Allan Deutsch
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THE FALL 2004 ISSUE of Endo-Mail I described the clinical technique for
use of the PulpOut™ bur in molars. The technique is based on our
recently published research (June 2004) in the Journal of Endodontics.
This research shows that the distance from the cusp tip to the ceiling
of the pulp chamber in molars is approximately 6.5 mm. That 6.5 mm
distance is very consistent in all molar teeth. We made the fixed
stop on the PulpOut bur at 7 mm. Locating the stop there assured
that access into the chamber would always be made without perforating the
floor of the pulp chamber.
We have just had our second morphological research
paper accepted for publication in the Journal of Endodontics.
We reasoned that if all furcated molars had a very consistent measurement
from the cusp tip to the pulp chamber ceiling, maybe the furcated bicuspids
did also. We got a little fancier in this study and used the Trophy
RVG digital imaging system to radiograph the bicuspids. Once the
digital x-rays were processed, we measured them using the Digipan measuring
mode of the Trophy system (Figure 1).
We measured the same anatomic landmarks for bicuspids
as we did for molars. These measurements can be seen in Figure 2.
The measurement that we were most interested in
is D. This is the measurement from the cusp tip to the chamber ceiling.
This measurement in bicuspids was 6.94 mm. Although this number is
statistically different from the average of 6.3 mm for molars, it is smaller
than the 7.0 mm of the PulpOut bur. Consequently, the PulpOut bur
will work very nicely for bicuspids as well as for molars. Statistically,
based on a bell curve, there will always be some bicuspids in which the
PulpOut bur will get very close to the ceiling of the bicuspid but not
penetrate it. In these instances, you will be only about 0.6 mm away
from penetrating the ceiling. Clinically, the PulpOut bur will get you
very close to your objective.
As an aside, it is very interesting to note that
the one measurement that was the same for molars and bicuspids was measurement
B. Measurement B is the distance from the pulp chamber ceiling to
the furcation. This seems to be a constant number for all teeth with furcations.
Why this is so, I have no idea.
So remember: Don’t perf out . . . PulpOut!
Winter 2004
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FIGURE 1: An example of the
measurements for a bicuspid, taken in a buccal palatal view.
FIGURE 2: Anatomic measurements
for bicuspids.
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