Our Approach

Many teeth that we deal with have extensive caries requiring removal and pre-treatment build-up. It is sometimes necessary to stabilise teeth with an orthodontic band to limit the risk of fracture until the referring dentist can place a crown.
This pre-treatment work is time consuming and may turn a tooth that we would normally treat in one visit into one where two visits are required. Retreatments are generally done in two visits.

Some other reasons for needing two visits include: severely calcified or curved canals or those that have been previously ledged.  Wherever possible, however, it is our intention to complete treatment in one visit.

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Core placement for posterior teeth

Henk takes it upon himself to ensure your restorative treatment following endodontics is as predictable as possible. In posterior teeth this means we can place a suitable permanent material that you can easily prepare for lab constructed cuspal protection restorations. Just mark the corresponding referral form field if you want us to place a core for you.

It is well known that a good coronal seal enhances endodontic success rates. We use Fuji IXGIC to provide an excellent seal over the canal orifices. We then use a bonded re-enforced resin such as Paracore for the core build-up. Bonding following the use of endodontic irrigants requires “refreshment” of the access cavity dentine; we do this using micro-abrasion to enhance bond strength.

In posterior teeth with subgingival caries, resin cores may be contra-indicated. In these cases, we use the classic amalgam Nayyar core This technique offers an outstanding deep seal as well as high strength and retention without the need for destructive post placement.

Temporization for anterior teeth

Following RCT, anterior teeth are generally temporised with Fuji IX GIC ready for the referring dentist to place an aesthetic bonded resin restoration.

Placement of post-cores and preparation of post spaces

Post and core build ups are something many dentists prefer not to do. If requested, Henk can provide this service. His preferred materials are either passive fitting titanium posts or fibre posts (depending on circumstances) and a re-enforced resin core such as Paracore.

Rarely, it may be better to place a cast post and core. Henk does not place cast materials but can prepare the post-space and send the corresponding burn-out post to you to take a post-space impression with.

Where post-cores are placed it is imperative to have a 1-2mm ferrule. If this cannot be created with a slight sub-gingival preparation, Henk will happily assist by doing a surgical crown lengthening and apically re-positioned flap or recommend that you refer to a periodontist of your choice. The permanent crown preparation will need to be delayed for six weeks, however.

What about teeth with existing crowns and bridges?

Like many Endodontists, Henk prefers to work through existing crowns and bridges whenever possible. We feel the damage that can be caused to the restoration as well as the supporting tooth or core does not justify their removal, unless they are leaking and need replacing anyway. Access cavities are filled in the same way as previously described for posterior and anterior teeth.