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Practice Profile

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Dr. Fleur A. Blethen

Dr. Fleur A. Blethen

Empathy, tenacity, and perseverance are keys to this clinician’s flourishing practice  What can you tell us about your background? I was born and raised in Seattle, Washington, and lived there until I was 13 years old. My family relocated...

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Dr. Ernest Reeh, Practice Profile

Dr. Ernest Reeh, Practice Profile

Focus on patients, family, academics, and endodontics What can you tell us about your background? I have a bachelor’s degree in chemistry with a minor in business. I was accepted off of the alternate list for dental school and then attained...

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Practice Profile - Dr. Anthony Horalek

Practice Profile - Dr. Anthony Horalek

Practice Profile | Dr. Anthony Horalek: The art and science of endodontics.

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Clinical Articles

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GuttaCore® system: a step forward in the evolution of endodontics

GuttaCore® system: a step forward in the evolution of endodontics

Dr. Andrei Zoryan dispels some of the common myths surrounding carrier-based obturation Carrier-based gutta percha Carrier-based obturation (such as Thermafil®, GT® obturator, ProTaper® obturator [Dentsply Tulsa Dental Specialties]) is one...

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Endodontic retreatment of a lower right first molar with WaveOne®

Endodontic retreatment of a lower right first molar with WaveOne®

Dr. David C. Baker uses a technique that facilitates quick and predictable results Patient history The patient is a 34-year-old female who was referred by a local colleague. She had broken her lower right first molar and complained of some general...

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The Laschal FXP set incorporates transferred oscillation technology

Background There are other ultrasonic devices on the market that depend upon direct contact with a separated file to loosen and remove. However, it is absolutely impossible to restrict the contact of the tip to the file remnant itself. The vibrations...

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Practice Management

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Superior customer service

Superior customer service

Dr. Roger Levin presents the 10 top ways to help create a perfect dental team With the changes brought on by the economy, top companies are bringing in the best resources they can find to evaluate where their organizations stand. They want to know...

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Office Matters: Hard-piped filtered water system vs. self-contained bottled water system

John Bednar helps avert problems coming down the pipe If your office currently has a hard-piped filtered water system, now is a good time to consider if and when you should change to a self-contained bottled water system. A hard-piped filtered water...

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Secrets to financial and personal freedom for endodontists

Secrets to financial and personal freedom for endodontists

In part 1 of his series, Dr. Ace Goerig offers the first steps to becoming debt-free I was presenting at a recent AAE national meeting with over 200 endodontists in the room, and I asked the question, “How many of you are completely debt-free?” ...

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Dr. Peter G. Delaney describes how proper endodontic isolation using pins will save time, money, and unnecessary stress

Proper endodontic treatment can be challenging enough without encountering isolation problems. With a standard case, isolation is usually not an issue, but with gross decay or a tooth that has already been prepped for a crown, it can be. The case study examined in this article is a tooth that has been prepped for a crown at the ideal 8-10–degree angle of convergence and requires root canal treatment (RCT). Every experienced clinician has encountered a number of these teeth and has struggled with various ways to isolate them.

delaney

One option is to refer the patient to a periodontist for an expensive and uncomfortable crown lengthening. This would allow the clinician to get below the convergence angle and obtain isolation with a rubber dam and retainer. Sometimes this is necessary if the biological width is compromised by secondary decay. If the biological width is not compromised, this procedure can be avoided.

A second option is to bond composite filling material to the tooth to create artificial undercuts. This seems to work most of the time, until a working length periapical radiograph is taken or the patient swallows, and his/her tongue engages the retainer from underneath the rubber dam, sending the retainer flying across the room and forcing you to keep the patients’ saliva from compromising the filling material.

A third, and least desirable option, is to engage the patient’s attached gingiva with the retainer. Not only is this uncomfortable for the patient when the anesthesia wears off, but also a “flying” or “sliding” rubber dam retainer is possible. Every practitioner has cringed while watching the attached gingiva tear off, a truly horrible feeling.

The fourth option, which is explained in detail below, is using dental retention pins (Coltene Whaledent). Placed vertically in the cavity preps, the pins are a very useful tool to gain added retention of filling material. By placing them horizontally into a crown-prepped tooth, a perfect artificial undercut is obtained. Four properly placed pins will not “pop off,” will not harm the soft tissue, and will not result in patient discomfort.


Case study

A 90-year-old man presented with the chief complaint of pain when biting on the lower left side. X-rays and examination reveal gross secondary decay under the crown on tooth No. 19. The old crown was removed, as was any and all present decay. There was no visible sign of pulpal exposure, thus a temporary crown was placed for an evaluation phase. After 3 weeks, the symptomology worsened, and it was determined the tooth had irreversible puplitis, and RCT was started. After administering local anesthesia and removing the crown, isolation was accomplished by placing two horizontal pins buccally and two horizontal pins lingually. A 56A retainer was placed over the pins, creating an artificial undercut to keep the retainer in place. (If necessary, the Minim™ [Coltene Whaledent] bending tool can be used to bend the pins in an apical direction to ensure an undercut is achieved.)

The RCT then was completed in a perfectly dry field. After completion, the pins were cut off flush with the crown-prepared tooth. The tooth then was restored with a post-and-core and final crown.


Concluding thoughts

The goal is that this technique will save time and unnecessary stress when isolating a crown-prepped tooth or one with gross decay. This procedure will save your patients time, unwanted discomfort, and financial distress. For the significant number of patients who desire nonmetal material in their mouths, reaming the remaining portion of the pin from the tooth and filling the void with composite resin material will yield the desired result.


delaneyheadshotBio: Peter G. Delaney, DMD, is a general practitioner in West Hartford, Connecticut, and was voted by his peers as one of Connecticut’s Best Dentists every year from 2009 to 2011 in CT Magazine. Contact, This email address is being protected from spambots. You need JavaScript enabled to view it. for questions, or visit http://www.west-hartford-dentists.com

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Latest News

There remains a growing belief among clinicians that obturation is to blame for endodontic failures. This notion has more recently fallen under scrutiny as researchers have discovered that the most thorough obturation can only reflect the quality of the cleaning and shaping of the canal. In fact, a number of researchers point to the thorough use of irrigants — making sure that the debris and irrigant itself are lifted completely out of the canal, not forced out the apex — as the most important determinant in the long-term success of an endodontic procedure.

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