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Non-surgical re-treatment
ENDODONTIC CHALLENGES IN DENTISTRY

Non-surgical re-treatment

Non-surgical re-treatment1

Endodontic re-treatment is considered to be one of the most challenging procedures in endodontics. In these situations, the OPMI is essential.
Dr. med. dent. Tomas Lang

It is almost impossible to find all root canals and to see the necessary level of detail without a dental microscope. When re-treatment is required due to missed canals, broken instruments or defective fillings, the magnification and the light modes of EXTARO 300 are crucial for me to carry out the work steps precisely and ensure that the treatment is as minimally invasive as possible.

Dr. med. dent. Tomas Lang

Sirius Endo, Essen, Germany

Benefits of using the OPMI on non-surgical re-treatment2

Removal of existing restorations, posts and core materials (especially useful for removal of composite cores)

Pre-operative radiograph of upper right first premolar showing metal posts
Pre-operative radiograph of upper right first premolar showing metal posts
Image courtesy: Dr. Tony Druttman, UK
Image courtesy: Dr. Tony Druttman, UK
Intracoronal removal of the post and core while retaining the crown. The post is being removed with ultrasonics
Intracoronal removal of the post and core while retaining the crown. The post is being removed with ultrasonics
Image courtesy: Dr. Tony Druttman, UK
Image courtesy: Dr. Tony Druttman, UK

Removing fractured instruments and evaluating files to avoid breakage

File evaluation

Evaluation of stainless-steel hand and NiTi rotary files under magnification and enhanced illumination is an excellent and quick way to determine if files are weakening and are at risk of separating. The dentist should look for overwound file flutes (flutes too close to each other) or unwinding flutes (the space between the flutes increases, which makes it appear shiny under enhanced lighting). Identifying this helps reduce the chance of file separation. It is much easier to identify these weak points in a file under magnification.

Pre-operative radiograph of upper right first molar tooth with two fractured instruments
Pre-operative radiograph of upper right first molar tooth with two fractured instruments
Image courtesy: Dr. Tony Druttman, UK
Image courtesy: Dr. Tony Druttman, UK
Post-operative radiograph of the same tooth with the instruments removed using ultrasonic instruments controlled under the OPMI. Note that the canals were curved in a bucco-palatal direction.
Post-operative radiograph of the same tooth with the instruments removed using ultrasonic instruments controlled under the OPMI. Note that the canals were curved in a bucco-palatal direction.
Image courtesy: Dr. Tony Druttman, UK
Image courtesy: Dr. Tony Druttman, UK
Endo Success ET 25 ultrasonic tip has been pre-curved to improve visual access for the removal of fractured instruments
Endo Success ET 25 ultrasonic tip has been pre-curved to improve visual access for the removal of fractured instruments
Distorted rotary file viewed at high magnification under the OPMI

Evaluation and repair of perforations

Evaluation and management of perforations

The ability to visualize and determine the exact extent of a perforation helps determine treatment options and prognosis and makes it possible to repair the site.

Apical plug with MTA

MTA is an excellent material for repairing perforations and sealing large apical foramina. The material can be placed with a great deal of control when using the OPMI to ensure that there are no voids.

Canal and perforation after post removal
Canal and perforation after post removal
Image courtesy: Dr. Tony Druttman, UK
Image courtesy: Dr. Tony Druttman, UK
Root filling and collagen matrix
Root filling and collagen matrix
Image courtesy: Dr. Tony Druttman, UK
Image courtesy: Dr. Tony Druttman, UK
MTA perforation repair
MTA perforation repair
Image courtesy: Dr. Tony Druttman, UK
Image courtesy: Dr. Tony Druttman, UK

Removal of existing root filling materials

Pre-operative radiograph of two lower incisors with apically placed silver point root fillings
Pre-operative radiograph of two lower incisors with apically placed silver point root fillings
Image courtesy: Dr. Tony Druttman, UK
Image courtesy: Dr. Tony Druttman, UK
Post-operative radiograph of lower incisors with silver points removed
Post-operative radiograph of lower incisors with silver points removed
Image courtesy: Dr. Tony Druttman, UK
Image courtesy: Dr. Tony Druttman, UK
The OPMI was used to position and engage two Hedstrom files around the silver points
The OPMI was used to position and engage two Hedstrom files around the silver points
Image courtesy: Dr. Tony Druttman, UK
Image courtesy: Dr. Tony Druttman, UK
Removal of tissue from the isthmus between the mesial canals of a lower molar using ultrasonically energised K-files
Removal of tissue from the isthmus between the mesial canals of a lower molar using ultrasonically energised K-files
Image courtesy: Dr. Tony Druttman, UK
Image courtesy: Dr. Tony Druttman, UK

Removal of necrotic tissue and residual root filling materials after re-preparation of the root canals

Removal of tissue from the isthmus between the mesial canals of a lower molar using ultrasonically energised K-files.

Overcoming ledges and blockages

Pulp stone in the palatal canal adjacent to the root filling
Pulp stone in the palatal canal adjacent to the root filling
Image courtesy: Dr. Tony Druttman, UK
Image courtesy: Dr. Tony Druttman, UK
Pulp stone partially removed from canal
Pulp stone partially removed from canal
Image courtesy: Dr. Tony Druttman, UK
Image courtesy: Dr. Tony Druttman, UK
MB2 canal has been missed
MB2 canal has been missed
Image courtesy: Dr. Tony Druttman, UK
Image courtesy: Dr. Tony Druttman, UK

Location of missed canals

MB2 canal has been missed.

Maximize your product usage with MyZEISS

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  • 1

    Cangas, Haas, Druttman, ZEISS: Microscopic Dentistry – A Practical Guide, EN_30_200_0149I, 92, 2014
  • 2

    Cangas, Haas, Druttman, ZEISS: Microscopic Dentistry – A Practical Guide, EN_30_200_0149I, 91-95, 2014