Wednesday, 11 December 2019

Avulsion Management

Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis.Tooth avulsion or exarticulation is a traumatic injury of dental tissue characterised by complete displacement of the tooth out of its socket. Successful treatment outcome of such an injury is dependent on the survival of the viable periodontal ligament cells attached to the tooth root surface. The viability of the periodontal ligament cells is best preserved either when the tooth is immediately replanted into its socket or if it is stored in an appropriate storage /transport medium till a time, the tooth can be replanted into its socket.


Outcomes Of Avulsion
The speed with which the avulsed tooth is replanted is the most important factor for success. There are several possible effects on the root surface and attachment apparatus of an avulsed tooth.

Case Report
This case report  of delayed replantation of avulsed maxillary central incisors after an extended dry extra-alveolar period. 10-year-old girl presented with avulsed maxillary central incisors due to trauma occurring 14 hours earlier.
His parents had let the avulsed tooth dry in a piece of paper and brought it to the clinic. 
After informing the parents of the patient about possible risks, treatment procedure started.
Treatment
Hold the tooth by the crown & Clean the root surface  with a stream of saline.
Administer local anesthesia.
Rinse the socket with saline and Chlorhexidine.
Reposition the tooth very gently in the dental socket with a light digital pressure.
Verify normal position of the replanted tooth clinically and radiographically.
In cases of soft tissue lacerations, suturing should be done to stop the bleeding
Apply a flexible/semirigid splint for 7 to 10 days.
 In cases of bone fracture, the tooth should be splinted for a longer period, (1 or 2 months), depending on the clinical situation
Administer systemic antibiotics .
It is recommended to prescribe antibiotic therapy to avoid the onset of infection during the first week after replantation The administration of systemic antibiotic prevents the development of external root resorption.

Patient instructions
Soft food for up to 2 weeks.
Brush teeth with a soft toothbrush after each meal.
Chlorhexidine rinses  prescribed and strict hygiene instructions given, for the entire splinting period.
 The parents were informed about the importance of regularly returning for clinical and radiographic follow-up. 
Follow-up
Splint removal and clinical and radiographic control after 2 weeks.
As the tooth has been out of the socket and kept dry for more than 1 hour, the calcium hydroxide filling was done for a long follow-up period to evaluate the rate of the replacement root resorption.
Clinical followup examination 1 week, 2  weeks,  4 weeks, 3 months, and then  6 months done.

Tuesday, 10 December 2019

Root Canal Treatment of Cacified canals

CALCIFIED CANALS.
Totally or partially calcified canals present a constant challenge in clinical endodontics with high risk of procedurals accidents, such as perforation and instrument separation, however under the magnification ,illumination provided by a microscope,ultrasonic tips and patience  the whole procedure could become very predictable.

Patience , time, 
diagnostic xray is important , read it before you start, straight line access, Try Keep it simple n sequentially #8 ,10,15 K files, remember U WILL NEED DOZENS, precurve (preflaring)where ever required MULTIPLE rvgs to access progress of files, Coronal Flare, 17% edta , glyde,   hypo irrigation.. 

Monday, 9 December 2019

Pediatric Dental FAQs

Below are common questions and our answers about the best way to care for children’s teeth.When should I schedule my child’s first visit to the dentist?We recommend that you make an appointment to see the dentist as soon as your child gets the first tooth. A child should be seen by six months after his/her first tooth erupts or by one year old, whichever comes first.
What happens during my child’s first visit to the dentist?
The first visit is usually short and simple. In most cases, we focus on getting to know your child and giving you some basic information about dental care. The doctor will check your child’s teeth for placement and health, and will look for any potential problems with the gums and jaw. If necessary, we may do a bit of cleaning. We will also answer any questions you have about how to care for your child’s teeth as they develop.
How can I prepare my child for his first dental appointment?
The best preparation for your child’s first visit to our office is maintaining a positive attitude. Children pick up on adults’ apprehensions, and if you make negative comments about trips to the dentist you can be sure that your child will fear an unpleasant experience and act accordingly. Show your child the pictures of the office on the website. Let your child know that it’s important to keep his/her teeth and gums healthy, and that the doctor will help to do that. Remember that your dentist is trained to handle fears and anxiety, and our staff excels at putting children at ease during treatment.
How often should my child visit the dentist?
We generally recommend scheduling checkups every six months. Depending on the circumstances of your child’s oral health, we may recommend more frequent visits.
Baby teeth aren’t permanent. Why do they need special care?
Although they don’t last as long as permanent teeth, your child’s first teeth play an important role in development. While they’re in place, these primary teeth help your little one speak, smile and chew properly. They also hold space in the jaw for permanent teeth. If a child loses a tooth too early (due to damage or decay) nearby teeth may encroach on that space, which can result in crooked or misplaced permanent teeth. Also, your child’s general health is affected by the oral health of the teeth and gums. If decay on a primary tooth encroaches onto the nerve, an infection may result causing pain and swelling. Bring your child in for an assessment, and we’ll let you know if there are any areas of concern and how best to look after your child’s teeth.
What’s the best way to clean my baby’s teeth?
Even before your baby’s first tooth appears, we recommend you clean the gums after feedings with a damp, soft washcloth. As soon as the first tooth appears, you can start using a toothbrush. Choose a toothbrush with soft bristles and a small head. You most likely can find a toothbrush designed for infants at your local drugstore, or we have some to give you complimentary at your dental visit.
At what age is it appropriate to use toothpaste to clean my child’s teeth?
Once your child has a few teeth, you can start using a paste on the brush. Use only a tiny amount for each cleaning, and be sure to choose toothpaste without fluoride for children under two, because ingesting fluoride can be dangerous for very young children. Always have your children rinse and spit out toothpaste after brushing, to begin a lifelong habit they’ll need when they graduate to fluoride toothpaste. Children naturally want to swallow toothpaste after brushing, and swallowing fluoride toothpaste can cause teeth to stain, a condition called fluorosis. You should brush your children’s teeth until they are ready to take on that responsibility, which usually happens by age six or seven.
What causes cavities?
Certain types of bacteria live in our mouths. When these bacteria come into contact with sugary foods left behind on our teeth after eating, acids are produced. These acids attack the enamel on the exterior of the teeth, eventually eating through the enamel and creating holes in the teeth, which we call cavities.
How can I help my child avoid cavities?
Be sure that your child brushes his/her teeth at least twice a day with toothpaste. Flossing daily is also important, because flossing can reach spots between the teeth that brushing can’t. Avoid sugary foods and drinks, limit snacking, and maintain a healthy diet. And finally, make regular appointments so that we can check the health of your child’s teeth and provide professional dental hygiene treatments.
Does my child need dental sealants?
Sealants cover the pits and fissures in teeth that are difficult to brush and therefore susceptible to decay. We recommend sealants as a safe, simple way to help your child avoid cavities, especially for molars, which are hardest to reach.
My child plays sports. How can I protect his teeth?
Even children’s sports involve contact, and we recommend mouthguards for children active in sports. If your little one plays baseball, soccer, or other sports, ask us about having a custom-fitted mouthguard made to protect the teeth, lips, cheeks, and gums.
What should I do if my child sucks his thumb?
The large majority of children suck their thumbs or fingers as infants, and most grow out of it by the age of four, without causing any permanent damage to their teeth. If your child continues sucking after permanent teeth erupt, or if your child sucks aggressively, let us know and we can check to see if any problems may arise from the habit.
When should my child have dental X-rays taken?
We recommend taking X-rays around the age of two or three. The first set consists of simple pictures of the front upper and lower teeth, which familiarizes your child with the process. Once the baby teeth in back are touching one another, then regular X-rays are recommended. Permanent teeth start coming in around age six, and X-rays help us make sure your child’s teeth and jaw are healthy and properly aligned.

Sunday, 8 December 2019

Denture Treatment

Why do I Need a Partial Denture Treatment?
Denture treatments are used to replace missing teeth.  Dentures can be removed from your mouth or put back in. It might take some time to get used to having dentures in your mouth, and they won’t ever feel exactly like your natural teeth, but with today’s advancements they are more comfortable and natural looking than ever before.
Two Types of Dentures
The two types of dentures are full or partial. These two terms refer specifically to the size of the dentures you are having fitted. A partial is used to replace fewer teeth but full dentures are used if all of the teeth are being replaced.
How Dentures Work
If you are fitted with full dentures, a special acrylic base that is the color of your gums will be fitted over your gums. They are shaped like a horseshoe with a base to cover the top of your mouth. we will take an impression of your mouth and gums and specially make dentures to fit your mouth comfortably. There are three basic fittings for dentures that the dentist will choose from.
  • Conventional Full Dentures are put in the mouth once the teeth have been removed and all the tissue has healed. Each person heals at a different rate, and this can be a lengthy process.
  • Immediate Full Dentures are put in immediately after the teeth have been extracted. The dentist will have already taken impressions in earlier visits. The advantage to this procedure is that you are not without your teeth for an extended amount of time.
  • Partial Dentures are built on a metal structure that will attach directly to your teeth. For some, crowns need to be placed directly on the remaining natural teeth which can serve as anchors.
Getting Used to Dentures
It can take some time to get used to dentures since they can feel uncomfortable at first. They can feel awkward for a few weeks and even for a few months for some people. It might even take some practice to learn how to eat with them in. It’s not uncommon for them to feel a little loose or bulky while you are getting used to them. You might feel like your tongue doesn’t have enough room and you may make extra amounts of saliva for a while. You will get used to them as time goes by and they will not be as uncomfortable.
When to See a Dentist about Dentures
Once you get dentures, you may have some difficulty speaking or with some pronunciations. You may need to practice saying words out loud in order to master their pronunciation. In no time, you will be able to speak properly with dentures. Some people experience a “clicking” sound when they are talking. If this happens, have the dentist examine them. Sometimes dentures can slip a little when you are laughing or coughing. They can be repositioned by biting down and then swallowing. If they continue to cause speaking problems speak to the dentist to see if an adjustment can be made.

Friday, 11 July 2014

Protaper Endodontic Files


 ProTaper geometries:


 The Endodontic ProTaper files have a unique features, including:

- Changing percentage tapers over the length of its cutting blades.
 - The progressively tapered design replicates the Schilderian Envelope of Motion technique and serves to significantly improve flexibility, cutting efficiency, and safety.

 - They are convex, triangular cross-section, which enhances the cutting action while decreasing the rotational friction between the blade of the file and dentin.
 - They have a changing helical angle and pitch over their cutting blades, which reduces the potential of an instrument from inadvertently screwing into the canal.
 - The noncutting, modified guiding tip. This feature allows each instrument to safely follow the secured portion of a canal, while the small flat on its tip enhances its ability to find its way through soft tissue and debris.
 - The ProTaper system is comprised of three Shaping and five Finishing files

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 There are two types of files for the ProTaper Endodontic Files;

 "The Shaping Files" and "The Finishing Files" ...

 The Shaping Files:


 - Shaping Files are Two: File No. 1 & File No. 2, Termed S1 & S2, Purple and White Respectively.
 - The Auxiliary Shaping File, termed SX, has no identification ring on its gold-colored handle and, with a shorter overall length of 19 mm.
 - The S1 and S2 files have D0 diameters of 0.17 mm and 0.20 mm, respectively, and their D14 maximal flute diameters approach 1.20 mm.
 - SX File, provides excellent access when space is restrictive. The SX file has a D0 diameter of 0.19 mm and a D14 diameter approaching 1.20 mm.
 - The Shaping files have increasingly larger percentage tapering, allowing each instrument to engage, cut, prepare and shape the canal, performing its own 'crown down' work.
 - SX File has a much quicker rate of taper between D1 and D9 as compared to the other ProTaper "S files", it is primarily used after the S1 and S2 files to more fully shape canals in "coronally broken down" or "anatomically shorter" teeth.

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 The Finishing files:

 - There are five "Finishing files" named F1, F2, F3, F4, and F5 have yellow, red, blue, double black, and double yellow colores corresponding to D0 diameters and apical tapers of 20/07, 25/08, 30/09, 40/06, and 50/05, respectively.
 - From D4–D14 each instrument has a decreasing percentage taper which serves to improve flexibility, reduce the potential for dangerous taper-lock, and reduce the potential to needlessly overenlarge the coronal two-thirds.

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 ProTaper shaping technique:

 - First, one should know that: The potential to consistently shape canals and clean root canal systems is significantly enhanced when the coronal two-thirds of the canal is first pre-enlarged, followed by preparing its apical one-third.

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 Scout the coronal two-thirds:



 - "Hand files" sizes 10 and 15 are measured and precurved to match the anticipated full length and curvature of the root canal.
 - The 10 and 15 hand files may be utilized within any portion of the canal until they are loose and a smooth reproducible glide path is confirmed.
 - The loose depth of the 15 file is measured and this length transferred to the ProTaper S1 and S2 files.

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 Shape the coronal two-thirds:


 - The secured portion of the canal can be optimally pre-enlarged by first utilizing S1, then S2. Prior to initiating shaping procedures,
 - The pulp chamber is filled with a full strength solution of NaOCl.
 - Without pressure, the ProTaper Shaping files are inserted into the canal and follow the glide path freely and easily.
 - For more optimize safety and efficiency, the Shaping files are used, like a brush, creating lateral space, which will make the Shaping file’s larger, stronger, and of more active cutting blades.
 - N.B: this brush-cutting action can be used to:
 Eliminate cervically positioned triangles of dentin,
 More effectively shape into fins, isthmuses, and canal irregularities, and
 To relocate the coronal aspect of a canal away from furcal danger.
 - N.B: If any ProTaper File ceases inside the secure Portion of the canal, then withdraw it and know that the debris blocked the intrablade spaces making the walls push the file away and decrease the cutting effeciency.
 - N.B: Upon removing each Shaping file, visualize where the debris is located along its cutting blades to better appreciate the region within the canal that is being prepared.
 - Following the use of each Shaping file, irrigate, recapitulate with a 10 file to break up debris, and move it into solution, then re-irrigate.

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 Scout the apical one-third:

 - The apical one-third of the canal is fully negotiated and enlarged to at least a size 15 hand file, Working length confirmed, then the patency file is established.
 - NOW, A decision must be made between whether to finish the apical one-third with rotary or hand instruments.


 - If, a new size 15 hand file glide easily inside the canal without any interupption, this means that the canal if of normal shape and having no irrigularities and anatomical morphologies, then the Rotary ProTaper will be very good, easy and successfull.
 - While If, a size 10 or 15 hand files must be precurved and necessitate a reciprocating handle motion, then the Manual ProTaper File is the best and most successful choice.

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 Shape the apical one-third:

 - Vigorous irrigation with NaOCl is very important now, to remove the debris that may decrease the effect of the shaping files (discussed befor in "Shape the coronal two-thirds" section), to avoid blockage of canals and facilitate the shaping proccess.
 - The ProTaper sequence is to carry the S1, then the S2, to the full working length.
 - Float, follow, and brush (discussed befor in "Shape the coronal two-thirds" section) until the terminus of the canal (Apical Foramen) is reached.
 - S1, then S2, will typically move to length in one or more passes depending on the length, diameter, and curvature of the canal.
 - Following each ProTaper file, irrigate, recapitulate with a size 10 file, then re-irrigate.
 - After using the Shaping files, particularly in more curved canals, working length should be reconfirmed, as a more direct path to the apical foramen has been established, leading to decrease working length.
 - The preparation can be finished using one or more of the ProTaper Finishing files in a non-brushing manner.
 - The F1 is selected and passively allowed to move deeper into the canal, in one or more passes, until the terminus is reached.
 - Apical flutes are inspected, and if they are loaded with dentin, then visual evidence supports, the shape is cut.
 - After using the F1 file, Irrigate with NaOCl, recapitulate, confirm patency, then re-irrigate to liberate debris from the canal.

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 ProTaper finishing criteria:


 - Following the use of the Protaper File F1, the ProTaper Finishing Criteria is to gauge the size of the foramen with a Manuale file 20 to determine if this instrument is snug or loose at length, If the 20 hand file is snug at length, then the canal is fully shaped and, if irrigation protocols have been followed, ready to pack.
- if the 20 hand file is loose at length, then gauge the size of the foramen with a 25 tapered hand file. If the 25 file is snug at length, then the canal is fully shaped and ready to pack.

 - If the 25 file is short of length, proceed to the Protaper File F2 and, when necessary, the Protaper File F3, the Protaper File F4, and the Protaper File F5, gauging after each ProTaper Finisher with the same D0 correspondingly sized hand file.
 - If the 50 hand file is loose at length, then use alternative NiTi rotary or manual files to finish the apical extent of these larger, easier, and more straightforward canals.


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Tuesday, 8 July 2014

Abrasion, Erosion

Dental Abrasion:It may seem logical that the harder you brush your teeth, the cleaner they'll be. But applying too much pressure can actually weaken the outer layers of the tooth structure. This condition, called dental abrasion, can occur when any foreign object causes friction against your teeth and gradually wears away the enamel on the surface. 

Tooth abrasion is not caused by one method alone but by numerous different activities. The main cause however can be due to brushing your teeth incorrectly. Brushing your teeth to hard to fast or even using the wrong toothpaste can lead to serious tooth abrasion. Other causes of tooth abrasion include grinding your teeth using your teeth as a cutting tool and chewing on hard objects.


Dental Abrasion Treatment: What You Should (and Shouldn’t) Do
While there are multiple ways to treat dental abrasion, it's always better to prevent dental issues before they start. You can start your dental treatment by following a few simple guidelines:
- Always use a soft-bristled toothbrush.
- Ask your dentist for tips on how to brush properly, and avoid brushing too hard.
- Refrain from chewing on toothpicks and pencils or biting your nails.
- Make sure removable dental appliances fit properly and have them checked on a regular basis.
- Don't forget to schedule regular dentist visits to give your dentist a chance to detect any problems early on.

Dental Erosion: Frequently consuming foods with a low pH value, such as soft drinks, fruit juices, pickles, fresh fruit and yogurt can lead to irreversible dental erosion. When food or drink that is acidic is consumed the enamel will soften for a short amount of time. Typically, saliva slowly helps to restore the natural balance of the acid found in the mouth.