Orthograde retreatment Coronal and coronal-radicular phase
I-Introduction:
Even today, devitalized teeth are very often restored using coronal and coronal-radicular restoration systems involving high-strength materials.
Whatever the reason, if re-intervention is required, it becomes necessary to remove these materials.
However, removing a root canal reconstruction can sometimes seem perilous.
II-Coronary phase:
- Removal of a silver amalgam restoration
Its color allows easy identification in relation to dental tissue. We try to remove it in a block without excessive fragmentation.
The amalgam is removed either with a fissure bur or with an ultrasonic insert.
2.2 Removal of a composite restoration
The composite is removed either with a diamond bur or using an ultrasonic insert
To easily identify the composite, the composite leaves a blackish trace after passing a worn cutter or an insert
- Removal of an inlay, onlay or overlay
The metal parts are cut by a cutter (transmetal Komet®, etc.), they can be detected with ultrasound.
Ceramic or composite parts can be chipped with a diamond bur or deposited with ultrasound
- Removal of single prosthetic crowns
2.4.1 Unsealing:
Loosening corresponds to the removal of the prosthesis by disintegration of the cement joint without damaging or destroying the element
2.4.1.1 Gripping instruments
The principle is to use a clamp ( Furrer clamp, KY pliers, etc.) with a means of hooking the prosthesis in order to unseal it. The main advantage is to be able to remove the latter without damaging it.
2.4.1.2 Percussion instruments
These instruments deliver a shock wave whose purpose is to break the sealing cement film ( crown remover, CORONAflex®; The objective is to remove the prosthesis quickly while keeping it intact
2.4.1.3 Active instruments
The objective of this category of tools is to prepare access to an instrument allowing a dissociation force to be exerted between the dental structure and the prosthesis (Metalift, WAMkey®,).
The operating protocol with the WAMkey® is as follows:
- Step 1 : Create a trench on the vestibular surface of the crown using a transmetal bur
- 2nd step: the cavity is extended horizontally in the lingual direction up to half of the occlusal surface of the tooth
- 3rd step: the key is inserted into this cavity then turned a quarter turn around its major axis.
2.4.2 Disassembly:
- The prosthesis is partially cut using a transmetal bur: a vertical trench is dug on the vestibular surface, starting from the cervical region, then extended over half of the occlusal surface.
- The two fragments are then separated using an elevator
- Removal of multiple prosthetic crowns
The prosthetic bridge can be unsealed or dismantled; in the case of unsealing, a specific instrument is used , the bridge remover, which allows for uniform distribution of forces along the bridge during unsealing.
III-Corono-radicular phase
3.1 – Removing the preformed metal tenons (Screw Post)
Remove the head of the post from the material (amalgam, composite, etc.) then proceed to remove the post:
- Either by using the tenon key which will be operated in the unscrewing direction)
- Either by using ultrasound
- Or the post can be held with a hemostat and then unscrewed
3.2 – Removing the inlay cores
The inlay core can be removed
- Either by the Gonon extractor
- Parachute technique
- Ultrasound
3.3 – Removing the fiber tenon
The fiber tenon can be removed either:
Using an insert;
- 1st step: reduce the composite and the coronal part of the fiber post with a round burr mounted on a turbine
- 2nd step : remove the post and the composite at the root level using a boul insert.
Using Gonon’s kit modified by Machtou,
- create an occlusal plane using a cylindrical bur mounted on a turbine
- A first pointer drill with a diamond-coated working end is inserted up to the stop
- a Peeso drill no. 2 (diameter 90/100) fitted with a stop at the length of the tenon and mounted on a blue contra-angle under water spray penetrates the tenon along the axis of its fibers
Orthograde retreatment Coronal and coronal-radicular phase
Wisdom teeth can cause infections if not removed in time.
Dental crowns protect teeth weakened by cavities or fractures.
Inflamed gums can be a sign of gingivitis or periodontitis.
Clear aligners discreetly and comfortably correct teeth.
Modern dental fillings use biocompatible and aesthetic materials.
Interdental brushes remove food debris between teeth.
Adequate hydration helps maintain healthy saliva, which is essential for dental health.