Dystrophic Calcification

Allen Ali Nasseh   uploaded 10 years ago

A tooth #10 with a history of trauma followed by a crown that broke off at the gingival level was sent for endodontic therapy prior to post space preparation. After access through the dystrophic calcification, a defected, rusted #17 Flexo-file fails upon insertion in the already patent and instrumented to size 10 canal. The file is loose and its retrieval with instruments /ultrasonic is not possible since the tip can not be grabbed by any instrument as well as the fact that the rusted file may shatter into pieces if ultrasonic energy is applied. A technique utilizing Cyanoacrylate is demonstrated to retrieve the instrument inside the canal. Following obturation, the a variation from the previously explained technique (look up Nasseh Post Preparation Technique) is demonstrated, which involves fitting a post first, followed by scoring the final fitted gutta percha at the apical level of the fitted post, then cementing the gutta percha in the canal and twisting off the handle (separating the handle from the scored tip) and then condensing the cemented segment.


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    • #4848
      AvatarFrancesco Piccione

      Hello Dr. Nasseh,

      Great video! Some questions for you:

      1. How did you cement temporaries in situations like these where there is no tooth structure remaining above the gingiva?

      2. Also how do you cement the temporary in situations like these while maintaining proper isolation? In order to cement the temporary you would have to remove the opal dam to expose the margin of the tooth, which is where the gingiva and the tooth meet, thus potentially contaminating the canal with seepage of fluid from the gingiva, saliva, etc. Is there a better way to maintain isolation, or in situations like these where there is extensive loss of tooth structure is it just a risk that we have to take?

      Thank you.

    • #4849
      Allen Ali NassehAllen Ali Nasseh

      Hi there! Teeth like this can be temporized with using the fiber post as an extension of the temporary in order to get some in track Ronald retention. It will also help you understand is the final crown can be maintained that way since there’s no ferule. Yes, it’s a compromise and involves a lot of trade offs; but as long as the patient understands it’s an attempt at saving the tooth and understands the limitations it’s worth a try. Regarding contamination, it’s easier in this area due to not having salivary flow and staying dry is not an issue. In the mandibilar molar area with the tongue and higher saliva content sometimes it’s better to do a quick build up on the tooth prior to the access. Hope this helps. 🙂

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