N Velmurugan, N Bhargavi, Lakshmi Neelima, D Kandaswamy
Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College, Maduravoyal, Chennai - 95, India
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|Date of Submission||13-Apr-2006|
|Date of Decision||02-Nov-2006|
|Date of Acceptance||08-Nov-2006|
| Abstract|| |
Management of vertically fractured tooth or a perforation frequently poses problem during endodontic management. Such teeth often need a pre-endodontic restoration prior to initiation of root canal therapy to aid in the placement of rubber dam clamp. This paper describes a simple method of placement of a pre-endodontic restoration using the canal projection technique using hollow metallic needles as sleeves.
Keywords: Canal projection technique, hollow metallic needle, perforations, pre-endodontic restoration, vertically fractured tooth
|How to cite this article:|
Velmurugan N, Bhargavi N, Neelima L, Kandaswamy D. Restoration of a vertical tooth fracture and a badly mutilated tooth using canal projection. Indian J Dent Res 2007;18:87-9
|How to cite this URL:|
Velmurugan N, Bhargavi N, Neelima L, Kandaswamy D. Restoration of a vertical tooth fracture and a badly mutilated tooth using canal projection. Indian J Dent Res [serial online] 2007 [cited 2014 Mar 7];18:87-9. Available from: http://www.ijdr.in/text.asp?2007/18/2/87/32427
| Introduction|| |
Badly mutilated teeth with open pulp chambers often pose problems to the endodontist during rubber-dam clamp placement. Hence a restoration prior to endodontic treatment is mandatory during management of these teeth. Maintaining the canal patency during such a procedure poses a challenge to the endodontist. This can be achieved by the canal projection technique as suggested by Gerald N Glickmann and Roberta Pileggi wherein a tapered plastic sleeve was used to maintain the canal patency. In this article, we have described the management of two cases, one with a vertical tooth fracture and the other, a badly mutilated tooth, both of which have been restored using canal projection technique prior to endodontic treatment using hypodermic needle as sleeves.
| Case Reports|| |
A 35-year-old female patient reported to our department with a complaint of pain in the right lower posterior tooth since three days. Examination revealed a deeply carious right mandibular first molar with pulpal exposure. Radiograph revealed pulpal involvement. Vitality testing gave a lingering response. A diagnosis of irreversible pulpitis was made and endodontic therapy was initiated.
Access opening was done under rubber dam isolation, pulp was extirpated, and temporary (zinc oxide eugenol) restoration was given. The patient was asked to report after two days. However, patient reported back to us only after 3 months. On examination of the right mandibular first molar, a fracture line of the crown was seen to extend mesiodistally, more towards the lingual aspect [Figure - 1]. On palpation and percussion, no symptoms were elicited from the patient. The fragments were not mobile. The tooth was banded first using a custom made orthodontic band, cemented with zinc phosphate cement. The old temporary restoration was removed and the fracture line was observed through the pulp chamber. The crack was seen on the pulpal floor passing between the mesiobuccal and mesiolingual orifices.
The orifices were widened with gates drills (size 3, 2, and 1) and with a round bur. A hypodermic needle with an outer diameter of 1mm and inner diameter of 0.75 mm cut off at the hub and bevel was used as a sleeve for canal projection. Three sleeves were used for the three canals, each with a K-file (10, 15 or 25 size Mani file) inside them [Figure - 2]. The bondable surfaces were etched for 15 sec. and rinsed. The sleeves were coated with a separating agent and then the sleeves along with their respective files were placed inside the canals and pushed apically as much as possible.
Bonding agent was applied (Single Bond.3M) to the etched surface and light cured for 20 sec. A thin layer of flowable composite was used over which packable composite was condensed and incrementally cured for 40 sec. The final restoration was upto the occlusal level with openings through which the files were patent upto the apex. The projectors/sleeves were removed by engaging an H-file. Working length was determined using Ingle's technique. The canals were cleaned and shaped using crown down technique. Obturation was done using cold lateral compaction of guttapercha [Figure - 3]. The guttapercha was sealed off at the orifices and the remaining projected space was restored with composite. The band was finally removed and final restoration was polished.
A 39-year-old female patient reported to the department with pain in the left lower second molar since 6 months following dislodged restoration. She gave a history of root canal treatment done elsewhere 1 year back. Examination revealed excessive loss of coronal tooth structure in the left mandibular second molar with complete 1oss of the buccal wall [Figure - 4]. Silver points were seen protruding from all the three orifices. Radiograph of the left mandibular second molar revealed root canals that were grossly underfilled with Silver points. These points were removed with cotton pliers. The hypodermic needles with the files in situ were placed within the three canals [Figure - 5] and core build up was done with composite as in the previous case [Figure - 6]. Once the core was built, regular endodontic treatment was carried out under rubber dam isolation.
| Discussion|| |
Canal projection technique using the 'projector endodontic instrument guidance system' (CJM Engineering, Santa Barbara, CA) provides pre-endodontic reconstruction of debilitated coronal and radicular tooth structure while preserving individualized access to the canals. This technique suggested the use of tapered plastic sleeves that mimics the canal shape. In our technique, though the exact taper could not be obtained due to use of a parallel core needle, efforts were made to widen the orifices. Badly mutilated teeth often pose a problem during rubber dam clamp placement. Though techniques have been suggested for isolation of badly broken down teeth, such as: using split dam technique, gingivectomy and crown lengthening procedures, customized splint with rubber dam or clamp placed on the attached gingiva, these techniques will not provide the same level of safety and moisture control as individual tooth isolation., Further, the chamber acts as a reservoir for the irrigant during instrumentation within the canals. Once the crown buildup was done, using canal projection, further endodontic treatment could be done with rubber dam isolation and adequate irrigation. This technique also offers another advantage of immediate post-endodontic restoration.
| Conclusion|| |
This article describes a clinical technique for canal projection using hypodermic needles as sleeves for maintaining canal patency during pre-endodontic restoration. This can be applied in the management of badly mutilated teeth, vertical tooth fracture or perforation repair.
| References|| |
|1.||Cohen and Burns. Pathways of pulp. 8th ed. P. 138-40. |
|2.||Lazarus JP. Provisionally restoring a necrotic tooth while maintaining root canal access. J Am Dent Assoc 2004;135:458-9. [PUBMED] [FULLTEXT]|
|3.||Reid and Callis. Rubber dam in clinical practice. Quintessence Publication: 1991. |
|4.||Chong BS. Coronal leakage and treatment failure. J Endod 1995:21:159-60. |
Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College, Maduravoyal, Chennai - 95
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]