Download Kenneth Tittle - UDA Dental Association

Can We Save This Tooth?
Utah Dental Association Convention
4/21/2016
What is the “question” with questionable teeth?
Outcomes
Process Centered
Diseased Centered
Patient Centered
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
Cognitive bias
Clustering
When is new information a game changer?
It changes treatment plan
It alters proposed treatment
What is an “X-ray”?
Attenuation
Cone Beam Computed Tomography
Artifacts
Beam Hardening
Scatter
Indications
Root Fractures
Interpreting CBCT Image
Longitudinal Tooth Fractures
Dentin Properties
Varying Strength of Dentin
Dentin Aging
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
Pericervical Dentin
Occlusal Risk Factors
Predisposing Factors
Diagnosis
Cracked tooth
Mesio-distal direction
Coronal to apical progression
Vertical root fracture
Bucco-lingual direction
Apical to coronal progression
Radiographic Features
Clinical Exam
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
Shaping:
Gates Glidden Use
Coronal Reinforcement
“Cleaning” a Narrow Shape
Importance of NaOCl Agitation
Indications for a Post
Principles for Posts
Types of Posts
3-D Ferrule
Difficulties Bonding Within the Canal
Resin Cements
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?
Root Resorption
Root Resorption:
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
Pressure Resorption
Orthodontic Related/External Apical resorption (EARR)
Infection Related Apical Resorption
Trauma/Infection Related Resorption
Replacement Resorption/Ankylosis
Invasive Cervical Root Resorption
Diagnosis of Resorptions
Treatment of Resorptions
Start With The End In Mind
Diagnosis driven
Do we understand etiology?
Predictability?
https://projects.propublica.org/docdollars/
Traumatic Injuries to the Teeth
http://www.iadt-dentaltrauma.org/
http://www.dentaltraumaguide.org
Incidence
Prevention
History
Family Violence
Exam
Pulp tests:
use as baseline only
cold and electric pulp tests
be aware of false negative response
retest at 30-90-180 days
Treatment timing
Crown Fracture
Pulp Capping
Follow-up
Pulpal response to trauma:
1. Repair
2. Mineralization/Obliteration
3. Internal resorption
4. Necrosis
Pulpal Revascularizaton/Regeneration
Treatment codes for Regeneration
3351 Pulp debridement and placement of antibiotic medication
3352 Interim medication placement
3354 Pulpal regeneration
Non-Vital Bleaching
Horizontal Root Fractures
Management of Tooth Luxations
Primary Teeth
Overall goal of Primary Tooth Treatment is to Preserve the Developing
Permanent Tooth
Avulsions
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.