Retreatment (4th year)

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4th Year Al-Azhar University Retreatment lecture.

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  • Retreatment (4th year)

    1. 1. Non-SurgicalRetreatment Oh My God! I hate that ?@!!@? dentist he keeps sending me those failed root canals for me to fix!!! Dr. Ashraf Refai BDS Msc DD HMD Al-Azhar University
    2. 2. Lecturer ofAshrafRefai Samir Endodontics Al-Azhar University BDS MSc DD HMD ashraf_refai@hotmail.com Ashraf Samir Refai www.arefai.edublogs.org www.idclinics.com +20101434323
    3. 3. What IsRetreatment? Non-Surgical Surgical
    4. 4. OfSteps RCT Non-Surgical Finding & Removal of Coronal Negotiating Obturation Disassembly Missed Canals Materials Managing Removal of Perforation blocks ledges & Posts, Fractured Repair apical instruments perforations
    5. 5. Coronal Disassembly Three Possibilities Intact Properly Intact Properly Constructed Restoration Constructed (Needs Extra Access) Restoration(No need for extra access) Improperly Constructed Restoration
    6. 6. Coronal Disassembly Grasping Instrument Percussive Instrument Active Instrument
    7. 7. Coronal Disassembly Cementing Removal Device Agent Factors Affectin Restoration g Design Removal Preparation Type Restoration Type
    8. 8. Coronal Disassembly Grasping Instrument
    9. 9. Coronal Disassembly Percussive Instruments
    10. 10. Coronal Disassembly Active Instruments
    11. 11. OfSteps RCT Non-Surgical Finding & Removal of Coronal Negotiating Obturation Disassembly Missed Canals Materials Managing Removal of Perforation blocks ledges & Posts, Fractured Repair apical instruments perforations
    12. 12. Finding Missed Canals Familiarity with Anatomy Techniques Armamentarium
    13. 13. Finding Missed CanalsRadiographic Analysis SLOB Rule Centralization of the Obturation
    14. 14. Finding Missed CanalsVision & Microscopy
    15. 15. Finding Missed CanalsProperly Accessed Tooth
    16. 16. Finding Missed Canals Ultrasonics
    17. 17. Finding Missed Canals Size #10 & #15 Micro-Openers 7 mm 4% & 6% Taper Angulated for Comfort
    18. 18. Finding Missed Canals Methylene Dyes Blue
    19. 19. Finding Missed Canals NaOCl Test Bubbling at the Suspected Area
    20. 20. Finding Missed CanalsTransillumination Color Explorer Pressure
    21. 21. Finding Missed Canals White Line Test Red Line Test
    22. 22. The Road toHell is Paved with Good Intention…
    23. 23. NegotiatingThose Canals Molars are difficult Conventionally done withstainless steel instruments & lubricants #8, #10 & #15
    24. 24. Of Using ConventionalDisadvantages Methods… They take time to negotiate Errors Ledging Apical zipping Canal Transportation
    25. 25. A NiTiRotary Solution…Pathfiles
    26. 26. Review1. What is Retreatment?2. Causes of Failure3. Steps of Retreatment I. Coronal Disassembly II. Negotiation of Missed Canals
    27. 27. OfSteps RCT Non-Surgical Finding & Removal of Coronal Negotiating Obturation Disassembly Missed Canals Materials Managing Removal of Perforation blocks ledges & Posts, Fractured Repair apical instruments perforations
    28. 28. OfRemoval Obturation Materials Obturation Materials Silver Gutta Resilon Carrier Points Percha Based Materials
    29. 29. OfRemovalSilver Points Careful Removal of Filling Material Use Ultrasonics & Surgical burs
    30. 30. OfRemovalSilver Points Grasping Instrument Try to use a Fulcrum Don’t Over Manipulate
    31. 31. OfRemovalSilver Points Indirect Ultrasonics Don’t Touch the Silver Trough Around the Point Directly Sivler Point
    32. 32. OfRemovalSilver Points Files, Solvents & Chelators
    33. 33. OfRemovalSilver Points Micro Tube & Glue
    34. 34. OfRemovalSilver Points Micro Tube & Files
    35. 35. OfRemovalSilver Points IRS Instrument Removal System
    36. 36. OfRemovalSilver Points IRS 0.8 mm 0.6 mm MicroTube Instrument Removal System Screw Wedge
    37. 37. OfRemovalSilver Points CreateStaging Expose The Position The Insert The Remove ThePlatform Silver Point Micro tube Screw Wedge & Apparatus or Secure The Instrument Silver point or nstrument
    38. 38. OfRemoval Obturation Materials Obturation Materials Silver Gutta Resilon Carrier Points Percha Based Materials
    39. 39. OfRemovalGutta Percha Files & Solvent
    40. 40. OfRemovalGutta Percha Heat & Instrument Removal
    41. 41. OfRemovalGutta PerchaHeat Removal of Gutta Percha
    42. 42. OfRemovalGutta Percha Ultrasonic Removal
    43. 43. OfRemovalGutta Percha Paper Points & Solvent (Wicking)
    44. 44. OfRemovalGutta Percha Rotary Niti Instrument Removal ProTaper Retreatment
    45. 45. OfRemoval Obturation Materials Obturation Materials Silver Gutta Resilon Carrier Points Percha Based Materials
    46. 46. OfRemovalResilon & Co. Similar to Gutta Percha Techniques
    47. 47. OfRemovalCarrier Based Obturation Fulcrum Mechanics IRSFiles & Solvent Ultrasonics Rotary Instrument Removal
    48. 48. OfSteps RCT Non-Surgical Finding & Removal of Coronal Negotiating Obturation Disassembly Missed Canals Materials Managing Removal of Perforation blocks ledges & Posts, Fractured Repair apical instruments perforations
    49. 49. OfRemovalPosts & Fractured InstrumentsPost Removal Type of Post Type of Cement Factors Affecting Anatomy Removal Material of Accessibilit Make y
    50. 50. OfRemovalPosts & Fractured InstrumentsPost Removal 1. Gain SLA 2. Remove Material From Around Post 3. Apply Method of Removal
    51. 51. OfRemovalPosts & Fractured InstrumentsPost Removal Rotosonic Vibration Ultrasonic Vibration Mechanical Method
    52. 52. OfRemovalPosts & Fractured InstrumentsPost Removal
    53. 53. OfRemovalPosts & Fractured Instruments Fractured Instrument St. St. vs NiTi Size of the Removal Instrument Bound vs Unbound Factors Instrument Affecting Design Level of Removal Fracture
    54. 54. OfRemovalPosts & Fractured Instruments Fractured Instrument 1. Gain SLA Removal 2. Create Staging Platform 3. Apply Method of Removal
    55. 55. OfRemovalPosts & Fractured Instruments Fractured Microtubes & Instrument IRS Removal Ultrasonic Vibration
    56. 56. OfSteps RCT Non-Surgical Finding & Removal of Coronal Negotiating Obturation Disassembly Missed Canals Materials Managing Removal of Perforation blocks ledges & Posts, Fractured Repair apical instruments perforations
    57. 57. Blocks &Managing Ledges Managing Causes? Blocks Take Radiographs Precurve Instruments Copious Irrigation & Pecking & Lubrication Watch Winding Motion
    58. 58. Blocks &Managing LedgesManaging LedgesCauses? Take Radiographs Precurve Scratch out Instruments the ledge
    59. 59. Blocks &Managing Ledges Managing Apical Transportation Type I: Type II: Type III: Obturate Retreated Surgical RetreatmentMTA
    60. 60. OfSteps RCT Non-Surgical Finding & Removal of Coronal Negotiating Obturation Disassembly Missed Canals Materials Managing Removal of Perforation blocks ledges & Posts, Fractured Repair apical instruments perforations
    61. 61. Review3. Steps of Retreatment III. Methods of Removal of Obturation Materials IV. ProTaper Retreatment V. Fractured Instrument Removal VI. Post Removal VII. Managing Blockages & Ledges
    62. 62. Non-Surgical Perforation Repair Before After
    63. 63. Non-Surgical Perforation Repair Considerations Timing Location Size Level
    64. 64. Non-Surgical Perforation Repair Considerations Timing Good BadPrognosis PrognosisImmediate 1 Week 1 Month 6 Months 1 Year Repair
    65. 65. Non-Surgical Perforation Repair Considerations Location Buccal Lingual Surgical vs Mesial Distal Non-Surgical Furcal Accessibility
    66. 66. Non-Surgical Perforation Repair Considerations Level Causes Coronal Intraoral Middle Communication Apical Prognosis
    67. 67. Non-Surgical Perforation Repair SizeConsiderations Surface Area Prognosis
    68. 68. Non-Surgical Perforation Repair Repair Materials Amalgam Tattoo Difficult to Manipulate No Longer Reccomended Amalgam
    69. 69. Non-Surgical Perforation Repair Repair Materials 1985 Reinforced ZOE White in Color Amalgam Seals Better Super EBA
    70. 70. Non-Surgical Perforation Repair Repair Materials Early 1990’s Moisture Sensitive Tooth Colored Soluble: Leaching Glass Ionomer
    71. 71. Non-Surgical Perforation Repair Repair Materials Tooth Colored Complex Technique Sensitive To Moisture Bonded Composites
    72. 72. Non-Surgical Perforation Repair Repair Materials All other Materials are Sensitive To Moisture MTA
    73. 73. Non-Surgical Perforation Repair What Is it?1990’s Torbindejad LomaLinda MTA
    74. 74. Non-Surgical Perforation Repair Chemical •Calcium Oxide 65% Compostion •Silicon Dioxide 21% •Ferric Oxide 5% •Aluminum Oxide 4% •Calcium Suflate 2.5% •Magnesium Oxide 2% MTA
    75. 75. Non-Surgical Perforation Repair pH: 12.5 Properties Working Time: 5-6 min Setting Time: 4-6 hrs Radioopaque Biocompatible Needs Moisture To Set MTA
    76. 76. Non-Surgical Perforation Repair Biocompatible Advantages Highly Inductive Sealing Ability MTA
    77. 77. CalcificBarrier
    78. 78. Non-Surgical Perforation Repair Long Setting Disadvantages Time Difficult to Handle Grey Color MTA
    79. 79. Non-Surgical Perforation Repair Uses Apexification Perforation Repair Pulpotomy Root End Filling Pulp Capping MTA
    80. 80. Non-Surgical Perforation Repair Basic Steps Hemostasis Applications of Barrier Material Repair of Perforation
    81. 81. Non-Surgical Perforation Repair Hemostasis Calcium Hydroxide (4 to5 Min in the Canal) MTA Calcium Sulfate Freeze Dried Bone Collagen
    82. 82. Non-Surgical Perforation Repair Application of Barrier Material Absorbable Non-Absorbable Collagen (CollaCote) Calcium Sulfate MTA (Capset)
    83. 83. Non-Surgical Perforation Repair Repair Of Furcation Or Coronal Perforation Step #1 Prepare & Obturate The Canals Fresh or Long Standing
    84. 84. Non-Surgical Perforation Repair Repair Of Furcation Or Coronal Perforation Step #2 Prepare the Perforation Fresh or Long Standing
    85. 85. Non-Surgical Perforation Repair Repair Of Furcation Or Coronal Perforation Step #3 Hemostasis
    86. 86. Non-Surgical Perforation Repair Repair Of Furcation Or MTA is the Coronal Material of Choice Perforation Step #4 •If There is a Sulcular Communication MTA Can’t be Used Apply Barrier •Choice Depends on & Repair Esthetics (Old Gery) Material
    87. 87. Non-Surgical Perforation Repair MTA is Difficult to Handle MAP System: Micro Apical Placement System
    88. 88. 2 Years
    89. 89. Non-Surgical Perforation Repair More Difficult to Repair Of ReachMiddle & Apical1/3 Perforations Possibility of Canal Blockage Principles are the Same If you Can’t Acquire Hemostasis Repair Perforation First (Maintain Canal)
    90. 90. AStory Success
    91. 91. SuccessAnother Story
    92. 92. Use ForAnother MTA
    93. 93. Pre Op
    94. 94. Post Op
    95. 95. 1 Years
    96. 96. Review1. What is Retreatment?2. Causes of Failure3. Steps of Retreatment I. Coronal Disassembly II. Negotiation of Missed Canals
    97. 97. Review3. Steps of Retreatment III. Methods of Removal of Obturation Materials IV. ProTaper Retreatment V. Fractured Instrument Removal VI. Post Removal VII. Managing Blockages & Ledges
    98. 98. Review3. Steps of Retreatment IX. Non-Surgical Perforation Repair
    99. 99. That’s Enough!!!
    100. 100. Lecturer ofAshrafRefai Samir Endodontics Al-Azhar University BDS MSc DD HMD ashraf_refai@hotmail.com Ashraf Samir Refai www.arefai.edublogs.org www.idclinics.com +20101434323

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