Common Sense approach to Molar Root Canals

Part 4 - Build-up and prep

Instructors:

Dr. Marvin Berlin, DDS

Dr. Marvin Berlin, DDS

Dr. Berlin has a very unique combination of providing comprehensive dentistry, mixed with a business first philosophy. He enjoys teaching his management and marketing techniques of a multi-doctor/multi-location practice and how it can be applied to practices of all sizes.

Dr. Marvin Berlin begins the build-up and prep for the crown.

We're all set and done. Something that I think some dentist forget to do or don't do that we absolutely require to do is to take a final x-ray once the temporary has been seated. I want to make sure that the margins are intact. That there's no cement left behind. I want to make sure that we're sending the patient off in the absolute best manner. In fact, if you think about this you can do the most perfect root canal. I mean you can get them completely numb. They don't have to feel a thing. You take all the nerve tissue out. It's a perfect fill. The crown fits perfect. And if your assistant puts on the temporary that's got a little sharp barb to it or rough to their tongue then they're going to blame that root canal. They're going to say this root canal was just bad based on the feeling of the temporary. So that's the final thing that you need to make right. Make sure that temporary is in. It's polished to perfection so it's nice and smooth. And it's out of occlusion. We don't want their temporaries touching at all. You're going to get some post operative swelling that's going to happen in root canal. And if you got a tooth that's in occlusion it's going to swell in to hyper-occlusions. So it's critical we take out just out of occlusion and we're very successful with that. Okay. We're going to have Victoria again. Actually we still have post-op PA. Of course, we're all using digital so we'll know immediately what our fill looks. All right. Okay. Take a look. Let's see how that looks. We like that. We like that. [In fact, my team, the men over here], you know, we have good fills. We have a little apical puff. These little areas where the sealer came out we like that. That's filled in where there was bacteria both our canals. We're sealed all the way. We knew we're going to be that. And we had our lengths at the apex locator. I felt good that we were 21 here, 23 here. So with that fill we're good with that. Our next step what we're going to do is we're going rid of this gutta-percha on the pulpal floor and build it up and prep it for a crown. All right. We got root canal done. We love our x-ray. It's right on the money. What we're going to do now is just buildup. I rarely do post. I don't like to put a stress on the roots. And so in this situation what we're going to do is I'm going to clean up the gutta-percha and I'll prep into each canal, yeah, into each canal maybe a millimeter or so just to get me a little hold if you will. So we'll place a little dimples in each there and then we'll fill it, we're going to build it up with LuxaCore and our bonding agent is going be CLEARFIL SE. So we'll bond it in, light cure that and then prep it and then we'll be done. GW we're going to fix that buddy. You're doing fantastic my friend. Let's clean out. I like to use for this just a simple little 8 round. This bur right there is great for just getting rid of this stuff and we used lots of water here. We're doing fantastic. All right. We got root canal done. We love our x-ray. It's right on the money. What we're going to do now is just core build up and I rarely do post. I don't like to put a stress on the roots. And so in this situation what we're going to do is we're going to clean up to gutta-percha and I'll prep into each canal, yeah, into each canal maybe a millimeter or so just to give me a little hold if you will. So we'll place a little dimples in each there and then we're going to build it up with LuxaCore and our bonding agent is going to be CLEARFIL SE. So we'll bond it in, light cure that and then prep it and then we'll be done. GW we're going to fix that buddy. You're doing fantastic my friend. Let's clean out. I like to use for this just a simple little 8 round. This bur right there is great for just getting rid of this stuff and we used lots of water here. We're doing fantastic. That's looking good. Clean it out a little bit more. I like that. We're super close. I'm going to switch to a small round bur probably a 2 or 4. I'm not sure what number this is but it's that size right there and I'm going to penetrate each of these canal and just create a little bit opening right into the canal. So there's a flowable buildup material that kind of fallen here and give us a little bit more support. I create a little indentation in each one of those canals so now that little buildup material I know it's going to flow there. And that will give us some little fingers to hold on to so I know that's going to be really solid. Okay. Let's build it up. What we're going to do in our buildup I'll get some cotton. Start a little cotton roll and I'm just going to set that. Keep the tongue out of the way. We'll clean up the tooth with some alcohol. We have rubbing alcohol in these little brushes here and literally I'm just going to scrub. And I'm going to scrub the inside of there getting rid of any debris. This kind of removes our smear layer as well. Bonding agent is going to be CLEARFIL SE. I love that. It's just simple. It always works. I've been using this for gosh ten years I guess. There're probably newer ones out there but this just work so good. I'm going to stick with it. And put a little bonding resin there. I'll make sure I flow that into each of those little holes that we put in there. That's going to be our attention. Victoria can you light cure that for me. We give it a little bit shape here just to make our prep a little easier. Again we're going to pull that back to make sure occlusion looks good. And we'll cure that and we'll cure it from the buccal. I want to pull the material away from the prep, coming from the margin. So cure that from the buccal for me and cure from the buccal then we'll cure from the lingual. We'll just cure that from the buccal and then we'll cure that from the lingual. Again it's pulling that material there. Excellent. Okay. Bill that's done. I know that's good. I know we're decay free. We're nerve free. I've already prepped pretty much the mesial and distal. So that's kind of handy. Now what we'll do is we'll prep the buccal and the lingual and then finish it with the margin. So I'm going to use Carbide Gold Bur for my initial enamel reduction. I like this a lot. Then we'll finish it off with the KS2 diamond. I'll show you in just a second. Again on high speed with our Kavo. We're going to go in a counter clockwise fashion. These burs turned clockwise so we go counterclockwise to get the most efficient cutting the method. A little more water. There we go. I want to bury that. This bur is about 1.5 mm in diameter so if I bury it I know I got a 1.5 mm which is the amount of clearance I need for E-Max. This is going to end up me and E-Max crown. I basically do my prep in half. I'll take the top half here. And then the same situation, we kind of follow it around. I'm going to prep right through the gums. I'm not going to bury it. I don't pack cords. We'll go in equi-gingival margin. I don't go sub. I don't go supra. I just keep it right through the gum line. My motto is you don't mess with the gum and they won't mess with you. So we try to not cause any bleeding. We might get a little distal because it was a little subgingival the decay was. Now I'm going to move a little bit here. I like direct view on the lingual. For a right handed, this just works better for me. I can see that margin from this view and I'm just going to follow the bur right where I need it. Again, I'm not trying to touch the gums. But plenty of reduction on the lingual. I think a lot of docs don't reduce enough on the lingual. I think we're taught that in school. Again E-Max seems to be 1.5 mm so let's give them 2. Okay. Here's our bulk reduction. That looks pretty good. You might get a little bleeding on the distal just because we were, had some pretty big decay there but we'll see how that shapes up. Again we're just doing bulk reduction right here. I'm just kind of getting rid about 1.5 mm of enamel and then we're going to fine-tune it with a KS2 bur which is my favorite. It's been my favorite bur since Spear and Kois invented it a million years ago. I love it. It creates just a real nice margin for porcelain. Anyway that's all I'll probably ever use. Love it. And I've already done most of the reductions. This is just more of a fine-tuning of that margin. So we're going to take it and just follow what we just did. And again we're going to go counterclockwise in our cutting. That's why this bur works the best. You follow that margin. This is when we slow down. This is when we just kind of fine-tune. I'm in no hurry here. We just want to make sure everything is ideal. I want to see that margin perfectly. I know if I can see it, if my lab technician can see it. That looks pretty good. Okay. We're at the occlusal, I'm going to go back to, we call this the football diamond cause it kind of looks like football. And I just kind of let it flow right in here. One thing we want with our E-Max porcelain we want to have no sharp angles. So we're going to soften everything up here. And then right in the occlusal table my final bur that I use is just a little, this is kind of overkill. But I like to give my lab to put some anatomy in the occlusal. So I sink that bur and kind of bury that so we can really put some deep anatomy in that crown, make it look good. He's got some pretty grooves seen in this adjacent too here. So I want to let the lab built to match that. So it looks a real tooth when we're done. Okay. Now I don't like that stain right there. I don't think that's a problem but let's get rid of it. I'm pretty sure that's not decay but let's just, we'll create this little buccal grove there and get rid of that. We want it nice and clean. It looks good. Just take a look at our margin. We're a little rough on the distal area. One more. Let's give it a final look. I think that looks pretty sharp. Nice and clean. That looks more tapered on that video than it is. It's not that quite that tapered but anyway that looks really good. Let's clean up our margins. Again I didn't even touch the gums so there's no reason to pack any cord. We use a little here and just clean up any bleeders. If it was really subgingival we use the biolase to touch it out but there's no reason. I can see all the margins easily. Here we go. Nice and clean. See those margins there then we know that when we seat our crown then we'll bond it in with Multilink that's not going anywhere. Let's check our occlusion.