Tag Archive: Access

Dura Cut Bur: Endo Access through modern crowns (Zirconia & Lithium Disilicates)

December 27, 2013 2:04 pm Published by

Accessing through the modern crowns is a new challenge to clinicians who end up with the prospect of the need for root canal therapy following cementation of a zirconia or an EMax crown (Lithium Disilicate).

Accessing through a crown is very different than cutting it off. A round bur rotates along its axis and its cutting ability is compromised when you try to cut with it tip (vs. its side.) This specially designed bur called Dura Cut Bur (BrasselerUSA) was chosen by RealWorldEndo to be in the modern Endo Access kit because it addresses the challenges of cutting through the harder modern crown materials.

In this Video, Dr. Nasseh demonstrates the use of Dura Cut for an access preparation through a crown.…

Scout Race Files (Part I)

October 7, 2013 3:26 am Published by

This is a part one of a two part review of Scout Race Files by Brasseler USA.

These files are used for pre-enlargement of the canal prior to final shaping. They are helpful for more difficult anatomy cases where NiTi flexibility and rotary speed comes handy as well as cases where the operator is not interested in using extensive hand filing. These instruments can replace most hand filing; however, the use of a stainless steel hand file, although small (size 6 or 8 hand file) is still recommended prior to using these files. Hand instrumentation prior to rotary instrumentation is always a safe way to prepare the canal.…

Conservative MB2 Retreatment

Conservative MB2 Retreatment

August 4, 2013 1:24 pm Published by

Endodontic failure that is limited to a radiolucency around the MB root of a maxillary molar has a differential diagnosis that includes a missed MB2 canal. Where such diagnosis is suspected, the clinician has the option of apicoectomy vs. non-surgical retreatment. Since apicoectomy in a non treated canal leaves a large volume of bacteria behind in the coronal portion of the canal, this options has been demonstrated to have a limited long term prognosis. In such cases, endodontic retreatment is the best option. Where well fitting, recent crowns with cast posts and other obstacles are present in canals that do not demonstrate any clinical signs of periapical infection, a conservative approach that entails access over the MB root alone may be taken to address the missed MB2 and retreat the entire MB root. Such cases generally do well if the canals are adequately enlarged and other canals were originally well treated. The current video shows one such case.…

Missed MB2 Retreatment

August 1, 2013 3:27 pm Published by

Several anatomical studies shows the prevalence of the MB2 canal in the mesiobuccal root of the maxillary first (and even the second) molar to be as high as 90%. This does not mean that all 90% are clinically treatable but if you have difficulty finding and treating anything less than 75% of your maxillary molars’ MB2 canal it means that you require higher magnification, illumination, and/or better practice in looking in the right place for finding this elusive canal.

The MB2 canal is normally about 2mm lingual, and somewhat mesial to the MB1 canal. This canal is often covered by a dentinal shelf that replicates the external anatomy of the tooth, that is the Cemento-Enamel Junction (CEJ). This shelf should be removed with the aid of ultrasonics or a size 2 slow speed round bur in order to get direct line access to the MB2.

The case shown here is a periapical lesion around MB root of tooth #3 that was referred for apicoectomy. An apico should not be performed in these cases as it does not address the remaining bacteria along the whole length of the missed canal. A conventional endo retreatment with microsurgical exploration to find the MB root should be performed to address the missed MB2 root first with the possibility that an apico may still be necessary (only 10% chance). However, if apico is performed after this retreatment the apico success would be exponentially higher than if it were done without the retreatment first (about 40% vs. 90% success for the apico according to the literature).…