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Management of Blunderbuss Canals in   Endodontics - A 3D attempt.      INDIAN DENTAL ACADEMY       Leader in Continuing De...
www.indiandentalacademy.com
Blunderbuss canals – Wider alternatives• Apexification.• Custom GP roll.• Radicular rehabilitation using resin posts - mon...
Apexification – Not always…!• Presence of periapical pathology - periapical abscess – destruction   of Hertwigs epithelial...
Case Report• 16 years / Male                                    dghseyhqatga• C/o pain & discharge.• H/o apexification  at...
Clinical Examinationwww.indiandentalacademy.com
Radiograph• Incompletely formed roots – blunderbuss apex.• Peri-radicular rarifraction.• Thin fragile dentinal walls.• Api...
Ultrasound – To continue apexification or not…??•   Provides 3 dimensional impression of    the space.•   Exact assessment...
Ultrasound•   Hypoechoic lesion - 6.5 x 5.6 mm with    posterior acoustic enhancement    consistent with fluid collection ...
Treatment planI. Preparatory Phase       II. Surgical Phase    III. Obturation Phase• Radiograph               • MTA as ba...
I    Preparatory Phasewww.indiandentalacademy.com
Diagnostic       Radiograph• Access cavity modified.• Radiographic Working lengthestablished – 21. 5mm.                  w...
• Wax pattern taken.• Flasking - Dewaxing process – acrylizing – heat polymerization  - Custom Resin Block → ENDODONTIC OB...
Volume of Obturator• The resin block is divided into different segments each  measuring 3mm in length and the width of the...
Spiral CTwww.indiandentalacademy.com
Volume of the canal space• The values obtained in the CT scan are calibrated  & scaled down to the required normal size an...
EndometricsVolume of the canal space                 Volume of the obturator→ 152.296 mm3                             → 14...
II Surgical Phasewww.indiandentalacademy.com
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www.indiandentalacademy.com
www.indiandentalacademy.com
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h qatgaDg hseywww.indiandentalacademy.com
Post-op IOPA                                   - MTA                Torabinejad M et al ; 1998 JOEwww.indiandentalacademy....
III Obturation Phasewww.indiandentalacademy.com
www.indiandentalacademy.com
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Dghseyhqatgawww.indiandentalacademy.com
To Conclude…• Wax pattern – Endodontic obturator fabrication with  Resin.• Segmental integration technique – Volume of the...
Thank Youwww.indiandentalacademy.com
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Management of Blunderbuss canals in endodontics /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients

State of the art comprehensive training-Faculty of world wide repute &Very affordable.

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Transcript of "Management of Blunderbuss canals in endodontics /certified fixed orthodontic courses by Indian dental academy "

  1. 1. Management of Blunderbuss Canals in Endodontics - A 3D attempt. INDIAN DENTAL ACADEMY Leader in Continuing Dental Education www.indiandentalacademy.com
  2. 2. www.indiandentalacademy.com
  3. 3. Blunderbuss canals – Wider alternatives• Apexification.• Custom GP roll.• Radicular rehabilitation using resin posts - monobloc concept.• Placement of barrier materials like MTA, Tricalcium phosphate in conjunction with customized post system or backfill technique (Obtura, Flowable resin). www.indiandentalacademy.com
  4. 4. Apexification – Not always…!• Presence of periapical pathology - periapical abscess – destruction of Hertwigs epithelial root sheath.• Repeated sinus tract formation.• Downgrowth of granulomatous tissue - Bleeding manifested when files placed short of apex.• Penetration of the cortical plate by apex.• Defective access seal.• Environmental contamination during procedure.• Inadequate cleaning and sanitizing wide open canals.• Closure not occurred within 2yrs – Failure.• Non-compliant patient. www.indiandentalacademy.com
  5. 5. Case Report• 16 years / Male dghseyhqatga• C/o pain & discharge.• H/o apexification attempted – 2 yrs prior. www.indiandentalacademy.com
  6. 6. Clinical Examinationwww.indiandentalacademy.com
  7. 7. Radiograph• Incompletely formed roots – blunderbuss apex.• Peri-radicular rarifraction.• Thin fragile dentinal walls.• Apically divergent canals .• Lack of apical barrier. www.indiandentalacademy.com
  8. 8. Ultrasound – To continue apexification or not…??• Provides 3 dimensional impression of the space.• Exact assessment of the nature of the peri-radicular tissues.• Information on the size of the lesion, its content & its vascularity.• Differentiates between lesions of endodontic origin. E. Cotti et al ; IEJ 2002 ; 148 – 151. www.indiandentalacademy.com
  9. 9. Ultrasound• Hypoechoic lesion - 6.5 x 5.6 mm with posterior acoustic enhancement consistent with fluid collection - near the root tip of right central incisor.• Few mobile internal echoes consistent with particulate debris - seen within the fluid collection.• Hypoechoic fluid loculation - focal erosion of anterior wall of corresponding alveolar socket - suggestive periapical abscess of right central incisor. Dr. M. Venkatesan, Cons. Radiologist, Bharat Scans. www.indiandentalacademy.com
  10. 10. Treatment planI. Preparatory Phase II. Surgical Phase III. Obturation Phase• Radiograph • MTA as barrier • Tailor-made resin• Wax pattern (2 step tech). obturator cemented• Heat polymerized – Gary D Matt et al ; with dual cure resin Endodontic obturator. JOE 2004 cement.• Spiral CT • LC Composite built-up www.indiandentalacademy.com
  11. 11. I Preparatory Phasewww.indiandentalacademy.com
  12. 12. Diagnostic Radiograph• Access cavity modified.• Radiographic Working lengthestablished – 21. 5mm. www.indiandentalacademy.com
  13. 13. • Wax pattern taken.• Flasking - Dewaxing process – acrylizing – heat polymerization - Custom Resin Block → ENDODONTIC OBTURATOR. www.indiandentalacademy.com
  14. 14. Volume of Obturator• The resin block is divided into different segments each measuring 3mm in length and the width of these segments are measured.• The computation of volume to the total length is done by integrating the entire segments of the resin block → SEGMENTAL INTEGRATION TECHNIQUE.• Volume of the Obturator → 149.625 mm3 www.indiandentalacademy.com
  15. 15. Spiral CTwww.indiandentalacademy.com
  16. 16. Volume of the canal space• The values obtained in the CT scan are calibrated & scaled down to the required normal size and the volume is calculated from the different segments by scaling technique using Engineering scaling principle.• Volume of the canal space → 152.296 mm3 www.indiandentalacademy.com
  17. 17. EndometricsVolume of the canal space Volume of the obturator→ 152.296 mm3 → 149.625 mm3 • Error % → 1. 8 % www.indiandentalacademy.com
  18. 18. II Surgical Phasewww.indiandentalacademy.com
  19. 19. www.indiandentalacademy.com
  20. 20. www.indiandentalacademy.com
  21. 21. www.indiandentalacademy.com
  22. 22. www.indiandentalacademy.com
  23. 23. www.indiandentalacademy.com
  24. 24. h qatgaDg hseywww.indiandentalacademy.com
  25. 25. Post-op IOPA - MTA Torabinejad M et al ; 1998 JOEwww.indiandentalacademy.com
  26. 26. III Obturation Phasewww.indiandentalacademy.com
  27. 27. www.indiandentalacademy.com
  28. 28. www.indiandentalacademy.com
  29. 29. Dghseyhqatgawww.indiandentalacademy.com
  30. 30. To Conclude…• Wax pattern – Endodontic obturator fabrication with Resin.• Segmental integration technique – Volume of the Obturator.• Spiral CT – Volume of the canal space.• Canal volume = Obturator volume → ENDOMETRICS• MTA barrier – apically.• Obturator cemented with dual cure cement. - 3D SEAL..!! www.indiandentalacademy.com
  31. 31. Thank Youwww.indiandentalacademy.com

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