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microdentistry & laser

Patient came complanning of dull pain which accentuated by percussion with buccal sinus related to previously Endodontic treated lower molar with metal post & zirconia cown 3 years ago Tracing of the sinus tract was done by gutta percha and confirmed direct relation to distal root Cone beam CT was done revealing large periapical lesion related to distal root but with no evidence of missing canal or fracture So after patient consultation Decision was made to : • Separation of zirconia crown & Retreatment under magnification by endodontic microscope • Naoch Irrigation with ultrasonic activation • Ultrasonic scouting Searching for missing canals using E20 Tip • Root canal sterilization plus sinus tract decontamination done by zolar 980 nm pulsed mode : Optic fiber 300 um Duty cycle 10msec on -10 msec off 5 sec for 3 cycles (total time 15 sec) • Final rinse with chlorohexidine 2% and proper drying with paper points • Obturation with warm vertical condenstation technique to ensure 3D obturation in combination of MTA endo sealer • Laser crown lengthening was done before crown preparation • Restoration by vertical preparation crown to preserve tooth structure as possible using vetri preparation kit ( butt bur ) • CAD CAM PMMA crown with minimum margin thickness using 3 shape system to be replaced later on by monolithic zirconia crown Follow up was done 3 months after treatment