Description
Calcified root canals are a highly prevalent problem among older generations. Calcified root canals occur when calcium gets deposited in the tooth's canal. When present, they also inhibit the dentist’s ability to perform regular root canal treatments, where an endodontist can help correct the issue.
Join us on the exclusive case based discussion with Dr Antonios Glynis DMD, MSc Endodontics, UK who makes us understand the significance of Management of Calcified Root Canals.
Résumé
- Dr. Antonio Gilinis discusses the management of calcified root canals, defining calcific metamorphosis, dystrophic calcification, and pulp canal obliteration. He highlights that calcification is a natural, slow process that accelerates after trauma, making canals difficult to locate and negotiate. Uncontrolled mineralization and traumatic injuries contribute to this condition.
- The lecture addresses challenges in diagnosing pulp vitality due to calcification, where thermal and electric pulp tests yield false negatives. Radiographic appearances range from partial to total obliteration, impacting treatment decisions. Treatment isn't always necessary unless signs of infection or apical radiolucency are present. Pulp stones, another form of calcification, are also discussed.
- Potential errors in dealing with calcified teeth include misdiagnosis, perforations, ledges, blockages, instrument breakage, and zipping. While these errors are undesirable, they are not always direct causes of failure if canals are adequately cleaned. Maintaining a clean root canal system up to the apex improves the prognosis, even with complications like a broken file.
- Dr. Gilinis emphasizes following anatomical guidelines, such as those described by Krasner and Rankow. This includes laws of centrality, concentricity, the cementoenamel junction (CEJ) landmark, symmetry, and the darker chamber floor. He also discusses how orifice locations often coincide with developmental fusion lines.
- Various tools are crucial for managing calcified canals. Microscopes provide magnification and posture benefits, though loops are a minimum requirement. Rubber dams are essential, though initial access might occur without them. Ultrasonic instruments, burs (including endo-z burs), long-shank burs, and DG16 probes are also important. Dyes, such as methylene blue, are useful, as are specific hand files like C-pilots and glide path files.
- The lecture covers advanced techniques, including CBCT for accurate canal identification. CBCT helps avoid perforations and plan access. Case examples are provided of how the CBCT images assist in difficult situations.
- Bio ceramics can seal perforations. Guided endodontics uses CBCT and 3D scans to create surgical guides for precise access, though accuracy diminishes closer to the apex. Dynamic navigation systems, like Nident, offer real-time guidance during the procedure. The importance of experience, thinking outside the box, and knowing personal limitations is stressed.
- Dr. Gilinis demonstrates an alternative access approach through the buccal side to avoid a normal access in an anterior tooth. He reiterates that the goal is to access, clean, and disinfect the canal while preserving tooth structure. Time management and knowing when to refer are crucial to avoid iatrogenic errors and ensure successful outcomes.
Exemple de certificat
À propos des intervenants
Dr Antonios Glynis
DMD, MSc Endodontics
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