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Similar to Prevent unnecessary endo tx (13)
Prevent unnecessary endo tx
- 3. Death spiral of tooth
Pascal Magne 2010
No Post No Crown -
Biomimetic Restorative Dentistry(DVD)
- 4. •4-6 years success rate
without apical RL: 93%(PAI 1 and 2)
現實⾯面…
Long-term outcome of Endo?
- 5. •10 years? 20 years?
更久之後的endo成功率?
現實⾯面…更久之後…?
Long-term outcome of Endo?
- 10. What should we do before Endo?
•Deep caries
•Cracked tooth
•Sealing fail
這三種情況的臨床指引,全部都不是⾺馬上根管治療喔!
- 19. 6 months f/u
stepwise excavation
technique
affected dentin
remineralized
dentin
GI application
Bjørndal L, 2002
- 25. 2002 4th 2011 6th2006 5th
partial caries excavation
and
indirect pulp capping
觀念的變遷
Caries control technique
- 26. Deep caries治療⽅方式⽐比較
• ⽐比較不同deep caries dentin處理⽅方式的結果
1、complete caries removal(⼀一次挖乾淨)
2、stepwise excavation (分次挖乾淨)
3、partial caries removal (部分挖)
4、no dentinal caries removal (不挖)
- 41. Banerji S, 2010
• without cusp coverage (ClassII OD)
• with cusp coverage (onlay, overlay)
利⽤用CRF補強的⽅方式
結構加強及保護:裂⽛牙的緊急處理⽅方式
- 45. Crown coverage
• Endo轉診的cases中,cracked teeth佔9.7% (796/8175)
• 127⼈人為reversible pulpitis(皆以crown治療)
其中21⼈人在58天後轉為irreversible pulpitis
其中6⼈人在149天後轉為necrotic pulp
reversible pulpitis的cases,有20%在半年內需要Endo tx.
- 47. Indirect Onlay coverage
• resin onlay黏著後進⾏行觀察
第⼀一週:88.37%不會疼痛,4.65%對冷及咬合敏感
第四週:93.02%不會疼痛,2.32%對冷及咬合敏感
共6.89%需要根管治療
• resin onlay 6年成功率:93.02%
- 50. • immediate direct composite resin overlay的中期(7年)成功率⾼高,
具有不錯的臨床治療價值(將來也可再換成ceramic)
• onlay/overlay兼顧保護功能及保守性治療
• 若有reversible pulpitis,建議不要直接跳到做full crown,以減少
需根管治療的機會(20% Endo…討厭的事是他不會⾺馬上發⽣生!!!)
• 治療指引中,cracked teeth無預防性根管治療的必要
整理
- 57. 順序: 1 2 3 4
Rubber dam
2、活性測試
測死最準測不到時最準 測活最準最⽅方便
- 61. step 1
cracked tooth
biting pain(++) biting pain(-)
test with direct composite coverage
without bonding
- 74. Sealing的迷思…
• Bonding = Sealing?
兩者是不同喔!
• Ranking of sealing ability?
那種材料的sealing能⼒力好?
要先知道要sealing的東⻄西是什麼!
immediate dentin “sealing” (IDS)?
“resin coating”
“protection”
- 94. Sealing ability of MTA
Sarkar, 2005
1, MTA進⾏行⽔水合作⽤用(hydration)
產⽣生calcium silicate hydrate, calcium
hydroxide等等
2, 在⽔水合產物表⾯面產⽣生Apatite-like precipitates
—>sealing MTA和Dentin之間的gap
- 100. 整理
• RDT的觀念,可在術前X光⽚片的資訊參考應⽤用
• Deep dentin sealing:
MTA> RMGI/GIC > self-etching bonding > total etching
• Enamel margin sealing
resin bonding system
• Dentin margin sealing
RMGI
• Dentin bonding穩定度
4th, 6th, GIC較佳
• MTA-Dentin之間能有很好的sealing,但仍要有2mm以上距離
- 104. Crack line
2.6mmEnamel margin
Caries margin
0-2.5mm
怎麼做?
• 留enamel margin
為了sealing
• partial caries removal
為了不傷⽛牙髓
• 移除部份crack line
減少leakage
• Direct resin overlay
為了受⼒力結構穩定
- 106. 染⾊色 ⾞車掉 再染⾊色 再⾞車掉,再染⾊色,再⾞車掉…
別做的過度,⼩小⼼心CEJ!!!
部分移除crack line
- 148. Case實戰V
What if the P’t is your mom?
• deep caries, close to pulp
• dentin margin
• pulp test:normal