Avoid killing marrow during fixed restoration

Date: 31/05/2018 / Author: Ms Cẩm

Broken teeth, large chunks or teeth with pulp problems should be carefully analyzed before fixation. If there is any doubt about the life of the pulp, endodontic treatment before prosthodontics rather than permanent fixation and marrow treatment as needed.

 Cure the pulp is not clean

 The teeth are inflamed

The pulp is considered to be the lifeblood of the tooth so it is necessary to avoid pulp death during permanent restoration to preserve the effective tooth structure

Avoiding the death of pulp in the permanent restoration of teeth is one of the challenges. In many discussions with the dentists around the world, I found that there are different perspectives on the relationship between fixed restoration and endodontic treatment. Some dentists say they prefer endodontic treatment to all permanent teeth, while others think that it is rarely necessary to do endodontics after fixation. The truth is that there are some challenges when performing fixed restoration without endodontic treatment. 

After many years of permanent restorations, thousands of crowns and discussions with hundreds of dentists, I have made some personal remarks to help dentists practice avoiding treatment failure. Orthodontics after fixation fixed.

Reconstruction of teeth can cause pulp damage

Reconstruction of the tooth is performed when the rest of the tooth rests on the fixed fixation prosthesis and when a small portion of the tooth structure between the preparation surface and the pulp chamber is left.

The tissue renewal materials and adhesive agents can stimulate the pulp. The most common tissue-rejuvenation material today is composite, but amalgam is still used. In order not to contribute to the endangered material, endodontic treatment is recommended. I recommend the self-etching system before placing the composite or using 4-methacryloxyethyl trimellitic anhydride or 4 META as an amalgam filler such as Amalgambond (Parkell, Farmingdade , NY) before placing amalgam.

Healthy pulp and tooth pulp have signs of infection

Stimulation of Cement material

In the past, fibrous stimulation was one of the most common causes of bone marrow transplant. However, reinforced cement resin glass ionomer such as RelyX Luting Cement (3M, St, Paul, Minn.) And Fuji Plus (GC America, Alsip, III.) Have become the most commonly used cement. in U.S.A. These are weak stimulating cement, which significantly reduces the sensitive matter of the teeth after attaching, I suggest continuing and expanding use of this type of cement.

Cutting tools

Some dentists use cutting tools that have a long shelf life. For me, a single-use drill and a $ 1 diamond tip should be used. This avoids the unintended consequences of cutting through the use of expensive and reusable equipment.

Dehydration in teeth

The preparation of teeth for permanent fixation removes most enamel, which causes dentin exposure and tends to lose a lot of water. To get a good sign, the area to be stamped must be dry and this tends to cause the tooth to dry excessively. Soft tissue protection and limited tooth drying are recommended to avoid damage to the pulp due to dehydration of the teeth.

Hand axis drilling

Drill axis deflection is a common problem when drills are used to grind quite a lot of tooth structure. After several hot disinfection, the high-speed drills are vibrated and the concentricity is reduced, causing impact on the teeth and potentially causing damage to the pulp. The dentist is advised to observe the concentricity of the rotary instrument in the drill. When detecting a non-concentric turning drill, it is necessary to repair or replace the drill. 

Pressure on the cutting tool

The steam drills used for cutting should lightly touch the teeth. However, in some cases, major changes in sound indicate that the cutting process is under the most extreme pressure. When using a rotary tool, just put a sufficient pressure to easily cut the tooth. If the rotary tool wears or the concentricity of the drill is reduced, a large pressure on the grinding tool must be applied during the work period. This large cutting force causes heat and eccentricity in the cutting tool, causing strong impacts on the teeth.

Dead bone marrow before starting prosthodontics

Large recovery teeth or teeth with pulp problems should be carefully analyzed before fixation. If there is any doubt about the life of the pulp, endodontic treatment before prosthodontics rather than permanent fixation and marrow treatment as needed. In my opinion, many crowns on deadteeth or teeth that are not treated with pulp, wrong months or years these teeth will have symptoms and endodontic treatment through the crown or prosthesis.

Structure of basic teeth

Bite the joint

Fixed fixation in the early contact condition will be the root teeth and the opposite teeth are sensitive. It is recommended that all permanent fixations be fixed before fitting to determine whether the bite is too high or too low for a bite like Accufilm 2 (Parkell) or Madaam Butterfly (Almore, Portland, Ore). . Newly qualified surgeons may make the mistake of adopting a lower bite restorative because the patient does not complain. Patients may tolerate lower bite restoration for 1 or 2 days but eventually the teeth next to the restorative denture will suffer from increased pressure and risk of fracture under increased pressure. .

Too many teeth

Some dentists tend to grind a lot of dental tissue when doing fixed restoration. Although this makes the process of making teeth in the lab easier but more dangerous to the pulp. Make as little teeth as possible to the extent possible to avoid damage to the pulp. This is especially needed for young patients with extensive canines.

The pressure on the water and the teeth are not appropriate

Spraying too much water while grinding teeth limits vision, but less water spray will produce heat that affects the pulp. In my experience, I recommend a simple clinical guide: If there is a layer of gray humus on the teeth while grinding, it should be more water / hoi. Water and vapor can be supplied from the hands or from the sprays by a dental assistant for easy viewing.


When clinicians find that fixed prosthodontics require more endodontic treatment, there are a number of adverse factors that contribute to the death of the pulp. The ten disadvantages I mentioned in this article are based on my observations over the years of fixation, research and discussion with other practitioners.

Vo Van Nhan DDS.PhD


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