Management of an upper second molar with a restorative approach
23/09/2023
Fellow
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Adhesive procedures have changed the way of restoring endodontically treated teeth.
Postless approaches have been proposed to improve and restore teeth.
The preservation of the dental structure of endodontically treated teeth is essential for this.
Before performing any endodontic procedure, one must know how the final restoration of that tooth will be handled and whether the procedure can be optimized during root canal treatment.
Fig. 1
A 52-year-old female is referred for the endodontic treatment of the upper second molar due to intense cold pain.The examination of the initial radiograph reveals very narrow canals.
Pulp diagnosis: symptomatic irreversible pulpitis.
Periapical diagnosis: normal periapical tissues
Fig. 2
Initial situation after anesthesia and rubber dam placement
As seen in the image, presence of caries and amalgam fracture.
Fig. 3
After removing the carious tissue and the bad restoration, access to the cavity was made, in this case profuse bleeding, for this the cervical third was instrumented a little to remove the pulp tissue and contain or reduce the bleeding, it was irrigated with hypochlorite sodium or saline preference only in this step.
Unsupported enamel was removed from the mesial surface and the edges were smoothed.
Fig. 4
A mesial and distal margin elevation and a pre-endodontic sealing of the dentin or a resing coating were performed.
This will help a lot in the adhesive strength, since the sodium hypochlorite will not be in contact with the collagen of the dentin.
Access was refined with the help of ultrasound tips.
Fig. 5
It was instrumented with rotary martensitic files with taper 04 due to the anatomy of the canals up to a caliber 35.04.
Fig. 6
Cone fit photograph
Fig. 7
Cone Fit X-ray
Fig. 8
Downpack was made leaving 3-5 mm of guttapecha
Fig. 9
Whenever the continuous wave technique is performed, the adjustment must be verified with an x-ray, this test is known as downpack.
Fig. 10
The backfill was finished and the pulp chamber was cleaned without excess cement or gutta-percha.
For this part, alcohol is used to better remove the resin-based sealer.
A build up was made with short fiber reinforced composite and the preparation for an indirect restoration was finished
Fig. 11
Final X-ray
Fig. 12
Mesial shift
Fig. 13
Inverted Xray
Conclusions
Knowing how the management of the endodontically treated tooth will be is important, it has a relationship to how we are going to make the access, how it should be instrumented, if space will be made for a post or not, if an indirect restoration will be made, if onlay or overlay, if it will only be reconstructed with composite resin or if a crown will be made
So we must think about what the final restoration will be like and based on that, address it endodontically.
Bibliography
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