ENDO ACCESS THROUGH A CROWN | 4K Resolution
You ask and you shall receive! I have had a request to demonstrate how to carry out an endodontic access through a full coverage crown. This particular type of treatment is deemed difficult because a crown can conceal the natural cuspal anatomy that can aid in accessing the tooth. Without this anatomy there is a risk of drilling away too much tooth tissue - and even perforating the tooth. In this case, I looked at the angulation of the root and used diamond ultrasonic tips to conservatively remove tooth tissue until two canals were found.
Its important to note that these videos are for your interest only, and that you should be a suitably trained professional to carry out these types of treatments.
TIMECODES
0:00 - Case introduction
1:06 - Checking the root line axis
1:49 - Checking bur orientation
2:05 - Starting the access
2:17- Depth and angulation check with machtou plugger
2:37 - Further access required
2:49 - Pulp horn exposure
3:23 - Attaching rubber dam
3:27 - Searching for the canal orifice
3:52 - Possible canal found?
4:30 - Orientation radiograph with a GP point
4:58 - More canal orifice investigation
5:12 - Canal orifice confirmed
5:56 - Irrigation with 2% Sodium hypochlorite
6:04 - Widening the canal orifice/coronal 1/3
6:33 - Irrigation with 2% Sodium hypochlorite
6:43 - Is the canal orifice off axis in a bucco-lingual direction?
6:58 - Investigating a possible second canal
7:42 - Finding the buccal canal
8:21 - Appreciating the buccal canal line axis
8:46 - Irrigation with 2% Sodium hypochlorite
9:01 - Widening the canal orifice of the buccal canal
9:19 - Irrigation with 2% Sodium hypochlorite
9:27 - Scouting the palatal canal with 8# k-file
9:36 - Mid 1/3 shaping with 15# Hylfex glidepath file
9:54 - Irrigation with 2% Sodium hypochlorite
10:00 - Gaining working length for palatal canal
10:15 - Apical shaping with 15# Hyflex glidepath file
10:22 - Final shaping attempt 25# Hyflex OneFile
10:30 - Recapitulation with 10# K-file
10:35 - Final shaping with 20# Hyflex shaper
11:01 - Attempt at working length measurement in buccal canal
11:15 - Achieving working length with 8# K-File in buccal canal
11:43 - Apical shaping Hyflex 15# buccal canal
11:53 - Irrigation with 2% Sodium hypochlorite
11:58 - Final shaping with 20# Hyflex shaper
12:16 - Palatal cone fit (matched Hyflex 20# GP cone)
12:30 - Buccal cone fit (matched Hyflex 20# GP cone)
12:51 - Final irrigation (NaOCl & 17% EDTA)
13:12 - Ultrasonic activation of NaOCl
13:36 - Final irrigation with 17% EDTA
13:42 - Drying with paper points
13:51 - Obturation with bioceramic sealer using single cone technique
15:10 - Removal of excess sealer
15:33 - Final GP compaction
15:58 - Coronal seal with RMGIC (light cured)
16:07 - final composite restoration
16:21 - Conclusion