Clamping and Isolating a Broken Tooth for Endodontic Treatment
When it comes to performing endodontic treatment, it is not uncommon for the tooth in question to be significantly broken down. In some cases, the defect may even be subgingival, which makes isolation of the tooth a real problem.
So, what are the best options for clamping such a tooth to obtain adequate isolation?
In this edition of CDA Oasis Live, Dr. John O’Keefe, Director of Knowledge Networks CDA, invites Dr. Joel Fransen, an Endodontist from Richmond BC, to discuss his best practices in isolating teeth for endodontic treatment.
Stressing the importance and the benefits of a rubber dam, Dr. Fransen introduces the Silker-Glickman clamp, a stainless-steel clamp with extended wings that allow for rubber dam placement around teeth with minimal tooth structure. Presenting case studies from his own practice, Dr. Fransen highlights the versatility of the Silker-Glickman clamp, not only in root canal treatment, but also in crown preparation.
We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.
Until next time!
CDA Oasis Team
Thank you for the great discussion Dr. Fransen and for the clamp recommendation!
Tried the clamp website and it’s horrible. Used several browsers and none worked to order. Sent them an email but haven’t heard back.
Hello VR,
Unfortunately, you are not alone. I too have run across problems ordering from these people. If you like, I can try to get a response on your behalf.
All the best,
Joel
Thanks for the interesting presentation.
My experience it is much easier to restore a tooth before endo then to try and worry about isolating a broken down tooth. I typically expose a defect excavate carries and restore with a deep reaching tofflemire and create a thin wall with some flowable. If I have good moisture control I sometimes elect go with clinically acceptable composite that I can rely on later down the road, but in many cases I etch Bond and restore as a known temporary measure just for isolation and will remove the whole restoration at the time of preparing for the final prosthesis. This does involve a bit of time upfront but I find it pays dividends. There is also a billable code for this procedure ” isolation of endodontic tooth for asepsis” or something to that effect.
This leaves me with no doubts about my level of isolation and the ease of using traditional damming techniques.
Hello Andrew,
I like your technique and thank you for the detailed explanation. It is also another great way to tackle these interesting cases.
Cheers,
Joel
How do you restore the tooth. #46 ? Mesial margin seems to be right at bone level. It needs CLP before crown fabrication.
Adding up the cost of Endo, perio surgery, post and core and permanent crown, not sure if extraction and implant will be a better option.
Thanks.
Hello SM,
The patient did make an informed decision prior to proceeding with treatment and turned down the implant option. The resorptive defect is mostly on the buccal surface and fortunately not that severe on the mesial wall. If it was, then the restorative challenges would be greater. However, crown lengthening is not an absolute necessity nor is a new crown. Nor is it an absolute necessity to perform crown lengthening prior to placing a new crown. This is a massive subject that I cannot do justice to in this short space but there are many ways to skin a cat. Of course, the patient needs to be informed of the issues and challenges prior to choosing how to proceed. In addition, the dentist needs to be comfortable before commencing on any treatment. Also, the documentation needs to be precisely done to protect oneself, especially if embarking on treatment that is not strictly ‘by the book’. Below are some images from a similar case with a three year follow-up. This 84 year-old women is happy we saved her tooth, and has no interest in period surgery, a bridge, or an implant.
Hello VR,
If you like I can try to get a response from them on your behalf. You are not alone in having trouble getting a response from these people. I am sorry that you have run across such obstacles.
All the best, Joel Fransen
Thanks!
I would love to get a contact so I can have this in my kit. I also do restore and then do the RCT sometimes as mentioned by the other commenter.
More images
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