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Documente Profesional
Documente Cultură
ENDODONTICS
Sebastian Brklein
Key words: endodontics, minimally invasive endodontics (MIE), preservation of tooth structure, surgical microscope
Successful root canal treatment depends on many factors. Up to now, most individual steps during root canal
treatment are carried out without a direct view into the
entire root canal system, especially in curved canal systems. Manual tactility in conjunction with a diagnostic
radiograph mainly represents the sole basis of the
treatment. This raises the question of whether
improved visibility leads to better preservation of tooth
structure or if it is more likely associated with greater
substance weakening.
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Fig 1
8 16
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Access cavity
The design of the access cavity is crucial to maintain
healthy tooth structure (Figs 3 and 4). A diagnostic radiograph to display the anatomy of the tooth and morphology of the root canals is a prerequisite to prepare minimally invasive access cavities as it provides a first orientation concerning the localization of the pulp chamber
and the root canals. However, before access cavity preparation, insufficient coronal restorations and caries
lesions should be removed and a pre-endodontic restoration performed to minimize the risk of recontamination
of the endodontic system during treatment procedures.
The preparation of the access cavity can be divided
into three steps:1
Primary access cavity: Cleaning the whole pulp chamber including complete removal of hard tissues that
may impede the straight line access to the root canals
represents the first step. The differentiation of tertiary
dentin (normally colored differently compared to
regular dentin) is only achievable with good illumination and after drying the cavity. Magnification aids
(eg, surgical microscope or magnifying glasses) facilitate the procedure. Fine diamond-coated or nondiamond-coated ultrasonic tips allow a careful dissection along the recognizable boundaries. This gentle
and fine preparation can usually be performed without the water cooling that hinders clear visibility.
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Possibilities of an operating microscope: gradual enlargement of a millimeter scale (output size 2 mm, scale 0.01 mm).
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Fig 6
size 40, taper .06 is proposed7 to guarantee proper irrigation in the apical part.
According to these requirements, the latest micro-CT
studies of the original taper of various root canals showed
that the functional taper (over the entire canal length) in
maxillary molars is about 1.5% in the buccal root canals
and 6.2% in the palatal root canal.8 In particular, concerning the treatment of noninfected root canals (vital extirpation) this raises the question of the necessity of excessive material removal caused by the use of instruments
with greater tapers. Namely, it is known that a reduced
taper of instruments is correlated with an increased fracture resistance of root canal treated teeth,9 as remaining
structural integrity is known to have an important impact
on the long-term survival rate after adequate coronal restoration of root canal treated teeth.10,11
So far, these considerations are of clinical relevance
because each root canal treatment is associated with a
significant weakening of the tooth structure (crown and
root). The fracture resistance of a root canal treated
tooth is directly correlated with the amount of remain-
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Fig 7 Radiographically adequate root canal filling with obturation of lateral canals without excessive weakening of the root.
CONCLUSION
Minimally invasive endodontics is desirable in the interest of the patient, and preserving tooth structure
requires optical magnification aids (surgical microscope), ultrasonic-assisted preparation techniques,
modern file systems, and in-depth knowledge of the
tooth and root canal anatomy. However, as yet there is
no clear evidence concerning the impact of MIE on the
success rate.
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