|Can We Save This Tooth?
Utah Dental Association Convention
What is the “question” with questionable teeth?
What is value?
We are loss averse
The psychophysics of chances
Tooth risk ratio
What does (any) technology offer us?
When is screening beneficial?
When the test doesn’t miss too many cases of the disease or condition.
When the test doesn’t harm you significantly.
When the treatment for the disease doesn’t cause more harm than good.
What do tests tell us?
System 1 and System 2
System 1 is effortless and immensely powerful
System 1 resolves ambiguity
When is new information a game changer?
It changes treatment plan
It alters proposed treatment
What is an “X-ray”?
Cone Beam Computed Tomography
Interpreting CBCT Image
Longitudinal Tooth Fractures
Varying Strength of Dentin
Water and dentin
Intrapulpal pressure of 10-28mm Hg
Water is bound to collagen
Water has a hydraulic cushioning effect
Hydrated dentin has significantly higher crack initiation and crack growth toughness
Existing Tooth Structure
Occlusal Risk Factors
Coronal to apical progression
Vertical root fracture
Apical to coronal progression
Longitudinal Tooth Fractures
Entities That Mimic Root Fracture
Why Are There So Many Nerves in Teeth?
Dentin is an intimate structure of organic and inorganic components
Endodontic irrigants are formulated to degrade organic material
Endodontic Decision Making
Changes in Access
Gates Glidden Use
“Cleaning” a Narrow Shape
Importance of NaOCl Agitation
Indications for a Post
Principles for Posts
Types of Posts
Difficulties Bonding Within the Canal
Is It Good to Have the Same Modulus of Elasticity as Dentin?
Can We Re-Grow a Ferrule?
Can We Re-Grow the Dento-alveolar Apparatus?
A condition associated with a physiologic or pathologic process that causes a loss of cementum or root dentin
Homeostasis of Pulp and PDL
Mechanism of Hard Tissue Destruction
Osteoclast in Repair
Classification of Root Resorption
Internal Root Resorption
Internal Radial Root Resorption
Internal Replacement Resorption
External Root Resorption
Orthodontic Related/External Apical resorption (EARR)
Infection Related Apical Resorption
Trauma/Infection Related Resorption
Invasive Cervical Root Resorption
Diagnosis of Resorptions
Treatment of Resorptions
Start With The End In Mind
Do we understand etiology?
Traumatic Injuries to the Teeth
use as baseline only
cold and electric pulp tests
be aware of false negative response
retest at 30-90-180 days
Pulpal response to trauma:
3. Internal resorption
Treatment codes for Regeneration
3351 Pulp debridement and placement of antibiotic medication
3352 Interim medication placement
3354 Pulpal regeneration
Horizontal Root Fractures
Management of Tooth Luxations
Overall goal of Primary Tooth Treatment is to Preserve the Developing Permanent Tooth
Extraoral time is a key factor. 90% success if replanted in less than 30 min.
5 Min is critical.
E.O. time less than 1 hr, perioidontal healing possible
For adult teeth, start RCT 1-2 weeks later with Ca(OH)2
RCT may not be required in immature teeth with short extraoral time.
Fair/poor prognosis. Ankylosis likely.