be initiated if there are clinical signs and symptoms indicative of a periapical disease.Tools and instruments that may aid the clinician in successfully treating cases with PCO can include (but are not limited to): SOM, CBCT, long shank small burs, EDTA, ultrasonics, and small diameter (size #6 and size #8) stiff hand files.
