Endo, cracks, lasers and few other ditties

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January 9, 2005 at 7:19 am #2954 Reply

Glenn van As
Spectator

Hi folks: I post this case for you which I completed on Thursday. It has a guarded prognosis and I am aware of that but thought the case showed a few things such as the value of the microscope for finding and documenting cracks such as this. How methylene blue dye (VISTA DENTAL and I get no kickbacks from them) helps disclose cracks. How erbium lasers can be used to help disinfect cases.

This is a lovely lady who has been having cold sensitivity on a tooth and chewing sensitivity for a short while and came to see me. She has no premolars and has the first molar touching the canine (after ortho many years ago). Very low restorative work in her mouth with this occlusal on the lower left first molar being the culprit to cold and chewing.

I took a picture and explained preop about cracks and my suspicion that the crack on the mesial might enter into the nerve. I chased the crack with Methylene blue mainly to reassure her that I did everything possible to not do the endo but she needed it. The crack went right into the pulp. I found it very interesting and disturbing to see how far the crack went. It went into the canals and started but didn’t completely cross the floor of the pulp.

Now a couple of things………that made me decide to keep the tooth.

No probings on this tooth

PA shows no bone loss in the furca yet

Patient has never had an endo and hated to lose the tooth so…….and in addition I have a few patients now with cracks similar to this that have kept the tooth for 3-4 years now.

I finished the endo (she is in mid 40s) and advised her to have a crown pronto but advised her that the crown doesn’t guarantee the tooth will last forever.

My last words to her were……..I have extended the lifetime of this tooth, but we don’t know for how long.

I used K3 variable taper and variable tip. System B and Obtura with 04 gps in the mesial and 06 in the distal.

The laser is cool in that it really helps reduce the bacterial load. Note on the photographs how just 30 secs of the laser with no other files in between irrigation sequences of bleach almost completely eliminated the bubbling. This is really amazing and something I use routinely for failures, and for non vital cases.

I did this one one step because it was vital and I was really concerned about the risk of fracture of the tooth. I have reduced the height of the tooth and she is coming in next week for a crown.

I know that some of you given the ability to see the extent of the crack may have chosen extraction but the patient decided to give this 50/50 tooth a chance.

Hope you enjoy this interesting case and happy new year to all.

Glenn

January 9, 2005 at 11:08 am #7541 Reply

mickey frankl
Spectator

Thanks for the Great presentation , Glen.
Your patient is very lucky to have such a dentist!
and we are lucky to lerrn from you on our pc’s all arround the world.

Happy new year and keep teaching us.
Thanks
Mickey

January 9, 2005 at 6:27 pm #7547 Reply

Glenn van As
Spectator

Thanks Mickey……its getting harder and harder to find stuff that is interesting to post. I am glad that you find the cases interesting and worthwhile. It makes the time it takes to put them together worth it.

Cya and happy new year

Glenn

January 9, 2005 at 6:51 pm #7538 Reply

drnewitt
Spectator

Nice Glenn

Gawd I like those pics! I think I am getting microenvy… I feel a lease comming on :/
This week alone at the office has convinced me I need some ammo against these damn insurance carriers. 3 molars declined, all by the same dentist, all three with amalgams the size of Nunuvit with cracks runing everywhere.

Anyone doing studies say on culturing the canals before and after erbium Tx (30 seconds)?

January 9, 2005 at 8:54 pm #7540 Reply

jetsfan
Spectator

Glen ,
Beautiful case and beautiful presentation.
I’m sure that I am not alone in saying that I look forward to your posts.
Robert.

January 9, 2005 at 11:18 pm #7545 Reply

Glenn van As
Spectator

Thanks Robert and Paul…….it is kinda fun with the scope sometimes and its hard to believe what you see .

Take care and thanks for the kind words

Glenn

January 13, 2005 at 6:20 am #7542 Reply

wilson11
Spectator

QUOTE

Quote: from Glenn van As on 6:19 pm on Jan. 8, 2005

The laser is cool in that it really helps reduce the bacterial load. Note on the photographs how just 30 secs of the laser with no other files in between irrigation sequences of bleach almost completely eliminated the bubbling. This is really amazing and something I use routinely for failures, and for non vital cases.

Glenn,

do you put the tip in with the bleach in the canal?

January 13, 2005 at 10:13 pm #7549 Reply

N8RV
Spectator

Hey, Glenn —

As usual, great presentation. Your posts are many times a little CE course all by themselves!

Thanks for taking the time to put these together. And never worry that the subject matter is too mundane — no such thing for most of us!

Like drnewitt, you’re giving me microenvy! Maybe next year …

— Don

January 17, 2005 at 2:58 am #7544 Reply

Glenn on the road
Spectator

Just back from Tucson guys and thanks Paul, Wilson , Don….so kind.

I am off to Europe on Tuesday for 10 days so dont fear that something unforeseen has happened.

First off , I dont put the bleach into the canal with the laser as when I first started doing the endos using the laser I had the coating (maybe it was aluminum) interact with the bleach and the coating came off in the tooth (I could see little flakes all in the pulp chamber with the scope).

I just put water in the canal and that is how we do the endo bacterial reduction.

Dn…..thanks and the scope is worth the effort when y ou get to that point.

cya for now

Glenn

January 24, 2005 at 1:37 pm #7550 Reply

Stomotolog
Spectator

Glenn,

Please post the phone # to get the methylene blue.

January 27, 2005 at 4:30 am #7543 Reply

BNelson
Spectator

Glenn
As usual, I agree completely with everyone else that you always do a fantastic job of documenting some very interesting cases. Largely because of you I purchased my scope and have enjoyed it immensely. The things one sees and never imagined before! Have fun with your travels.

January 28, 2005 at 6:37 am #7539 Reply

drnewitt
Spectator

Hi Glenn

you mentioned a diagnositc breakdown of various cracks in teeth. I had this guy in today and wondered if you could describe the cracks with the method you had mentioned.

(Edited by drnewitt at 10:38 pm on Jan. 27, 2005)

January 28, 2005 at 3:56 pm #7548 Reply

Lee Allen
Spectator

Glenn,

Cool stuff as usual.

I wish we had a classification method for cracks since they are not all like. These are beauties.

My take on large cracks like this are: When they spread in all directions from a deep class 1 like a spider web (see the first photo), the tooth is in destruct mode. I have yet to see one that is not an endo. It will eventually fracture down the root and be a perio problem . I will post a spectacular case when I figure out how to get them on this site. These teeth are on a limited life span. Crown is madatory.

At least she knows that and is willing to take the gamble. I would too. You have a good sense of her desire for keeping this tooth. It is important to cover this with the patient.

Great use of laser for endo and solid treatment as usual. We may have to create a new standard in dentistry: Friends of Glenn Society.

January 28, 2005 at 7:30 pm #7537 Reply

Anonymous
Guest

QUOTE

Quote: from Lee Allen on 10:56 am on Jan. 28, 2005

We may have to create a new standard in dentistry: Friends of Glenn Society.

Lee, that would make us FOGS, would it not? Maybe not a great moniker for those doing digital imaging and scopes. 😉

If you need help posting images let me know.

January 31, 2005 at 9:11 am #7546 Reply

Glenn van As
Spectator

Hi folks……..just back from Europe and its 2 am here and cant sleep……..sheez.

Anyways Lee, what a kind post that was and thanks so much for the compliment but I havent the FOGGIEST idea why my posts are so valuable (Pun intended!)…..seriously though Lee, thanks.

I was kind of surprised at the beginning how much my posts could help but with time I have seen that with the scope sometimes I see some pretty interesting stuff. I see that friends like Bruce Nelson (thanks Bruce for the kind words), David Kimmel, Andrew, Ron Kaminer, Ron Schalter, Bob Gregg, Paul Honeycutt, Kelly and hopefully soon Mark Colonna on board. Others have also started to look at microscopes for their laser dentistry. I know that part of the equation is the fact that the two technologies are suited for each other but my hope is that maybe some of my posts had some small influence over the microscope becoming more popular with my laser friends. I have to admit its nice to know that I am not the only cowboy out there doing this……..

Well, its time for me to rest my tired eyes and I will see if I can get these FOGwebs out of them!!

THanks again for all your support folks, its so kind to have you all as friends ……….

Glenn
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