Blending Technology for Innovative Endodontic Success
Treatment plans have become more complex with the merger of restoring natural teeth along with implants. How often does the failure of a single root canal condemn an entire completed treatment plan? It’s expensive and frustrating both to the dentist and the patient. There are many types of technologies and techniques available to assist our colleagues in these threatening situations. Understanding how CBCT, surgical microscopes, and lasers can be used together helps rescue many failing cases with a small degree of invasiveness.
We perform many apical surgeries, but prefer retreatment and have incorporated our ALERT (Advanced Laser Energy Retreatment Technique) protocol, which blends together the different new technologies on the market. Many practitioners don’t realize that these teeth can be saved, rather than scheduled for extraction.
A 70-year-old patient was referred with the chief complaint of pain while chewing. The restorative dentist had replaced a crown 3 months before on tooth No. 4. The root canal was done 4 years earlier with no history of symptoms. The medical history revealed the patient was on Plavix and suffered from mild Essential Tremor Syndrome, common in the elderly population. The occlusion and periodontium were within normal limits.
The objective was to retreat the root canal with little disturbance to the tooth, post core, and crown. We planned to use 3D technology to guide us, a surgical microscope to allow us to see the negotiated path, select armamentarium to help us negotiate the canal, and laser technology to help us sterilize before obturation.
A traditional periapical film was taken, which revealed periapical pathology at the apex of tooth No. 4, as well as intimate sinus proximity. To determine a more precise course of endodontic treatment, ProMax 3D CBCT (Planmeca) is a standard procedure in our office. There is a low degree of metal artifacts outside the field of view, so a small volume is sufficient. Although the patient suffers from involuntary movement of tremors, the ProMax 3D CBCT has a large variety of image settings to tailor to any patient’s situation. A quicker scan will be needed. The ProMax has a new breakthrough technology, Ultra Low Dose imaging, which has a reduced exposure time and significant reduction in radiation exposure, without the loss of image quality. A small volume (50 × 50 mm, 400 ?m) is used for 10 seconds on HD mode. This delivers an effective patient dose of 3 ?m. The volume confirms the tooth is in close proximity to the sinus, but most important, the buccal-palatal position of the post and the unfilled canal space to the palatal aspect of the post. With this information, 2 treatment plans were presented: surgical treatment or nonsurgical retreatment. Surgical intervention would leave the patient with a compromised crown/root ratio, with already increased occlusal forces and the inability of platelet clotting from the Plavix. The patient’s concern was the expense and time of a new post and crown. The treatment of choice was the retreatment of the root canal.
The technique used in this case has benefited many patients in our practice. Both patient and dentist are exceptionally satisfied not having to go through the extra time, expense, and frustration of a new treatment plan.