hello everyone and welcome back to the 17th episode of the Diary of an endodontist and today we'll be talking about conservative access cavities so stay with [Music] me this patient was referred to me and as you can see on the cbct there is a very large paricular regul lucency on the upper right five the patient has been experiencing pain from the tooth and as you can see the root feeling doesn't look too bad it's important to notice that the cervical bone is intact meaning that it may not be a case of a cracked tooth but
probably an untreated Canal or residual canal and that's exactly what it is the PTO Canal was untreated and leaving residual bacteria which explains the contamination apically so what we suggested to the patient as the crown was a was a new Crown we suggested the access cavity through the crown you need to be careful because prolar are quite prone to fracture upper prolar and what you need to do is to be very conservative accessing that cavity through the crown because the other thing you don't want the crown to fracture so lots of water when you were
drilling into the porcelain we retreated the canal and as you can see there is enough porcelain on both in all directions so the tooth was strong enough with that Crown the acccess was very small enough just to to see the canals we then retreated it you can see how how dark and how white that infection is the the access cavity shouldn't be any wider than the canals um there is enough Co core is still on that tooth and we just warned the patient about the Decay the carries inside the under the amalgam feeling on the
upper right six and explain to the patient that could go to necrosis and needed a root canal treatment if it's not already because I can see widening of the apol liament so the truth was still vital and we suggested that the patient to have that treated electively treated because it needed a crown 12 months later the tooth as you can see Caris got a little bit wider and the tooth became symptomatic and we could see healing from this tooth here the upper right five so good healing patient was absolutely happy and now ready for the
root canal treatment on the upper right six the patient was already aware of the seven needing retreatment as well but he wanted to do one thing at a time the retreatment was done for the six and 18 months we could check that the healing was uh getting there it's a very big lesion so it takes time for the bone to get mature but what I normally say is once we start seeing healing that will carry On Healing because the the bacteria in that area when you have bacteria the bone doesn't grow so the bone will
only grow in the absence of bacteria so once it's under control then you have bone healing and you don't really need to do lots of reviews because it will carry On Healing as long as everything is fine and there is no corono leakage I hope you have enjoyed this case and I hope you look after those access cavities so you don't start enlarging them and necessarily because if you enlarge them you put the tooth at risk at mainly cervically where is the weakest point of the tooth so be careful with your ax cavy don't forget
to use magnification as well otherwise it's quite difficult for you to see with those uh small AIS cavities thank you very much and stay safe take care [Music] bye-bye
