Memoir~clinical cases

  Composite resin is a very tricky restoration that needs a lot of practice and expertise. It's a continuous learning process. Today I'll share a few procedures I have learnt while restoring anterior teeth. Yes, it a small drop of a huge ocean and there's a lot more learning and practice for me to do..... let this be the first milestone of a really long way to go!! STEP 1: Preoperative evaluation. We often undermine the importance of working models and preoperative record. An impromptu treatment is often a recipe for disaster. Understanding the tooth angulation, emergence profile and tooth shade often help us to determine the type of restoration required and the armamentarium needed. STEP 2: Isolation longevity of any restoration depends mainly on how well we maintain the isolation. Rubber dam isolation might be frustrating. But, it's a lot better than your patient returning back with a failed restoration.                      ...

       When a tooth smiles at you that signals danger!! A C-shaped root canal often formed because of f ailure of the Hertwig’s epithelial root sheath to fuse on the lingual or buccal root surface or it  may also be formed by coalescence because of deposition of the cementum with time. ( Melton DC, 1991, JOE). There are multiple fins and connections in a C shaped root canal making it difficult to completely disinfect. I will describe my experience dealing with such canals. IDENTIFICATION??? We can identify a C shaped canal with a pre-operative radiograph by careful observation. some features observed are:  The pulp chamber is large in the occluso-apical dimension and with a low bifurcation. The semicolon-type C-shaped root canals often present with  (i) fusion or close proximity of two roots,  (ii) a large distal root canal,  (iii) a narrow mesial root canal and  (iv) a blurred image of a third canal in-between. ACCESS OPENING:...

        At the time of tooth eruption, the root development is only 60-80% complete. If the pulp undergoes necrosis due to trauma or carious exposure, dentin formation ceases and root growth is arrested. The resultant immature root will have an apical opening that is very large. This is called an open apex, also referred to previously as a blunderbuss canal.      The walls of the canal with an immature root are thinner and more fragile (because of less mineralization) compared to a mature root. These walls may diverge, be parallel or converge slightly depending on the stage of root development. Open apex may also occur in mature teeth due to external resorption resulting from orthodontic treatment or periapical inflammation.   Problems with an open apex : 1.   larger apical diameter vs. smaller coronal canal diameter makes debridement difficult. 2.    lack of an apical stop makes obturation difficult. 3.   thin...

  In our clinical practise, we often assume a canine to have one root and one root canal. So was my assumption but my habit of critically evaluating the preoperative radiograph has helped to predict the presence of 2 root canals in the present case. On a literature search, I have realised that the occurrence of 2 canals is as high as 12% in some populations and it was about 3.2% in the Indian population. This made me realise how often we might be missing out on these extra canals which might later cause treatment failure.  On examining the preoperative radiograph 2 root canals were seen joining at the apex. It shows a typical Vertucci type II canal system. we went ahead with access opening which was made in a buccolingual direction similar to maxillary premolar. the simple logic here is that the canine roots are broader on the buccolingual direction and that facilitates extra canals. The canals were slowly negotiated with a 10 size K file and working length was determined and ...