‘how to’ technique

Issue 31 2013 How to create an easy access hole for a

fractured anÉerior tooth requiring RCT .

Tip on restoring a fractured anterior tooth

when easy access to the root canal is
required.

Background: When an anterior tooth has suffered a crown

fracture with pulp involvement in may be necessary to use a
material, such as calcium hydroxide, as a temporary root filling.
In such circumstances there is a challenge for the operator.
It is to provide the patient with an aesthetic restoration but
still allow easy access to the root canal to replace the
calcium hydroxide when necessary.
One way of doing this is to use a large gutta-percha (GP)
point in combination with a resin composite.

Technique:
before after
1. Ensure the involved tooth is well isolated.
2. After placing the temporary root filling remove the material With a fractured tooth, when it is necessary to
have access to a root canal, yet provide the
from the coronal 1/3 of the canal.
patient with an aesthetic restoration, the follow-
3. Select a large GP point and cut it so that it provides a snug ing technique can be used:
fit in the coronal third of the canal.
4. With the GP point in place, etch the adjacent enamel with
37% phosphoric acid for 10-15 seconds. Include all the area to Technique
be restored.

1
5. Wash, dry and place an unfilled resin (or a primer and a
bonding agent such as Optibond FL [Kerr Corp] or a two-step,
self-etching dentine bonding agent such as Clearfil SE Bond
temporary
[Kuraray]). Light cure. root filling
6. Build up the restoration with increments of resin composite, e.g. calcium
hydroxide
light curing each increment. Ensure that the area around the
protruding GP point has no gaps.
7. Remove the protruding GP point to be level with the lin-
gual surface of the resin composite and check the occlusion. large gutta-
Add or remove resin composite as required. If adding resin percha snug fit
composite do not cover the GP point. point

8. With a suitable bur remove the surface layer of the GP

point to a depth of 1.5 mm.
9. Restore the resulting cavity with a darker-shade resin Remove the coronal third of the temporary
composite. This will allow for easy identification of the access root filling and cut a large gutta-percha point to
cavity at a later stage. fit snugly as shown.

Reference: Cooper JR, Blalock JS. A suggested

solution for endodontic provisional challenges.
Oper Dent 2009;34:356-358.
>>

Source: www.dentaloutlook.com.au
 ‘how to’ technique
How to create an easy access hole. (cont)

Postscript:
2
Another advantage of the technique is when subsequent re-entry
is made into the root canal and the GP point removed, there is a
well-defined access cavity.
So, if another temporary root filling is required, an operator has
the option of using a more conventional means sealing of the
etch, wash
access cavity if desired. and dry

3 4 Etch the enamel area to be restored

with 37% phosphoric acid then
wash and dry. Place an unfilled
resin or the primer and resin
from a suitable dentine-
resin each increment bonding agent and light
composite of resin com- cure.
posite light
cured

Build up the restoration with small Light cure each

increments of resin composite. Ensure increment of resin
that the material is packed well composite.
around the gutta-percha point.

5 6

heated
instrument

GP removed to a darker-shade resin

depth of 1.5 mm composite placed
The gutta-percha point is cut to be flush
with the lingual surface and the occlusion The surface layer of the GP point is removed to a
checked. It may be necessary to add or depth of 2 mm. The cavity is restored with a darker-
remove some resin composite to achieve shade resin composite (for easier recognition).
the proper contour.

Source: www.dentaloutlook.com.au