Root Canal and Bonded Core Restoration in One Visit
A 9-year-old male patient presented with throbbing pain on tooth No. 13, which had an old amalgam. I first applied Hygenic Endo-Ice spray (COLTENE) to the tooth, recording response/recovery times. They were both abnormal. I also percussed the tooth, which was positive for sensitivity. With these results, I deemed the tooth to have irreversible pulpitis with acute periapical pathology.
(Note: If these 2 diagnostic methods are inconclusive, I occasionally will try electronic pulp testing. Research, however, has shown that it can be unreliable. If Endo-Ice and percussion results are definitive, I feel comfortable about pursuing endodontic therapy.)In addition to a successful clinical outcome, I typically treatment-plan with a 2-fold goal: patient comfort and profitability. In this case, I decided to complete endodontic treatment and placement of a bonded restoration as a core in a single visit.
After administering anesthesia, I donned my loupes with the FireFly cordless headlight (DenMat) to enhance visualization during this intricate procedure. First, I re-moved the old amalgam restoration and created access to the 2 canals. After isolating the operative site using a latex-free rubber dam (Hygenic Flexi Dam, COLTENE), I performed coronal shaping of the canals. For obturation, I used the GuttaCore obturation system (Dentsply Sirona) and was able achieve a 3-dimensional fill at the apex.
Moving on to the restorative phase, I placed a sectional matrix (Palodent, Dentsply Sirona). Then, a combination of composites was employed. To bulk-fill the chamber, I initially placed Surefil SDR flow+ (Dentsply Sirona). Secondly, I capped off the core with Admira Fusion (VOCO) to create the final restoration.
With this endodontic/restorative procedural juggernaut, we killed 2 birds with 1 stone (or in this case, 1 visit). Using good technique and superb materials, we created a win-win situation. The patient went home pain-free with a long-lasting restoration, and we completed treatment efficiently and successfully.