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2018.01. Do we really need operating microscope for endodontic treatments?

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Anna Bojti from DrPrezi.com

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Transcript of 2018.01. Do we really need operating microscope for endodontic treatments?

Correct diagnosis
Everybody can carry out proper endo treatments, within their
own limitations.
Using microscope we can be more
conservative
Operating microscope
itself does not perform any root canal treatment
DO WE REALLY NEED
CONSERVATIVE ENDODONTIC TREATMENTS
OWN LIMITATIONS
OPERATING MICROSCOPE
CONCLUSION
ANATOMICAL VARIATIONS:
MB2
PREMOLAR WITH 3 ROOTCANALS
LOWER INCISORS
PERFORATIONS
BROKEN INSTRUMENTS
MIDDLE OR LOWER THIRD RAMIFICATION
SCLEROTISED ROOTCANALS
SURGICAL PROCEDURES
IDENTIFICATION OF CRACKS
Good coronal seal
Selected cases had been carried out within my own limitations
Equipments used properly which I had that time
Proper treatment plan and strategy
Good decisions
7 years
follow up
7 years
follow up
20 years
follow up






m
ADVANTAGES OF OPERATING MICROSCOPE
Full visual control
Localization of missing and sclerotised rootcanals
Examination of the external and internal surface of the tooth
Identification of cracks and fractures
Separated instrument removal
Management of perforations
Microsurgical endodontic treatments
Ergonomy
Documentation
Conservative approach
Discovering DB rootcanal
MB2
DB
MB1
MB2
CASE STUDY
ROOT CANAL VARIATION IN UPPER FIRST MOLARS, RCT-TREATED from 04.2016 - 04.2017
MB2
BROKEN INSTRUMENTS
CASE STUDY
96,5%
3,5%
with 4 or more rootcanals, orifices, septum variations
with 3 rootcanals
144 upper first molars


Two years follow up
Int Endod J.
 1995 Jan;28(1):12-8.
Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration.
Ray HA , Trope M.
Department of Endodontology, Temple Dental School, Philadelphia, PA 19140, USA.
1
1
Kulild JC1, Peters DD. : Incidence and configuration of canal systems in the mesiobuccal root of maxillary first and second molars. J Endod.
1990 Jul;16(7):311-7
MB2 canal was located in the coronal half of 95.2% of the roots.

Dr T. Schwarze DDS, Dr. med. dent.*, Dr C. Baethge, Dr T. Stecher and Professor W. Geurtsen : Identification Of Second Canals In The Mesiobuccal Root Of Maxillary First And Second Molars Using Magnifying Loupes Or An Operating Microscope Australian Endodontic Journal ,
Volume 28, Issue 2
, pages 57–60, August 2002
41.3% of MB2 root canals were identified using magnifying loupes, whereas 93.7% were found by using of an operating microscope.

John J. Stropko
, DDS : Canal morphology of maxillary molars: Clinical observations of canal configurations
Journal of Endodontics Volume 25, Issue 6
, June 1999, Pages 446–450

However, as the operator became more experienced, scheduled sufficient clinical time, routinely employed the dental operating microscope, and used specific instruments adapted for microendodontics, MB2 canals were located in 93.0% of first molars and 60.4% in second molars.






Good Resto
Poor Resto
Good Endo
Poor Endo
90%
68%
44%
18%
MIDDLE AND LOWER THIRD RAMIFICATION
CASE STUDY
REGENERATIVE ENDODONTICS
dr. Gergely Benyőcs, Budapest, Hungary
AEEDC 2018, Dubai
OPERATING MICROSCOPE
FOR ENDODONTIC TREATMENTS?
Post-op
Pre-op
MB1
Cone-control
MB2
Pre-op
Selective root retreatment.
Palatal and distobuccal root without visible or perceived pathosis.
Healey 1960, Helfer, Schilder 1972:
teeth became more brittle due dentine dehydration.
AAE Glossary of Terms.
Gary B. Carr, John A. Khademi,Richard S.Schwarz:
Introduction x. Best Practice in Endodontics: A Desk Reference
"Modern endodontics is a branch of restorative dentistry.  It’s goal is not only  the prevention or elimination of apical periodontitis, but also the long term preservation of sound dental structures."
"Modern endodontics is a branch of restorative dentistry.  It’s goal is not only  the prevention or elimination of apical periodontitis,
but also the long term preservation of sound dental structures.

TO BE
LESS INVASIVE
VS
John A. Khademi: Image-Guided Endodontics: The Role of the Endodontic Triad, Endodontics 08.2016
IMAGE AND IMAGINATION GUIDED TREATMENT PLANNING
ORIFICE PROJECTION
BUCCAL ACCESS, UPPER CENTRAL INCISOR
CARIES/RESTORATION DRIVEN ACCESS PREPARATION
CENTRAL PROJECTED ACCESS, LOWER MOLAR
DOUBLE ACCESS, TRUSS ACCESS
CENTRAL PROJECTED ACCESS, UPPER MOLAR
CENTRAL PROJECTED ACCESS, UPPER MOLAR
MODIFIED DUAL ACCESS, CENTRAL PROJECTED ACCESS, SECOND LOWER MOLAR
NO TREATMENT
NO RETREATMENT
SELECTIVE RETREATMENT
CONSERVATIVE ACCESS PREPARATION
MINIMALLY INVASIVE ROOT CANAL SHAPING
BROKEN INSTRUMENTS
REGENERATIVE ENDODONTICS
SURGICAL PROCEDURES
GUIDED ENDODONTICS
VITAL PULP THERAPY
GUIDED ENDODONTICS
USE YOUR BRAIN
X-RAY DRIVEN ENDODONTIC TREATMENTS
CBCT DRIVEN ENDODONTIC TREATMENTS
3D IMAGING SOFTWARES
COMPUTER AIDED DYNAMICALLY GUIDED ENDODONTICS
NAVIGATION WITH 3D PRINTED TEETH
3D PRINTED TEMPLATE GUIDED ENDODONTIC TREATMENTS
3D PRINTED TEMPLATE GUIDED SURGICAL ENDODONTIC TREATMENTS
dr. Bertold Molnár
dr. Bertold Molnár
Oral Health Prev Dent. 2004;2 Suppl 1:287-92.
What is minimally invasive dentistry?
Ericson D1.
"Minimally Invasive Dentistry is the application of "a systematic respect for the original tissue."
The reasons for extraction were periodontal disease (40.3%), endodontic failure (19.3%),
vertical root fracture (13.4%)
, nonrestorable cuspid and crown fracture(15.1%), nonrestorable caries (5.2%), iatrogenic perforations and stripping (4.2%), and prosthetic (0.8%).

Journal of Endodontics, November 2011Volume 37, Issue 11, Pages 1512–1515
Analysis of Reasons for Extraction of Endodontically Treated Teeth: A Prospective Study
Babacar Touré, DDS, PhD Correspondence information about the author DDS, PhD Babacar Touré Email the author DDS, PhD Babacar Touré, Babacar Faye, DDS, PhD , Abdoul W. Kane, DDS, PhD
Cheikh M. Lo, DDS, Bassirou Niang, DDS, Yves Boucher, DDS, PhD
David Clark, John Khademi 2010: the dentine near the alveolar crest is irreplaceable. This critical zone, roughly 4 mm above and below the crestal bone is important. Long-term retention of the tooth and resistance to fracturing are directly related to the amount of residual tooth structure. The more dentine is kept, the longer the tooth is kept.
Sedgley CM, Messer HH 1992: This study support the interpretation that, it is the loss of structural integrity associated with access preparation, rather then changes in the dentine, that lead to higher occurence of fractures in endodontically tretaed teeth, compared with vital teeth.
Huang Tj, Schilder H 1992: The result of this study does not support the theory, that dehydration after endodontic treatment per se weakens dentin structure in terms of compressive and tensile streghts.
J Endod. 1992 May;18(5):209-15.
Effects of moisture content and endodontic treatment on some mechanical properties of human dentin.
Huang TJ1, Schilder H, Nathanson D.
July 1992Volume 18, Issue 7, Pages 332–335
Are endodontically treated teeth more brittle?
Christine M. Sedgley, BDS, MDSc, FRACDS1, Harold H. Messer, MDSc, PhD2
Gianluca Plotino, Nicola M. Grande, Eugenio Pedulla 2017: Teeth with traditional endodontic cavity access showed lower fracture strength than the ones prepared with conservative endodontic cavity or ninja endodontic cavity.
Dent Clin North Am. 2010 Apr;54(2):249-73. doi: 10.1016/j.cden.2010.01.001.
Modern molar endodontic access and directed dentin conservation.
Clark D1, Khademi J.
J Endod. 2017 Jun;43(6):995-1000. doi: 10.1016/j.joen.2017.01.022. Epub 2017 Apr 14.
Fracture Strength of Endodontically Treated Teeth with Different Access Cavity Designs.
Plotino G1, Grande NM2, Isufi A1, Ioppolo P3, Pedullà E4, Bedini R3, Gambarini G1, Testarelli L1.
Yuan Xie 2016: Minimally invasive access preparation reduced the stress distribution in crown and cervical regions.
Eur J Oral Sci 2016; 124: 591–596
Comparative evaluation of the impact of minimally invasive preparation vs. conventional straight-line preparation on tooth biomechanics: a finite element analysis
Yuan K, Niu C, Xie Q, Jiang W, Gao L, Huang Z, Ma R. Comparative evaluation of
the impact of minimally invasive preparation vs. conventional straight-line preparation
on tooth biomechanics: a finite element analysis.
Krishan 2014: Although CEC was associated with the risk of compromised canal instrumentation only in the molar distal canals, it conserved coronal dentin in the 3 tooth types and conveyed a benefit of increased fracture resistance in mandibular molars and premolars.
August 2014Volume 40, Issue 8, Pages 1160–1166
Impacts of Conservative Endodontic Cavity on Root Canal Instrumentation Efficacy and Resistance to Fracture Assessed in Incisors, Premolars, and Molars
Rajesh Krishan, DDS Frank Paqué, DMD, Arezou Ossareh, BASc, Anil Kishen, MDS, PhD, Thuan Dao, DMD, MSc, PhD, Shimon Friedman, DMD Correspondence information about the author DMD Shimon Friedman
Conclusion:
Remaining sound tooth structure could be the key for the long term survival.
Strong evidence (randomised controlled trials) is needed to prove that the effort of preserving dentine facilitate the tooth lasting longer.
Remove:
restorative material, caries ahead of tooth structure
enamel before dentine
occlusal tooth structure ahead of cervical dentine
Sedgley CM, Messer HH 1992: This study support the interpretation that, it is
the loss of structural integrity
associated with access preparation, rather then changes in the dentine, that
lead to higher occurence of fractures
in endodontically tretaed teeth, compared with vital teeth.
David Clark, John Khademi 2010: the dentine near the alveolar crest is irreplaceable. This critical zone, roughly 4 mm above and below the crestal bone is important. Long-term retention of the tooth and resistance to fracturing are directly related to the amount of residual tooth structure.
The more dentine is kept, the longer the tooth is kept.
Krishan 2014: Although CEC was associated with the risk of compromised canal instrumentation only in the molar distal canals, it conserved coronal dentin in the 3 tooth types and conveyed a benefit
of increased fracture resistance
in mandibular molars and premolars.
Summary:
Nil nocere!
Think patient centered.
Save as much sound dental structures as reasonable.
A paradigm shift is necessary to be less invasive during endodontic treatments.
Thank you for your attention!
dr. Gergely Benyőcs, Budapest, Hungary
gergelybenyocs@gmail.com
www.precedent.hu
Prasanna Neelakantan 2017: Debridement of the pulp chamber was significantly compromised in DDC. The type of access cavity did not influence the amount of residual pulp tissue in the root canals and isthmus.
Does the Orifice-directed Dentin Conservation Access Design Debride Pulp Chamber and Mesial Root Canal Systems of Mandibular Molars Similar to a Traditional Access Design?
J.Endod. 2017.10.010, https://doi.org/10.1016/j.joen.2017.10.010
PrasannaNeelakantanMDS, PhD*KhadijaKhanBDS*Geoffrey PakHei NgBSc, RMT†Chui YingYipBSc†ChengFeiZhangDDS, PhD*Gary ShunPan CheungMDS, PhD*∗
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