With new heat treated NiTi files, we no longer need straight line access to achieve exceptional outcomes even in severely curved teeth. This is particularly important in cases like this, where the restorative dentist has already received the crown from the lab, and extreme care must be taken to provide as minimal of an access as possible in order to avoid taking new impressions and incurring additional lab expenses to remake the crown. […]
Cracked Tooth Syndrome: Here is a case where our patient presented with significant pain with 2 teeth but neither the patient or referring Dr. could determine the root cause. Clinical objective testing MUST be done and proper diagnosis cannot be made by looking at an image alone. Significant findings included 1] deep isolate probing between the teeth but moreso when canted towards the posterior tooth (left one) 2] Periradicular bone loss around one of the roots causing a J-shaped appearance 3] Bone loss most extensive at the alveolar crest (green arrow), suggesting that the crack started at the level of […]
Retreatment: Here is an interesting case of root canal retreatment from a failed initial attempt at initial endodontic treatment. This particular case was filled with a carrier-based filling material, which has no solvent. This, along with the presence of a metal post cemented in the tooth, makes it inherently more difficult to treat. If you look closely at the photo of the post-treatment access, there is a 3rd canal (not separate) within one of the roots. Another cool case! […]
Compromised Teeth: Here is an interesting case where there are 2 things going on with the same tooth. First, there is significant bone loss around one of the roots (see green arrows) which would seem to suggest possible fracture (this tooth also had deep isolated probing in a specific area which would also support non-restorable fracture). Additionally, there is root resorption associated with the same root (see red arrow). Due to circumstances outside of our control, we did not complete this case for 6 months. We were happy to see that not only did we achieve complete bony healing, but […]
Compromised Teeth: Let us preface this post first by saying that choosing to save compromised teeth requires very clear communication between the patient, comprehensive dentist, and the specialist. There are many factors involved in making decisions to save or not to save teeth. Here, the factor that would limit success of the tooth is the restorative aspect, and not the endodontic treatment. Although a dental implant may be a more predictable long term outcome, longevity of the tooth truly depends on the patient so long as the endodontic and restorative treatment are adequate (i.e. maintaining hygiene and always be aware […]
Adverse Outcomes: We present here a case where the patient presented with a broken instrument within one of the canals. This is always a cause for concern for patients who are worried of infection and systemic effects. We must first recognize that bacteria causes infection, not foreign materials. The broken instrument only serves as a physical obstruction towards proper cleaning of the tooth. Here, we were able to identify with CBCT that the canal with the broken instrument shares a common exit with other canal which does not have a broken instrument. In this case, we were able to bypass […]
Success/Failure (of root canal treated teeth) – The prognosis for endodontically treated teeth depends on 3 main factors which are as follows: 1] How good is the root canal? 2] Is there an appropriate restoration for the endodontically treated tooth? How good is the restoration? 3] THE PATIENT: We like to call this the X-Factor. It is up to the patient to maintain the dental work so that it will last as long as the expected. Here, the endodontic treatment and restorative treatment were adequate when compared to older radiographs, but recurrent decay set in underneath the prosthesis rendering the […]
Diagnosis and Internal Root Resorption: Interesting case presented here. This tooth is non-vital and infected. However, prior to getting to this state there was a process of internal root resorption (green arrow) which can only have happened while the tooth was alive (live tissue is required for this process to happen). Additionally, there is significant bone loss evident in the furcation area. This is NOT caused from the resorption defect; rather likely from an infected accessory canal! Pretty interesting because there are multiple things going on with this tooth. […]
