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Upper premolar endo and Emax crown

Practicing in a small town or a big city, these two are completely different scenario in respect to charges. Its same as comparing developing nations and developed nations.

But comparing the quality of treatment, it may be exactly same. I started practicing microscope assisted dentistry in 2013. I was charging INR 1200/- for molar root canal at that time. Slowly earning from clinic was directly invested to upgrade clinic with equipment and to upgrade myself for clinical skills by attending various national and international programs. Practicing in small town with limited budget, I had to use the available resources in such a way that quality should not be compromised and money involved should be less. In this case I have used #dummy_bur, we get with new airotor hand-piece, for gingival contouring/ trimming.

34 years healthy male patient came to our #Karnal clinic with complain of pain in right lower back and left upper back jaw. Left upper jaw #pain was only after having chilled or hot stuff. Mild #sensitivity was also there with both hot and chilled food. He was very afraid of dental treatment and wants to get the simplest work done first. There was small cavities in 36 and 37. So we decided to fill those first.

C/E: showed grossly carious 24 and caries in 25. Cold test was positive, in 25, with exaggerated response and mild pain. R/E: 24- periapical lesion, 25- caries involving pulp.

Tx plan: Extraction of 24 followed by dental implant and RCT in 25.

After giving LA, I decided to trim the excess gingiva to create a margin and ease of rubber dam placement. There are many ways to trim the extra gingiva like, using scalpel, cautary, lasers, tissue trimmer bur by DFS, thermacut burs, etc.

Ultimate aim for this is to create a proper margin to ease in rubber dam placement and final restoration. When any of these burs are used, they are used without water so that with heat production bleeding doesn't happen or stops immediately (heat coagulation). I had an idea to try #dummy_bur available with new airotor handpiece and it worked.

Long shank burs are preferred with smaller mouth mirrors (no 3 here) to get better room for access and visibility.

Here, we can appreciate proper rubber dam adaptation on mesial side. It is impossible to adapt rubber dam without tissue/ gum trimming.

If age of patient would be less than 20 years with large canals, with this small exposure we may opt for #direct_pulp_capping with #MTA or #Biodentin.

After entering the pulp chamber, always extend the access cavity or pulp chamber with #safe_end_bur like #EX_24. It is available with most of the companies and is available at regular bur price. #Endo_access bur by #Dentsply is also good option but is comparatively costlier.

#Edge_endo files used for shaping. For coronal shaping/flaring I prefer to use 20/06 or 25/06 according to canal width.

A clean isthmus can be appreciated here. Along with shaping with good files, it is also mandatory to clean the canals well with sod. hypo. 5% and EDTA 17% with any form of agitation/activation.

#Warm_vertical_compaction (WVC) technique is best for obturation of the root canals. WVC helps in achieving 3D fills with least efforts and best accuracy. Only requirement is, we need some dedicated device for WVC.

Its very uncommon to find round canals and GP cones are round in shape. With #WVC we can achieve 3D fills.

Again, colored composites as first layer. It will help us to identify the boundary of pulp chamber and slower the speed of hand-piece in case of re-treatments and stops us before any endodontic mishap.

#Vertical_preparation is very good specially for premolars because of their narrow mesio-distal dimentions. #VertiPrep saves a lot of tooth structure at the neck of tooth, weakest part of tooth.

Before cementation of crown, we should always clean our preps, so that cementation happens to the tooth not biofilm.

Plaque disclosing solution is applied for 10-20 seconds to tooth and then rinsed thoroughly. We can notice the leftover solution/ dye adherent to plaque which must be cleaned before crown cementation.

To remove plaque it is best to use any sandblasting devices or tooth polisher. If not available then tooth polishing brush can also be used to clean the prep.

A good tooth preparation with no undercuts and adequate inter-arch clearance is mandatory for long term predictable outcome.

#Emax (Ivoclar Vivadent), I love the most due to its adequate strength and no harsh effect on the opposite tooth. #Emax crown made by #Dentcare lab, Kerala.

His fear (patient) fear vanished and he got his adjacent tooth (24) extracted and immediate implant placement. If we treat the patients with love and passion, they become yours. Thank you for your valuable time. Your comments and suggestions are welcome. It helps me to perform better in next cases.

Dr. Neeraj Narang #MicroDentistryIndia

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