After severe trauma (avulsion, intrusion, and some more indications) teeth need to be replanted. In most instances an endodontic treatment is needed.
there are different protocols for the endodontic treatment: immediately (extraorally; with conventional technique - orthograde; or retrograde, using a special bur-post-system), or postponed (orthograde approach; 7 to 10 days after reimplantation; or within a few days).
All orthograde approaches have to deal with the problem that for a sufficient preparation of the root canal aggressive and toxic irrigants are needed to remove all tissue remnants. When done extraorally these irrigants might contaminate the unsheltered PDL. If done after reimplantation a damage can't be excluded in the PDL, since the irrigants may escape via the apical foramen: the fibers of the PDL are ruptured and thus cannot prevent fluids or dissolvable substances from contaminating the apical outer surface of the root. This might provoke ankylosis and replacement resorption; it has been repeatedly reported that ankylosis started at the apical third of replanted teeth.
The retrograde approach using a special bur-post-system removes all tissue remnants mechanically, avoiding the need for using aggressive irrigants; the burs are used intermittently (withdrawn from root canal completely) and cooled by physiologic saline intensively. There seems to be some smear layer partly filling the entrance of the dentinal tubules.
There are two main questions:
1. Up to now we had no adverse results using Diaket.this sealer is no longer available.are there any recommendations which sealer should be used now? It should be stable against discoloration. Or should the root canal better be prepared somehow before application of the sealer?
2. The bur-post-system is only applicable for teeth with a round or oval root diameter, that means front teeth of the upper jaw. Incisors from the lower jaw can't be treated with that method. Are there any proposals considering the drawbacks mentioned above?
1. Mta like materials as sealer?
2 Sorry, I was unclear.
I didn't mean a Post Core System.
We use machine driven burs to prepare the root canals from a retrograde direction, with diameters of 1.6, 2.0, 2.5, and 3.0 mm.we then insert titanium posts into the prepared root canal using some sealer.
this prevents any contamination of the root canal and the dentinal tubules and therefore any infection related resorption (formerly: inflammatory resorption). It increases the prognosis. It also spares all radiographs related to the Endo treatment, reduces costs, and has some more advantages.
We are looking for a sealer which is working best in the given situation: some debris at the entrance of the dentinal tubules and does not show discoloration with time.
The tooth crown remains untouched, no palatal access cavity. This seems to keep a certain structural integrity thus avoiding any fracture of tooth crown, or root, despite we prepare the root canal quite wide...
1. Yes, MTA like material for complete root canal obturation.
2. Titanium posts? Why so? Posts do not reinforce a tooth. The goal of the post is exclusive to anchor a core (see evidence).
Not quite sure in regards of the suggested treatment approach using sealer and post...etc.
Have you considered the elasticity modulus of the tooth when compared to that
of the titanium post? Evidence is clear against rigid posts and in favour of FR.
BTW I am quite close to Bonn when in Germany. We should organise a come together and get some studies running. What do you think?
Sorry, again, I have to explain a little bit more.
I attach a picture demonstrating the method.
As you can see, we insert a titanium post into the root canal. It is primarily meant to complete the Endo treatment immediately. The post may or may not project beyond the apex/the plain of resection, it is shortened according to your intention. For geometric reasons (the fulcrum moves more apically, thus mobility is decreased) one may choose a certain projection.
even in cases with projection the situation is different compared to usual post problems: since the projecting part of the post is surrounded by connective tissues, there are no bending forces between post and tooth.
When are you in Germany?
Hm!
Have you ever performed a finite element study on this?
Not quite sure in regards of the elasticity modulus ....fulcrum ...etc.
Back in germany the week starting on the 27th of may.
My practice number is 02651900490.
No, not yet, but I thought of FE studies since some time, as we have a specialist for these questions in our clinic.since there were no hints that this method would provoke any complications which could be explained by FE studies (see later) and time is limited, I decided against these studies up to now and did some alternative studies.
Concerning fulcrum: there is histology which show that the smallest width of the "PDL" is located apical of the resection plane at the post.
Do you rate the E module as that important? Since the tooth is more or less intact, and unlike in prosthodontics there are no bending forces this seems to be of a small impact: Clinically we didn't lose any replant that healed in with a functional (= normal) PDL, and in no case we observed any infections which would establish if the Endo would not work or even provoke some fractures of the root. Our observation periods reach at least those of all other studies. In former years we even used posts made of ceramics. But nevertheless you mention some interesting points which are worth being considered. I will think about that.
Do you have any fixed appointments when here in Germany?
I think that you would also be interested in endo studies? I would then ask our specialists to join us. I dedicated my scientific life to trauma cases, studies with that backgound are never a problem... every other topic is, however, difficult....
tel. 004922828722407 - department
mail [email protected]
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