Thermafill retreatment #30 with some accessory portals. Root canal completion #31. More anatomy….. […]
Thermafill retreatment #30 with some accessory portals
Category: Endodontistry
Thermafill retreatment #30 with some accessory portals
Lesion Shape Suggestive of Root Canal Anatomy
LESION SHAPE SUGGESTIVE OF ROOT CANAL ANATOMY
LESION SHAPE SUGGESTIVE OF ROOT CANAL ANATOMY: This is a pretty good demonstration of periapical lesion associated with the canine tooth (#6). Pre-operative radiographic survey reveals that the lesion is off to the side at the apical third. Post-operative radiograph highlights a couple accessory canals providing a route of infection and inflammatory response in the area of the lesion. Good demonstration of anatomy here. […]
INVASIVE CERVIAL RESORPTION
INVASIVE CERVIAL RESORPTION
INVASIVE CERVICAL RESORPTION: Here is an interesting case. This patient ended up in our care after a root canal was done on tooth #9. He was informed at that time that it wasn’t guaranteed that the tooth could be saved and that a dental implant might be necessary or a surgery of some sort. As one can see on the pre-operative radiographs, sagittal slice of the CBCT and clinical photo, there is clear evidence of invasive cervical resorption on the buccal aspecdt extending below… the level of the crest. Additionally, the granulation tissue was not addressed via non-surgical access. Because […]
Compromised Teeth
Restorative Considerations
Compromised teeth: Many times the limiting factor in the prognosis of teeth requiring endodontic treatment is the restorative aspect. Here we present a case in which rerstorability may be in question becuase fo the fractured portion of the crown. As part of the endodontic treatment, we repaired the portion of the crown prior to initiating the endodontic treatment. The endodontic treatment is quite standard, but we would like to point out the soft tissue response of our repair at 6 weeks when the case was completed. The difference betweent he pre-operative photo and the 6 week follow-up is significantly different […]
CBCT Imaging
CBCT Imaging
CBCT IMAGING – As many of us are aware, CBCT imaging applications for dentistry are growing at an exponential rate. This case highlights an unusual scenario where the patient received an apicoectomy on tooth #9 ~25 years prior to presentation. His chief complaint was a large sinus tract that had recently developed. Convential PA shows a moderate diameter lucency around the root apex. However, the …CBCT volume highlights an existing osseous graft (later revealed to be bovine bone graft through histology) that is infected and encapsulated by soft tissue. The native bone destruction is actually quite large and perforated on […]
COMPROMISED TEETH:
COMPROMISED TEETH 3
Here is a 79yo healthy female with non-remarkable medical history. She presented with a history of massive palatal swelling due to perforation of the palatal root from attempted retreatment by her dentist. As you can see, a part of the previous casted post remains in the palatal root. We have identified the perforation on 2D imaging and confirmed with CBCT (we area aware of an untreated MB2 canal; however, there is no evidence of periapical pathology and retreatment will not be attempted until we can confirm that we have rectifed the palatal pathology). We have decided to attempt repairing the […]
MAGNIFICATION:
MAGNIFICATION:
One cannot treat what one cannot see…But if you can see more with assistance from the dental operating microscope, you will be able to make very small access openings into teeth/restorations. Here is a great example: recently placed crown and neither the patient nor referring Dr. were too keen on having the new prosthesis drilled through. Both changed their tune once they saw what we were able to do…this does not happen without enhanced magnification. […]
Selective Root Retreatment:
Selective Root Retreatment:
Here is a case where the mesial root of this molar displayed recurrent infection. In the other root, there is a properly placed fiber reinforced post. In order to save tooth and crown structure, the decision was made to treat only the infected root. Of course, this is done with very clear communication between the patient and us that we would be responsible for the tooth should the other root become infected. This way, we are able to keep the access opening through the crown as small as possible.. […]
Fractured? Or just compromised?
Fractured? Or just compromised?
This case was referred to our office for evaluation and expected extraction with eventual dental implant. Radiographically there was a large lesion associated with the mesial root, accompanying deep probing, and large swelling at the gingival margin. This case has several signs that would be consistent with non-restorable fracture. However, we used all available diagnostic tools, including CBCT, and could not definitively identify a fracture that would condemn the tooth to extraction. Therefore, we pursued retreatment with 6 weeks intracanal medicament. At the time of case completion, this patient was completely asymptomatic and the gingival tissue was healthy and firm. […]
TOOTH RESORPTION:
TOOTH RESORPTION:
This one is interesting. This patient winds up in our office for a 3rd opinion because the tooth had been condemned for extraction. After careful discussion with both patient and restorative dentist, we were able to identify that the resorption process was still above the level of the bone. Osseous crown lengthening was discussed as a potential requirement for an adequate restoration. We were able to completely degranulate the resorption tissue using the endodontic microscope, treat the area with acid, and repair with defect from within the endodontic access. Additionally, we placed a fiber reinforced post so that the restorative […]
