Archive for October, 2011
October 24, 2011 at 9:52 pm by Ian Kerr
Filed under Clinical Cases
This case shows one part of what was a comprehensive overhaul of every single tooth, involving direct restorations, root canal fillings, crowns, extractions and dentures. The part I am showing here is the part affecting the front teeth which were badly worn, stained and misaligned. Given the extensive nature of the restorations for the back teeth we elected to do direct fillings to minimise tooth reduction and to reduce overall fees. As we were changing the bite as part of the treatment it was also helpful to work with a material that can be adjusted and added to easily in the mouth over a period of weeks as the new bite is accommodated.
Lengthy treatment plans such as these need to be staged over several months and require multiple visits but the results can be very rewarding, giving improved comfort and confidence and avoiding the loss of multiple teeth. If you are worried about the health of your teeth and are looking for a comprehensive approach to your care then please give us a call on 01580752202 and book an initial consultation today. We will discuss every option with you and will give you a full written report itemizing all costs before we begin any treatment.
October 18, 2011 at 10:10 pm by Ian Kerr
Filed under Dental Research Update
This post is a rather specific one for dentists with a keen interest in endodontics and may not be of much value for patient information. If you are a patient visiting this site looking for information on root fillings please follow the link or look at other clinical cases within the blog.
The case shown below is one I completed using the 2mm file from SAF with only a single hand file for initial apical gauging ( I got lucky and guessed with a 30 file). No rotaries were used at all. The upper left central was treated a few years ago by an endodontist in Poland using conventional techniques. What interests me is how smaller the apical preparation is with the non rotary (SAF) approach. I think we are so conditioned to look for the wide “robust” apical plug that we might look at the SAF result as rather under prepared. I filled with a F4 ProTaper GP using a softened tip approach (1 second dip in solvent then placed soft to length and removed using locking tweezers) prior to sealing and heat condensing to 3mm from full working length. I am confident from seeing the shape of the modified tip that this represented an accurate impression of the apical shape and wonder now whether the apical filling in the upper left central may represent a degree of over preparation. The post I used was a directly applied and adapted system from StickTech, The EverStick Post System and did not require any removal of coronal tissue to accommodate a wide metal post.
As ever these posts are done to generate response and debate so we can all learn and progress our techniques. I certainly don’t think that either approach is entirely right or wrong and each will have its place but I wonder now if we need to impose our design on to the canal anatomy quite so much as before?
October 18, 2011 at 9:53 pm by Ian Kerr
Filed under Clinical Cases
I see a lot of people who are experiencing pain or infection caused by their teeth. Usually the nerve in the tooth is dead or dying and this is causing tooth ache and or a dental abscess. Often these people have been referred to me by another dentist and very often they assume that they are going to have to have the tooth removed. For a lot of the people I see the thought of losing a tooth is a traumatic one and something that they are desperately keen to avoid. This is where root fillings come in. A root canal filling is, as the name would imply, a way of filling the root canals that used to house a live healthy nerve. If the nerve is dead or dying it is due to the presence of bacteria in the tooth and this process leads to infection developing around the tips of the roots. On a radiograph the infection is often seen as a shadow around the tips of the roots and is caused by the body removing the bone around the tooth. The body does this in the style of a “Russian Retreat” to create a “no mans land” around the tooth to help contain the infection. Unfortunately there is an inexhaustible supply of bacteria coming from the mouth via the tooth so the body always loses this battle, causing the area of infection to grow and grow, as can be seen in the first example where almost all the bone around the tooth has been lost. All is not lost however and, if successful, a root canal filling can seal the canals to stop the flow of bacteria which in turn can allow healing to take place at the tip of the roots. This is seen clinically as pain and swelling resolving and is seen on radiograph as the shadow clearing and bone being replaced around the tooth.
Case 1
Large shadow around roots caused by infection
Infection treated allowing bone to regrow in the area
Sometimes the first attempt at the root filling is not successful and the infection remains at the tips of the roots. In this case the shadow around the tips of the roots had grown over a period of time and the patient was still experiencing pain. By redoing the root filling we were able to help resolve the infection and allow healing to take place. The tooth is now comfortable and can stay in place for, hopefully, many more years.
Case 2
Root filling in place but infection still growing arond tip of root
New root filling in place and infection resolved
If you are having problems with tooth ache or infection and would like to know if we can help you keep the tooth then please do not hesitate to call the surgery on 01580 752202 and we will he happy to help