If the tooth broke with the force of the rubber dam clamp, the restorative prognosis of the tooth was not good in the first place.
The answer to your first question depends on the following variables:
- Pre-operatively, what was the restorative prognosis of the tooth? Did you have sufficient ferrule or tooth structure to place a rubber dam? If the tooth had almost no natural tooth structure and was essentially a 5 surface amalgam/composite crown, then you really have to think about long term prognosis. If there wasn't enough tooth structure or ferrule, then next time, clamp on the tooth behind, slit dam, and use opal dam around the tooth if you feel that a root canal can save the tooth (maybe need CL/posts to retain a crown in the future). So... if you were to think what you may have done wrong, I'd say assessing the restorability of the tooth should've been first, especially if it broke at the gumline.
Second question: Prognosis is worse, not because the rubber dam fell off, but because of the amount of remaining tooth structure. There's only a few times that I'd do endo on a non-restorable tooth, mostly when there are contraindications for extraction such as long term IV bisphosphonate use.
Another thing to consider, if the patient kept getting caries, you have to think whether rctbucrown would have been an appropriate option if OH is bad.
The patient has a full upper jaw denture and in the lower jaw he has i think i remember it as being his second molar in the forth quadrant, and then the second premolar in the third quadrant and a premolar in the 4th quadrant. So something like 7,5+5 are holding the whole partial denture. He always comes in with terrible oral hygiejne despite it basically being only 3 teeth he needs to take care of, and there is lots of plaque and residue especially around the tooth i did the root canal treatment on.
The 7+ he had problems with a month ago with it breaking and they did an emergency treatment simply building up the whole tooth crown in composite, as it was exam time and someone else had to do it. The premolar i was doing the root canal treamtent on he had also had numerous caries problems with. Whenever he came i would notice there was caries, and usually always around margo gingiva. It was typically very hard to put a matrix bond on and even my teacher could not succed in placing it and it resulted in gingival tear. We ended up dropping the matrix band and instead retraction cord and improvise with a cervical matrix half cut. So as you see in the end there was no real tooth left above the margo gingiva. Only composite filling. The filling was sufficient enough and shaped in size as a normal tooth. But i guess from this experience it means that a composite crown isnt ever strong enough to use a rubber clamp on? Does it mean we cant ever use a rubber clamp on the teeth with crowns that are t5 surface composite fillings or can you please explain to me what you meant by that i have to consider the prognosis when its a 5 surface composite? Because the suggestion in this forum is that i could place the clamp on other teeth but there were none others close by as you see.
The reason for the root canal treament was pulpa necrosis, and we wanted to do it because he wanted to do everything to save his last 3 teeth as they were holding the whole lower jaw prothesis and if anything happened to those he would have to get a new prothesis made which he didnt want. After the crown fell off my teacher also discussed that we will probably have to put a post on and then later put a crown on it, however as there is metal from the denture around that premolar i was told it will be hard to make the crown fit perfectly.
But so i do you guys think i messed up too much? The thing is that it was my teacher who put it up for a root canal treatment so i think the prognosis is was ok or else she wouldnt have choosen that and instead just asked it be fully extracted. Now the whole game changed though as he cracked his 7+ so maybe we will anyway need to redo the denture .
Its my 1st year at the dental clinical with real patients after simulation lab so as i saw my teacher seeming stressed about it a bit in the end i started wondering if she thought im not good enough or something. She is probably too nice a woman to say it, but i still would like to find out for my own sake anyway instead of walking around thinking everything is fine and get the shock once i graduate. Thats why i choose to ask here wanting to find out if the process was ok or weather i messed up badly.
I really had prepared very well in advance and knew every step just fine, and came half an hour before to get stuff ready. Everything went well despite him arriving half an hour too late, from giving him Infiltration anesthesia to placing the rubber dam, so i felt i had plenty of time as usually we have 3 hours for it and students have a hard time with placing the rubber dam, while i got it on in 5 minutes. However once it broke off suddenly the whole protocol was changed and it ended up lasting 4,5 hours instead of the maximum 3 as i had to find the canal again i got scared of drilling because i did not want risking the crown falling off again, so she came to help me find it. Then when i had to take the x ray to check the length of the file he was jumping in the chair whenever i pressed down to with the film and wasnt having it. She came again and while i couldnt get apex on the x ray my teacher didnt even get anything of the tooth on the first x ray she took but her 2nd try was just perfect. I think i had taken maybe 6-7 with no apex until i gave up.
I managed to rinse with all xfiles and then place calciumhydroxide, and fuji triage in the end and got him sent home with no more help from her.
Can you guys please tell me if it was ok or if you think i am to bad compared to you when you had had your first year at the clinic and on your 2nd root canal treatment.
Im really sorry the reply got this long and also about my english as im no english native speaker.
