Monday, October 22, 2012

Episode 398/500: Crown Removal - Richwill Crown Removal Tabs

There are a number of ways to remove crowns - not that you typically want to remove definitely luted crowns - but - there are the times when it "just has to be done".

Just like this morning.....

Chief Complaint: 55 YO female presents with a chief complaint, "my crown is loose - can you cement it back on?"

There are many things that run through my mind when a patient presents with this scenario, including:


  1. If it fell off, what's the success going to be if I just cement it back on?
  2. How many times has it fallen off?
  3. Did it fall off - or - did the tooth/core fracture?
History of Present Illness:  The patient's crown on tooth #13 (FDI #25) was dislodged over the weekend and caused some discomfort.  The tooth has been previously endodontically treated and the full coverage restoration was placed approximately 5 years ago.  

Clinical Exam: Tooth #13 crown was still intact intraorally and on the preparation.  By using an explorer and engaging the palatal crown margin and lifting coronally, I was able to start moving the crown.

Radiographic Exam:  Tooth #13 has been previously endodontically treated and does not appear to have a post placed in either canal.  Periradicular tissue is normal (radiographically)

So - the story continues - as I am about to remove the crown, I"m thinking that perhaps I had better capture a triple tray impression of the quadrant to ensure that if the crown/tooth fractures, I will at least have a "go-by" stent to fabricate a provisional restoration.  The other option is of course, to take/make alginate impressions - however - this is a sick parade/emergency patient and there really isn't time.  I suppose that as I reflect - I could have taken alginate impressions and rebooked her for another appointment.  Either way - here we are.

Anyways, long story short - the crown wouldn't come off and I suspected that she had fractured her core.  After provision of some local anesthetic (you'll see why if you look at the photo), I just couldn't get the crown off w/ hemostats (my crown removal forceps were at our other clinic). So, we scrounged around and found these friends - the Richwill Crown removers.  These are great little friends that only work in specific situations - and this was one of them.  Dental versions of jujubes, these guys, once heated and placed on the crown you intend on removing - make life just a little easier.  However, just like the instructions say - ensure that the opposing dentition is intact, or you may be removing a restoration from the opposing arch as well.

The little tag of tissue was most likely the culprit causing the patient some discomfort when the crown was rocked to the buccal.  This discomfort was also a great hint that most likely the tooth/core was fractured.

Now what to do?!

Here are the instructions for these green friends.

http://www.almore.com/Instructions/Richwil%20English.pdf
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The crown removed from it's resting place of 5 years.  The white core material appears to be a composite core buildup.  
There was no post placed, and it's hard to determine how
much ferrule was used.

richwill crown remover, crown, removal, fractured crown, dental crown,

richwill crown remover, crown, removal, fractured crown, dental crown,
I'll be $4 that the little tissue tag was causing the discomfort when
I tried to remove the crown w/out local anesthesia.

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Ok, the crown is off.

Now what?

Saturday, October 6, 2012

Episode 397/500: Endodontic Access Help - C+ files

I've moved into another clinic (with 12 other clinicians) and I'm really appreciative of the great things that I learned during my residency.  Such simple things that even now I take for granted - are either not shared with others - or - we have information/marketing overload.  "EVERY product is amazing" nowadays.

Our endodontic cabinet is an absolute zoo.  There are remnants of file systems and products from many other clinicians and I hope not to be one of those folks - but - I probably will.  So here I am, standing infront of this huge filled cabinet and I'm trying to determine what's required and low and behold, there are no #6 files.  Of course, there probably are folks reading this right now and think, "I don't even use #6 files".  Well, uhm....ok.

For the rest of us, there are #6 files and C+ files.  C+ files are just a little more stiff than the conventional #6 files and allow you to apply just "a little" more apical pressure.  Careful - these ones have a cutting tip and who knows where that tip may cut into if you're not diligent.


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C+ files in their little carrying case. Ever used a mirror with an endo ruler milled  into the handle?


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C+ files are made in the #6,8,10 and 15 file sizes.  There are, however, a few other files out there that appear to accomplish the same thing.  The first time I heard about them was today, when I searched PubMed for any literature on c+ files.

This literature article popped up:

 2012 Oct;38(10):1417-21. doi: 10.1016/j.joen.2012.05.005. Epub 2012 Jun 29.

Mechanical behavior of pathfinding endodontic instruments.


Try these and others out - they make just make that afternoon a little easier.