OUR APPROACH
Wherever possible, we intend to complete treatment in a single visit. This includes removal of all caries and plastic restorative materials and placement of a permanent core to finish the case. Rotary NiTi files have significant biomechanical advantages over “reciprocating” files and for this reason, Henk only uses rotary file systems.
Due to our enormous experience and investment in sequential rotary NiTi filing, i.e. one motor per file size, even retreatments are generally done in one visit. However, there are exceptions and typically, we treat non-draining teeth with periapical abscess in two visits.
Some other reasons for needing two visits include: severely calcified or curved canals or those that have been previously ledged. Wherever possible, however, it is our intention to complete treatment in one visit.
Free Core placement for posterior teeth.
Henk takes it upon himself to ensure your restorative treatment following endodontics is as predictable as possible.
In posterior teeth this means we can place a suitable permanent material that you can easily prepare for lab constructed cuspal protection restorations. Just mark the corresponding referral form field if you want us to place a core for you. WE DO NOT CHARGE FOR THIS SERVICE.
It is well known that a good coronal seal enhances endodontic success rates. We use Fuji IXGIC to provide an excellent seal over the canal orifices. We then use a bonded re-enforced resin such as Paracore for the core build-up. Bonding following the use of endodontic irrigants requires “refreshment” of the access cavity dentine; we do this using micro-abrasion to enhance bond strength.
In posterior teeth with subgingival caries, resin cores may be contra-indicated. In these cases, we use the classic amalgam Nayyar core This technique offers an outstanding deep seal as well as high strength and retention without the need for destructive post placement.
Temporization for anterior teeth.
Placement of post-cores and preparation of post spaces.
Rarely, it may be better to place a cast post and core. Henk does not place cast materials but can prepare the post-space and send the corresponding burn-out post to you to take a post-space impression with.
Where post-cores are placed it is imperative to have a 1-2mm ferrule. If this cannot be created with a slight sub-gingival preparation, Henk will happily assist by doing a surgical crown lengthening and apically re-positioned flap or recommend that you refer to a periodontist of your choice. The permanent crown preparation will need to be delayed for six weeks, however.
What about teeth with existing crowns and bridges?
We feel the damage that can be caused to the restoration as well as the supporting tooth or core does not justify their removal, unless they are leaking and need replacing anyway. Access cavities are filled in the same way as previously described for posterior and anterior teeth.
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