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- Dr Glenn A van As, DMD
Dr Glenn A van As, DMD
TUFI® Access Refinement Tips Clinical Article
Hi folks: nothing revolutionary here, but its been a long time since I posted a case.
This gentleman had the endo done many years ago as a teenager (he is in mid 30s now) and a SSC placed overtop. The SSC came off over time and the tooth didn't hurt so he left it.
What prompted him to come in was the color of the tooth, so we discussed the need to have the endo redone despite the fact that no periapical pathology was seen but because it was open for so long. I suspect that they had IRM in the access, but the cotton pellet was still in the tooth.
I removed the coronal Gutta Percha with a TUFI® #1 tip. For those of you that have ultrasonics you might want to try these tips out. They are very durable and the coatings last forever. I do some work for them so I am biased but I honestly mean this, these tips are very very good. Manufacturer is San Diego Swiss Machining and here is their website [www.sdswiss.com]. They also make a great instrument retrieval system that is their star product.
In any event the Ultrasonic with the #1 tip is useful for taking the Gutta Percha out without water. It's safe (compared to Gates Gliddens) and I could get 12mm of the GP out before I had to use rotaries. The US with water also helps flush out the canal of GP.
I widened it to 04 tape 60 tip and it was interesting to see that as I got to my master apical files how the GP came out with darkness on the pieces (as seen under the scope) showing bacteria either from before or more likely due to coronal leakage.
No 2nd canal found, and we obturated with GP and placed flowable over the top and a pellet with Sodium Perborate to help bleach the tooth.
Length control was ok not perhaps perfect but I think the end result for an easy case was decent.
Hope it is of interest... photos shot through the scope to give you a chance to see what makes microscope endo so fascinating.
Cheers,
Glenn
Click to download PDF: TUFI® Access Refinement Tips Clinical Article: Dr. Glenn A. van As, DMD
Original PA before Retreatment
![Original PA before Retreatment](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/1-original-pa-before-retreatment-250.png?t=1420579561)
Preop Photograph of Tooth
![Preop Photograph of Tooth](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/2-preop-photograph-of-tooth-250.jpg?t=1420579562)
Rubber Dam Placed and Caries Removal
![Rubber Dam Placed and Caries Removal](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/3-rubber-dam-placed-and-caries-removal-250.jpg?t=1420579562)
Cotton Pellet on Top of Gutta Percha
![Cotton Pellet on Top of Gutta Percha](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/4-cotton-pellet-on-top-of-gutta-percha-250.jpg?t=1420579563)
Close Up View
![Close Up View of Gutta Percha](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/5-close-up-view-of-gutta-percha-250.jpg?t=1420579563)
TUFI® #1 Ultrasonic Tip (San Diego Swiss Dental Machining)
![TUFI No 1 Ultrasonic Tip (San Diego Swiss Dental Machining)](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/6-tufi-no-1-ultrasonic-tip-250.jpg?t=1420580116)
Tip Placed on GP Dry to Remove Coronal Portion of GP Easily
![Tip Placed on GP Dry to Remove Coronal Portion of GP Easily](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/7-tip-placed-on-gutta-percha-250.jpg?t=1420580117)
Gutta Purcha Removed to 12mm with Ultrasonic
![Gutta Purcha Removed to 12mm with Ultrasonic](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/8-gutta-purcha-removed-to-12mm-with-ultrasonic-250.jpg?t=1420580119)
Close Up View
![Close Up View](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/9-close-up-view-gutta-purcha-removed-250.jpg?t=1420580119)
Rotary at End of Root, Note GP in File and Bacteria on GP
![Rotary at End of Root, Note GP in File and Bacteria on GP](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/10-rotary-at-end-of-root-250.jpg?t=1420580120)
Close Up View of GP and Rotary File
![Close Up View of GP and Rotary File](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/11-closeup-view-of-gutta-percha-and-rotary-file-250.jpg?t=1420580412)
GP Fragments in Canal at High Mag
![Gutta Percha Fragments in Canal at High Magnification](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/12-gutta-percha-fragments-iin-canal-at-high-magnification-250.jpg?t=1420580413)
Note Small Amount of GP in Canal Under Scope
![Note Small Amount of Gutta Percha in Canal Under Scope](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/13-gutta-percha-in-canal-under-scope-250.jpg?t=1420580414)
Using Ultrasonic TUFI® Tip with Water to Flush Out Last Bit of GP in Canal
![Using Ultrasonic TUFI Tip with Water to Flush Out Last Bit of GP in Canal](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/14-using-ultrasonic-tufi-tip-with-water-250.jpg?t=1420580414)
Last Bit Removed with Ultrasonics
![Last Bit Removed with Ultrasonics](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/15-last-bit-removed-with-ultrasonics-250.jpg?t=1420580415)
Ultrasonic File (Satelec) to Help with Irrigation
![Ultrasonic File (Satelec) to Help with Irrigation](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/16-ultrasonic-file-satelec-to-help-with-irrigation-250.jpg?t=1420580416)
Erbium YAG Laser to Help Disinfect Dentin
![Erbium YAG Laser to Help Disinfect Dentin](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/17-erbium-yag-laser-to-help-disinfect-dentin-250.jpg?t=1420580759)
Another View of Laser at Work to Remove Smear Layer
and to Disinfect Canal Prior to Obturation
![Laser at Work to Remove Smear Layer and to Disinfect Canal Prior to Obturation](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/18-laser-at-work-to-remove-smear-layer-250.jpg?t=1420580760)
Trial Cone in Place
![Trial Cone in Place](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/19-trial-cone-in-place-250.jpg?t=1420580761)
Obturated Canal
![Obturated Canal](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/20-obturated-canal-250.jpg?t=1420580762)
Higher Mag View of Obturation
![Higher Mag View of Obturation](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/21-higher-magnification-view-of-obturation-250.jpg?t=1420580763)
Cleaned Up Floor of Pulp Chamber with Bond in Place
![Cleaned Up Floor of Pulp Chamber with Bond in Place](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/22-cleaned-up-floor-of-pulp-chamber-with-bond-in-place-250.jpg?t=1420580763)
Flowable Over GP
![Flowable Over GP](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/23-flowable-over-gutta-percha-250.jpg?t=1420580764)
Pellet of Sodium Perborate for Bleaching in Tooth
![Pellet of Sodium Perborate for Bleaching in Tooth](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/24-pellet-of-sodium-perborate-for-bleaching-in-tooth-250.jpg?t=1420580764)
Temporary Restoration in Place
![Temporary Restoration in Place](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/25-temporary-restoration-in-place-250.jpg?t=1420580765)
Final Postoperative Radiograph
![Final Postoperative Radiograph](https://cdn10.bigcommerce.com/s-x4ykdg9/product_images/uploaded_images/26-final-postoperative-radiograph-250.png?t=1420580765)