Amy Dukoff
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TECHNIQUES in endodontics advance, keeping up is not always easy.
However, the effort is always rewarded. A practice that is
vibrant, with the practioner always in motion, always moving toward
techniques that are new and better, attracts the attention and
admiration of its staff and its patients. Always trying to better
oneself is the key to being a success.
An example of the need to adapt to new techniques is
the process of evaluating a tooth with older root canal therapy.
The way we shape canals today has affected our evaluations of cases,
particularly our evaluations of cases that may require
retreatment. Today, we advocate enlarging the canal system to a
.08 taper with nickel titanium versus traditional step-back
technique. Also, we encourage enlarging the apex with a #35
SafeSiders® reamer. The larger apical size along with the
greater taper allows for a cleaner and well-shaped canal that tends to
correlate to the architecture of the canal structure.
Planning treatment—or retreatment—for a case is difficult in
itself. Planning begins with a diagnosis of the tooth. Most
often a general dentist plays the key role in that step, and the
dentist faces several difficulties. For one thing, it is always
hard to look at a prior root canal that has become symptomatic, and
know why the root canal therapy is problematic. For another, it
is usually difficult to decide whether to retreat a case or just have
the tooth extracted. Even the diagnosis of pain can be
troublesome for the practitioner.
Silverpoint fillings in teeth with old root canal
therapy are likely to become problematic even if they are not
problematic on examination. However, does that mean that one
should always retreat a tooth with an old silverpoint fill even when
there is no rarefaction or symptoms? In such a case, it is
certainly best to inform the patient fully, state the options, and then
give your considered professional opinion regarding the advisability of
retreatment.
On the other hand, when a case that has been filled
thinly looks good but has percussion and thermal symptoms, should one
retreat even though the existing fill looks “good” at first
glance? In this case, the answer is almost always yes.
The appearance of a finished tapered canal is quite
different from the appearance of a conventional 0.02 taper.
Seeing the modern fill—denser and wider than the thin, wispy fills of
the past—helps a practitioner understand why a patient may still have
symptoms if proper debridement has not occurred. The narrower
preparation for a thin fill may not have removed all the dead, damaged,
or infected tissue. It is a good idea to retreat a case that is
symptomatic. The patient is seeking help because she or he cannot
tolerate the discomfort any more. When a patient has passed the
point of tolerance and is seeking resolution of a painful situation, it
is good to offer solutions. Of course one cannot guarantee a successful
outcome if a crack or blockage exists that might make retreatment
impossible.
Things change, and endodontics is no exception to
that rule. The way that we shape canals has changed
considerably. As a result of the change in the way we shape
canals, the way we look at how a case is filled has changed.
July - August 2007
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Things change, and endodontics is no exception to that rule.
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