X ray source Image intensifier

Transcription

1 Prof. Paul Lambrechts K.U.Leuven Belgium X ray source Image intensifier Sagital Coronal Axial Cone Slice 200 pulses x 70 ms = 14 sec / turn Real scan time: 2-6 sec Less dosage. 30 µsv High sensitivity image intensifier X ray source 1

2 Evaluating subjective image quality 3D Accuitomo. Cone beam CT scanner 125 µm slices Pulp cavity Lamina dura 3D Accuitomo 80 µm resolutie Cortical bone Trabecular bone Dentin Gums Periodontal ligament space CBCT on multirooted first upper molar Cracked tooth technique RinsEndo (Dürr) Pressure/Suction technology Pressure <0.5 bar, 65 microliter per puls marc quirynen_ SL RinsEndo Rinsing 2

3 EngelenAnnab el880504v010 Sagital section 3

4 Sagital section Patient 24 years CBCT Accuitomo, Morita Field of view 4/4 cm 80 kv 3,1 ma Slice interval: 0,125 mm Slice Thickness: 0,125 mm LuyckxJeanPhilipp e841102m286 Dosis: 28 micro-sievert 4

5 Recall 2012 Final result

6 Crack Crack CBCT Scout, Hyperlink One volume viewer CBCT Accuitomo, Morita Field of view 4/4 cm 90 kv 5 ma Voxel size: 80 µm Slice interval: 0,160 mm Slice Thickness: 0,160 mm Dosis: 30 micro-sievert Vestibular Lateral Palatal Palatal Video Homogeneous gutta invagination track/canal obturation Bone destruction Vestibular apical view 6

7 Invagination gap Invagination gap Palatal defect Gutta Invagination end point Invagination gap Palatal view Invagination gap Gutta Vestibular apical view Gutta Gutta Vestibular cortical defect Palatal bone defect along groove Vestibular view Palatal bone defect along groove Invagination folded groove History of trauma and Ca(OH) 2 capping Consult for orthodontic treatment 7

8 Sagital section VanDammeBruno M116 8

9 Sagital section DeclerckSigrid V367 Sagital section Sagital section Pulpstone

10 BossensHendrik M165 - Apical gutta percha obturation - Internal rootsplinting with Glassfiber post Luting resin Sagital section DevosStijn820903M VISIT PAD PROTOCOL Representative isosurfaces for sample with major connection Missed 4th canal Retreated by Drs. Bart Huybrechts Representative isosurfaces for sample with anastomoses Prof. Lars Bergmans 10

11 CSEM Observation Fusobacterium nucleatum & Enterococcus faecalis (fixed and HMDS dried) E. faecalis + F. nucleatum Biofilm, Nair. SPL Mixed Oral flora (SPL) CSEM Observation Microscopic - Composite transmission electron micrographs show the presence of bacteria (BA) and fungi (FU) in the accessory canal. - Note the distinct electron lucent cell wall and the larger size of fungal organisms in comparison to that of the bacteria. The fungus shows several dividing forms, some of which form chains. E. faecalis & F. nucleatum fixed and HMDS dried Observation Of Bacteria E. faecalis + F. nucleatum Fusobacterium nucleatum (S-PL) CSEM Observation E. faecalis: initial contamination, fixed and HMDS dried E. faecalis Symbiosis Enterococcus faecalis S-PL CSEM Observation Enterococcus faecalis CSEM Observation Enterococcus faecalis 11

12 CSEM Observation Enterococcus faecalis ESEM Observation Enterococcus faecalis colony dominant in growth Bacteria from the root canal lumen, invading the dentinal tubules Strings Ropes Micro-organism adhesion in biofilms through extracellular PS-matrix (S-PL) The dentinetubules are a natural diffusion pathway for micro-organisms Micro-organisms colonizing & widening the tubules technique Bacteria can penetrate deeply in the dentin tubules and are sheltering which makes it difficult to reach and eliminate them. They also have a survival and culture reversal potential. TEM. Sagital section TEM. Longitudinal section 12

13 Research S1 First Cut Research Dr. Cliff Ruddle Results ProTaper SX Use Like Brush Preparation by Dr. Cliff Ruddle Research Dr. Cliff Ruddle Research Dr. Cliff Ruddle Prof. Lars Bergmans Research Dr. Cliff Ruddle Research Preparation by Dr. Cliff Ruddle Prof. Lars Bergmans Prof. Lars Bergmans 13

14 Research canals systems Pro Taper K³ Research Debris removal?? Not all areas of the complex root canal anatomy are adequately reached Dentin removal: how much? Where? Biofilm, Nair Transmission electron micrograph of bacterial (BA) mass in the tortuous space of the isthmus that reveals numerous islands of fibrodentinal (D) structures (3,200x) Superelastic NiTi smooth files (EMS). ESI Endo Soft Instrument DT-069 technique Ultrasonic Biofilm Smoke EMS ESI-tip NiTi Ultrasonication 14

15 Sagital section Missed 4th canal Anastomosis filled BillietPieter840514M 153 Accessory canal filled CCD VistaRay, 2 years recall Anastomosis filled Accessory canal filled Coronal seal 2 years recall CCD + endofilter At 61 months year Complete healing? PAD PROTOCOL (faster healing??) Recall and healing after 2 years Overlay initial situation and after 2 years Sagital section Sagital section 15

16 ..\ConeBeamCT2de\BillietPieter840514M153\PIETER BILLIET_ SL..\ConeBeamCT2de\BillietPieter840514M153\PIETER BILLIET_ SL Initial periradicular lesion Recall and healing after 2 years Initial periradicular lesion Recall and healing after 2 years Initial periradicular lesion Recall and healing after 2 years..\conebeamct2de\ BillietPieter840514M 153\PIETER BILLIET_ SL\ODViewer.exe../ConeBeamCT2de/ BillietPieter840514M 153/PIETERBILLIET _ S L/ODViewer.exe Sagital section 47 HestersCarmen V204 C-shaped canals Interradicular C shaped indent 16

17 Digora -Initial X-ray - Length determination X-Ray - After obturation X-Ray CCD VistaRay, Baseline CCD VistaRay, 1 month recall at restoration placement CCD VistaRay, 1 month recall at restoration placement Coronal seal 6 months recall Sagital section CCD VistaRay, 6 months recall HestersCarmen V204 C shaped canal in lower second molar C-shaped canals

18 JacobsEdwin M093 technique treatment Before After Recall Healing Sagital section Prof. Lars Bergmans MB S-shape Sudden curvature Treated by Drs. Bart Huybrechts GT Protaper 2 separate D roots Middle mesial canal Profile Treated by Drs. Bart Huybrechts Odontogenic sinusitis. Retreat: 4 canals Retreated by Drs. Bart Huybrechts 5 root canals Pre-op Post-op Operative technique Leuven BIOMAT Research Cluster Huybrechts Bart, Bergmans Lars, Gunst Veerle, Van Meerbeek Bart, De Munck Jan, Peumans Marleen, Panagiotis Moisiadis, Dimple Baradway Van Landuyt Kirsten, Palaniappan Selvi, Vanherle Guido & Lambrechts P. Prof. Lars Bergmans 18