The Diary of an Endodontist - Episode 15 - Deep caries

hello everyone and welcome back to the 15th episode of the Diary of an endodontist today we'll be discussing about deep carries so stay with [Music] me dip carries are quite common aren't they so it's always like a doubt if we can save those teeth or not when the carries become like a two sub Ginger bow so when we see like in this case in this lower right six we can see here quite a big cavity and it's sub Jingo so the gingo margin is over there the other truth is Al also broken down and there

is a possible periapical Regency so this x-ray was referred to us the first thing we do is although the cbct was not um you know advised for for deep carries but you can see deep carries in there and that's exactly what you see and yes it is sub Jingo quite deeply Sub sub jingal but look at the bone level the bone level is not too bad compared to where the margin of the tooth may be of course you will remove all of that because it's all decayed but what I pay attention is where the foration

area is if the foration is quite below that area the tooth can be restored even if you need some crown lengthening but if the foration was about here or or the carries was about there then for you to do bone like a crown lengthening on that tooth you will end up exposing forcation and then it's always about like Crown ratio and see what is inside of the bone what is outside to see the longevity of that tooth but every time you go below CJ for example it becomes more and more compromised but in this case

it was quite clear that the tooth could be restored and sometimes clinically it looks too bad but on the when you take the X-ray you see more inside of the bone and then it becomes a bit clearer whether we can save this truth or not so a bit more evident where the peral Regency is so you can see over there and also in the misio a little bit of widening and also on the disto root of the lower right seven so both aties were advised and a crown on both teeth in this tooth here I

would say as there is enough coronal toothy structure there is is no need for posts even if it's quite horizontal here you can do a very nice core build up and put a crown without post the first root canal treatment was done and the main thing is to disinfect this tooth properly so you can start seeing your lateral canals and the sealer puffs when you are when you see that you are always happy saying oh I got it I've disinfected enough and pay attention on the apical portion as well because you won't the sealer to

go over there so if it's a bioceramic sealer there is no problem and it's advised to have a tiny bit of that Extrusion it means that you've done enough patency when you were cleaning your teeth so the feeling was a semi-permanent feeling and that gave us time to do the root canal treatment on the other tooth and that is the final the completed root canal and as you can see quite complex curvature so be careful not to start ledging that Canal it's very easy to ledge so pre-end your files is very important so you can

negotiate this uh curvature another important thing is for you when you are doing your final core uh if you do a composite core make sure you go and go slightly deeper into the canal about 2 to three millimeters deeper so you can put the flowable composite before you you Bond your composite um there was a little bit of void here but don't worry too much that's fine it will be strong enough both teeth will go for crowns this is not the ideal core so it will have it replaced uh a bit more solid but uh

we wanted to finish the root canal treatment for the dentist to carry on with that treatment so just make sure it's stay able because you don't want any coronal leakage once the patient is completely symptom free that's when we advise the crown before that uh I would say for example sometimes you just rush into the crown in a week or so but if the truth is still a bit uncomfortable I would rather wait a little bit longer don't wait too long because otherwise you start to have Corona leakage and you don't want that you want

to be in control of the case you want everything to be sealed and um so it's more predictable for the long-term prognosis I hope you have enjoyed this case and don't forget dip carries they can be quite tricky and sometimes clinically you think you can save the tooth but make sure you do a proper examination combining all the scans and xrays and parodontal probing and make sure we can save more teeth now take care and good luck with your [Music] cases