Page 13 - The Beauty and Sorrow in Endodontics-Chapter 2

(Fig 22E) (Fig 22F)
Rubber dam placement becomes easier Maintaining good pre-op and post-op
with the copper band in place. Access coronal seal is as important as

cavity preparation and subsequent achieving tight apical seal at the end of

cleaning and shaping can all be treatment.

completed more smoothly as well.

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The patient in Case 21 was lucky in the sense that the recurrent caries on 36 did not
infect pulpal tissue and therefore can simply be restored. However, if the caries has

already damaged the pulp, and endodontic treatment is the treatment of choice, all carious
tooth structure and old restorations must be removed, and coronal buildup completed
prior to initiating endodontic treatment (Fig 22A). Without this, we cannot confidently

irrigate and disinfect the canals with sodium hypochlorite (Fig 22B). Dr. Schilder always
recommended fitting a copper band around any molar and premolar tooth that requires
root canal treatment (Fig 22C). Copper bands are hollow tubes, it is rigid prior to heat
treatment, but softens after, which allows for any shaping and fitting to the tooth prior to
cementing it (Fig 22D).

The biggest advantage of placing a copper band is prevention of any coronal
microleakage that will result in infection of the root canal system. It also provides enough

space to contain adequate volume of sodium hypochlorite required to properly disinfect
the system. In addition, it simplifies rubber dam placement and access cavity preparation
(Fig 22E). When there is limited tooth structure, dentists are often wary about removing
more dentin even after coronal buildup, which limits the size of the access cavity,
resulting in increased difficulty during cleaning and shaping. Furthermore, pre-treatment

allows the dentist to assess the restorability of the tooth, whether crown lengthening
surgery will be required prior to crown placement, and provide the patient with informed

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