CLASS 4

CASE REPORT: A 47 year old male patient presented with broken upper left central incisor. patient had trauma around 6 years back since then incisor third of the left central incisor was missing.
On examination patient had no pain. tooth was vital and there was no any periapical pathology. fracture on left central incisor was involving enamel and dentin











Patient wished for more conservative and affordable treatment therefore composite build up was done with respect to upper left central incisor (CLASS 4)

Full ceramic crowns

CASE REPORT: A 47 year old male presented with the complain of pain and food lodgement between upper left second premolar (25) and upper left first molar (26). Patient had previous repeated filling done between the contact area and it had failed and patient had wished for crown placement with closed contacts between upper left second premolar and first molar.                                                                                                                                                               




 On examination there was a food lodgement broken composite filling on distal surface of the upper left second premolar and mesial surface of upper left first molar ( CLASS 2). Moreover there was a swelling around marginal gingiva with respect to both the teeth.

considering the poor oral hygiene and more consideration of self cleaning rather than aesthetic, supragingival margins of crown cutting were placed after patient's consent and full ceramic crowns were selected for placement.

proper depth and margins were  achieved with the help of putty index and occlusal clearance was maintained for full ceramic crowns following which putty and wash impression was taken with putty and light body rubber base impression material.

final crowns were placed with proper margins of the crowns and maintaining centric occlusion.

Treating one root canal

CASE REPORT: A 22 year old male patient presented with pain on his lower right back tooth since 3 weeks on examination lower right third molar tooth (46) was treated with root canal treatment 2 years back and no crown was provided.

Radiograph showed underfilled distal root canal with periapical radiolucency which was the reason for positive tenderness on percussion.

By keeping a young age of the patient in to the consideration total root canal treatment was avoided and hence only under filled root canal was exposed and treated
The estimated working length was determined of the distal root canal by apex locater but it lacked accuracy due to bio-mechanical preparation and apical flare of the root canal hence the proper working length of the distal root canal was determined with IOPA which is showed in the image below                                                                                                                                                                                             

The apical opening of the distal root canal was located at root resorption near periapical radiolucency












The distal root canal was obturated and later on tooth was crowned to provide additional strength. 

(apologies for the bad photograph as due to more transparency in radio-graphic film picture had to be taken in such a way.)













After completion of root canal treatment full ceramic crown was placed which is shown in the following pictures

Extra root canals

INTRODUCTION:

Knowledge of internal dental morphology is an extremely important in planning and administering endodontic therapy.The numerous anatomical variations existing in root canal system may contribute to the failure of root canal therapy. Failure to explore and instrument even one of the canals results in improper cleaning of root canal system and can lead to endodontic treatment failure. The mandibular first molar, the earliest permanent posterior tooth to be erupt, seems to be the tooth that most often requires root canal treatment. The usual canal distribution is two canals in the mesial root and one or two canals in the distal root.

CASE REPORT:
A 38 year-old female patient presented with a chief complaint of pain in the mandibular left posterior tooth for the past two weeks. Clinical examination revealed a carious left mandibular first molar (36). The clinical and radiographic findings led to a diagnosis of acute exaggeration of chronic periapical abscess.






Down below are the images and radiographs of given treatment.

Figure above shows Pre operative radiograph of the mandibular left first molar tooth showing the presence of more than one canal in distal root, in the patient in the case report

All canals were identified and working length was established by using apex locators and IOPAs

Below is the post operative x ray in which mesial orifices had an additional orifice between the two main buccal and lingual canals and distal orifices showing an additional orifice between two main buccal and lingual canals

Complete obturation was done with full ceramic crown and on recall after 2 months patient had no pain or any sign of infection.