Dr.Shoukat Bettani

Root canal treatment of lower six with four canals

انسانی دانتوں اور چہرےکو دماغ سے جو رگیں اتی ہیں وہ بہت کمپلیکس یعنی پیچیدہ ہوتی ہے
۔۔ لہذا دانتوں کے علاج کو اسان علاج نہ سمجیھں اور علاج دانتوں کے مستند ڈاکٹر سے کریں۔۔زندگی جان کر جیۓ

Whole story in One picture.. Lower 5
Root canal treatment and Direct composite..

Leaving Root fragment criteria during tooth removal...

بچوں میں دانت نکلنے teething کی وجہ سے ہونے والےمسائل :

بچوں میں جب نئے دانت نکلنا شروع ہوتے ہیں تو ان کے لئے یہ ایک نیا اور تکلیف دہ مرحلہ ہوتاہے جسکی وجہ سے بچہ ہر وقت اور خاص طور پر رات کے وقت روتا رہتاہے اور اس کو بخار, diarrhea ، رال کا ٹپکنا droolingاور بےچینی جیسے symptoms بھی آ سکتے ہیں..

اس کے حل کے لئے بچے کے والدین کو چاہئے کہ جب بچہ ایک سال کی عمر کو پہنچ جائےتو اسے سخت چیزیں چبانے کے لئے دی جائیں جس سے مسوڑھوں پر زور پڑتا ہے اور دانت جلدی نکل آتے ہیں اس کے علاوہ مسوڑھوں پر شہد لگانے سے بھی بچے کی تکلیف کافی حد تک کم ہو سکتی ہے جبکہ doltee کے نام سے teething drops بھی میڈیکل سٹور میں مل جاتے ہیں جو کہ دانت نکلنے کے مسائل سے بچانے میں مدد کر سکتے ہیں.

Teething کا مسلۂ بچوں میں عموماً چھ ماہ سےایک سال کی عمر میں شروع ہوتا ہے اور دو سے تین سال کئ عمر میں ٹھیک ہو جاتا ہے جب بچے کے سارے دانت وقت پر نکلنا
شروع ہو جاتے ہیں۔

Healing after 8 months...

3 unit zarconium bridge...

Lower 5 rct...power of irrigation

Upper 6 rct..

The theme for World Mental Health Day 2022 is “Make mental health and well-being for all a global priority"

Old PFM bridge was replaced by new zarconium bridge gingival shade is added..

Upper 4 with severly curved canals.
.. 25mm long
File fanta endomtor motopex
Adseal sealer

Healing after six months...

INTRESTING CASE...
Some time our little effort can save someone money whic may be un abale to pay for patient

Female patient came to our clinic with pain and swelling after examination it was found that lower fixed pfm bridge was there . after opg it was noticed that there was lesion and swelling in right lower six..
Patien asked " بس دانت نا۔نکا لیں اور یہ درد اور سوجن ختم ہو۔۔"
Opning was done under the metal crown
Details after each pic..patient is now pain free

Re RCT case with four canals
Old gp was removed distal 2nd canal was missed by previous dentsit

Root canal (RCT) of lower 6 with curved canals

ROLE OF PAPER POINTS...

Paper points should be used to dry the canals before Obturation so that the sealer bonds well with the canal surface.

Multiple paper points should be used unless u come out with a paper point that is absolutely dry.

Size of paper point should be same as the final prep size of canal so that the paper point can have maximum contact surface area circumferentially.

Always have a good look at the paper point when you come out.If the paper point shows red marks at the tip..it means that the paper point has gone beyond the apex.

Always avoid blowing the canals with air through your 3 way syringe while attempting to dry the canals as in rare cases, it might lead to air embolism/facial emphysema which could be life threatening too.

knowledge

Case of upper fixed pfm bridge
pfm bridge is finished in one month timming

Details are in each picture

Gingival enlargement,
also termed gingival overgrowth, hypertrophic gingivitis, gingival hyperplasia, or gingival hypertrophy refers to an increase in the size of the gums.

Gingival hyperplasia may be

-Inflammatory
-Drug induced
-Enlargement associated with systemic diseases or conditions.
-Neoplastic enlargement
-False enlargement.

Inflammatory enlargement is most commonly due to prolonged exposure to bacterial plaque.

In drug-induced gingival hyperplasia, about 50% are attributed to phenytoin, 30% to cyclosporins and the remaining 10-20% to calcium channel blockers.

Systemic factors include pregnancy, puberty, vitamin C deficiency, nonspecific( pyogenic granuloma), leukemia & sarcoidosis.

Neoplastic enlargement is due to fibromas, papillomas, giant cell granulomas, carcinoma & malignant melanoma.

False gingival enlargements are due to an underlying bony or dental tissue lesion.

Credit .Braces

Today case
root canal of upper premolar

Scaling and polishing of a smoker young patient

Today case
Zarconium crown
Young female patient with discolored tooth

What is zarconium??
It is a biocompatible material to our body and strength is like a steel,
color and texture is like a natural tooth

Thanks dental lab multan

Today case
lower 6 with 4 canals

What is ...??🦷🦷

A Dental abscess is a collection of pus that can form inside the teeth, in the gums or in the bone that holds the teeth in place. It's caused by a bacterial infection. An abscess at the end of a tooth is called a periapical abscess. An abscess in the gum is called a periodontal abscess...
This kind of dental abscess needs proper xray and ( RCT )root canal treatment from qulified doctor

Lower 6 rct with deep caries and class2 filling

Know where to Inject Superior Alveolar Nerve
For maximum effect on tooth to be treated.

.shoukat bettani
Bites & Braces Dental

Sodium Hypochlorite irrigation is considered as a standard protocol in Endodontics due to its pulp tissue dissolving & bactericidal action. The reason why it is the most common and indispensable irrigant solution to be used during Root canal treatments. In fact, not using the solution can compromise the successful outcome of the treatment.

Hence, alongwith the other risk involved in a Root canal treatment procedure, there will always be a potential risk of hypo extrusion while Irrigating the canals & can happen with any dentist doing Root canal Treatment at his clinic.

Sharing few insights on the Signs & Symptoms, Prevention & Management of Hypo extrusion cases that all of us should be aware of...

Starting with the Signs and Symptoms that one can encounter during Accidental Hypo extrusion cases.

1. To start with, there will be immediate pain to the patient.

2. Profuse bleeding from the root canal can be seen.

3. Redness over the affected side of the face along with swelling and edema.

4. After few hours,signs of ecchymosis or even paresthesia can occur in severe cases.

Treatment wud include...

1. Abort the further procedure.

2. Immediately forceful irrigation of the canal with copious amount of saline or lignocaine solution so as to neutralize the effect of hypo to some extent & reduce the pain.

3. Analgesics to reduce the pain.

4. Corticosteroids can be added to reduce the localized inflammation.

5. Antibiotics in case of medically compromised patient or to prevent secondary infection.

6. Extraoral cold compression immediately following the accident to reduce the swelling.

7. After 24 hours, Warm compression and frequent warm saline mouth rinses to facilitate localized healing.

Bt all this will just provide symptomatic relief to the patients....Facial swelling due to Hypo extrusion take their own sweet time to recover extending over a week or two.

If ecchymosis occurs then gradually after few days the skin colour changes from red to bluish grey and then gradually disappears over a period of 1 -2 weeks.

So at the end..what matters most is effective communication with the patient, constantly being in contact and reassuring him that things will improve gradually with time.

But as we always say that
Prevention is better than Cure....

To prevent hypo accidents...

1. All syringes to be duly named after the irrigant it contains to avoid interchanging of solutions during use.

2. We should educate our assistants to fill up the syringes with utmost care and the potential risk involved if care is not taken..

3. A good pre endo built up alongwith rubber dam isolation is must to avoid any leakage of solution & accidental spills during use.

4. Use of protective eyewear for both the dentist & the patient.

4. Always use a Luer lock needle & syringe so as to avoid opening of needle from the syringe while dispensing the irrigant inside the canal.

5. Irrigant should be delivered using 30 gauge Metal or Plastic Side vented needles in a slow up & down motion inside the canal making sure at any point of time, the needle is always around 1 to 2 mm short of WL.

6. At no point of time, the irrigating side venting needle should be wedged inside the canal as wedging the tip inside the canal during irrigation increases the chances of apical extrusion of the hypochlorite solution.

7. The delivery of the irrigant should be very slow & with very little pressure, around 3 ml of hypo solution to be dispensed in around 1 nd half to 2 mins.

Lastly, I always say ,
Hypo is like Fire.🔥
Good servant but Bad master.
& Risks & Complications go hand in hand with any treatment modality..Fortunately, Hypo extrusion does not cause any permanent damage. Things become back to normal within 1-2 weeks with/without medications.

Hope this Helps..

Dr.Ganesh Maurya
Mumbai

خاتون مریضہ 50سال عمر
جو دانت نہ ہونے کی وجہ سے نہ ہنس سکھتی تھی اور نہ پسند کا کھانا اچھی طرح چھبا سکھتی تھی ۔
علاج کے ہر تصویر کے ساتھ تفصیل بھی مینشن ہے

Story of upper 5 and 6 rct with deep class 2 fillings details with each picture

Surgical needle classification
tips

Local anesthesia guide line

TETRACYCLINES.
Tetracyclines lead to permanent tooth staining when ingested during pregnancy, nursing, or during the developmental period of secondary and primary teeth.
Tetracyclines (tetracycline, doxycycline, minocycline, tigecycline) are a class of medication, used to manage and treat various bacterial infections. Tetracyclines classify as protein synthesis inhibitor antibiotics and are considered to be broad spectrum.
The overall prevalence of tetracycline staining is 3% to 4%.
Teeth appear fluorescent yellow. Exposure to sunlight, though, causes a change in color, and the teeth become brownish or grayish over time. Since sunlight affects final tooth color, it's not uncommon to have greater discoloration in the front teeth.
Treatment planning for severely tetracycline-stained teeth usually involves placement of veneers or crowns to cover the darkened teeth. It is usually the severity of the stain that may discourage any attempt to whiten these teeth using bleaching agents.
.braces

Great achievement indeed

Street Dentistry 😢😅
Everything is Painful in this Picture.
Don't know whether to be Sad about it or
Make fun of it.
There is also a Lesson in this Picture......🤔
Health standard is not the same everywhere !
It starts from a Bottomless pit where you work with
whatever you have to the highest form of Healthcare
where you have Everything.
Will this ever be Standardized ?
Will it ever stop diffrenciating humans ?
Will this ever End ?

One of the things that dentists and dental students can't comprehend is when their tutor or educator tells them that there is an undercut.

Without fail they agree then go back to their desk and try to fix it and then return with the same undercut present or made worse.

The problem stems from not knowing what they are looking at.

There are 2 parts to a margin. An external margin is visible when the crown is seated and the internal margin where the internal wall meets the margin floor.

Regardless if it's a shoulder or a chamfer the same applies.

Both the internal and external margins need to be visible from the path of insertion 360º. Any area where the internal margin is not visible is an undercut.

Bone loss in 3 years
if we dosen't replace teeth it occurs and change our face structure

Gingival disease severity increases with time

Designs for incremental placement Of composite restoration, follow the protocols to reduce chances of polymerization shrinkage