Sharing the Endodontic Knowledge


Unexpected Bleeding

May 30, 2021

At the end of the shaping and cleaning stages of root canal procedure, we should be able to dry the root canal system with sterile paper points. But, this is not always the case!

Unexpected bleeding intra-operatively can occur for a range of reasons…

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scientist holding a vial

Updated Antibiotic Guidelines

December 10, 2019

While the most important step in managing endodontic infections is prompt treatment by general dentists or endodontists, use of antibiotics when indicated may be necessary in managing certain endodontic emergencies. The American Association of Endodontists (AAE) has recently updated the guidelines for the use of systemic antibiotics for the urgent management of dental infections…

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manual dynamic agitation

Manual Dynamic Agitation

May 5, 2018

The apical 3mm of an infected root canal system is considered to be the “Critical Zone” when it comes to the chemomechanical preparation.  Mechanical instrumentation and chemical disinfection of the root canal system to its full length significantly affect the outcome of treatment…

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a discoloured tooth

Walking Bleach since 1938

May 11, 2017

Tooth discolouration as a result of intrapulpal hemorrhage (i.e. traumatic dental injuries, pulp necrosis, pulp tissue remnants after endodontic therapy, internal resorption, etc.) can be effectively and safely corrected with walking bleach (internal bleaching) technique. This technique is a conservative alternative to a more invasive esthetic treatment such as placement of crowns or veneers…

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intentional replantation

A Compromised Tooth is Still a Tooth

February 21, 2017

Endodontic diagnosis for tooth #2-7: previously treated, symptomatic apical periodontitis. Intra-oral examination reveals a wide, 6 to 8mm clinical attachment loss (i.e. probing defect) distal to tooth #2-7 and loss of distal contact due to enamel fracture. A CBCT scan shows intact buccal and palatal bone and a significantly shortened palatal root due to external inflammatory root resorption…

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sinus tract

A Misdiagnosis: a Big Nail in This One’s Coffin

August 23, 2016

Patient presents with apparent sinus tract in quadrant 4. According to the patient, the sinus tract had been identified by a hygienist during a hygiene appointment. Subsequently, the endodontic treatment had been initiated in order to resolve the infection…

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clinical photo of a tooth

An Unconventional Access

March 16, 2016

Patient presented with #1-3 pulp necrosis and chronic apical abscess. Due to missing #1-2, mesially tilted tooth #1-3 had been restored as #1-3 and #1-4 splinted crowns in the place of #1-2 and #1-3. The clinical picture shows a ceramic interdental papilla which covers the root of tooth #1-3…

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dens evaginatus

The Little Devil Horn – part II

December 8, 2015

Depending on the location and size of dens evaginatus, most tubercles fracture off as soon as the teeth come into occlusion. The resultant pulp exposure goes unnoticed until patient develops pain and symptoms and a combined endodontic-restorative procedures would then be necessary. Therefore, observation alone is not an acceptable approach…

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CSI: Canine Space Infection

November 27, 2015

The maxillary canine space can become directly involved as the result of infections from the maxillary canines. The infection from these long teeth can involve the canine space, the area superior to the muscles of facial expression. The resultant swelling obliterates the nasolabial fold on the affected side…

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clinical photo of dens evaginatus

The Little Devil Horn

October 30, 2015

Dens evaginatus (a.k.a. Leong’s premolar) is an odontogenic developmental anomaly. This anomaly, an enamel-covered tubercle with an extension of pulp horn in most cases, occurs primarily in premolars. Loss of this tuberculated cusp during natural root maturation and development will result in early pulp exposure, pulpal necrosis, periapical disease, and arrested root development…

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direct pulp capping

The Young and the Resilient

August 7, 2015

When deciding on an endodontic-restorative plan for a tooth, one should always keep in mind the age of the dental pulp (i.e. patient’s age). Younger dental pulp = more cellular, vascular, defensive and therefore resilient. This fact can help us decide on a more appropriate and conservative treatment for a tooth when facing pulp exposure as a result of trauma or caries excavation…

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pulp stone

The Non-Precious Pulp Stone

June 26, 2015

One of the factors contributing to root canal failure is remaining infected pulp tissue and the pulp stones, if left behind unnoticed, are the main reason for trapping tissue and retaining infection. Pulp stone removal is therefore a crucial factor in achieving a successful result in endodontic treatment…

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law of concentricity

Recognize the Rotated Ones!

April 1, 2015

One of the scenarios that we have to always be prepared for is accessing through a crown that is placed on a rotated tooth. One of the key elements discussed was the use of a probe to gain a better appreciation of the root outline at the CEJ level. The “Law of Concentricity” then allows us to start our access cavity preparation in the right direction…

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cracked tooth

Protect the Cusps

March 18, 2015

Heavy bite, specially with less than ideal occlusion or cusp-fossa relationship, can result in cracks and fractures in teeth. Here is an example of a case with heavy occlusal pressure concentrated on the lingual inclinations of the buccal and lingual cusps of tooth #2-4. Two mesial enamel cracks are evident in this case…

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visible vertical root fracture

What Lies Beneath!

February 4, 2015

Excessive root dentin removal during endodontic treatment and use of posts are the predominant risk factors for root fractures. Common clinical findings associate with root fractured teeth have been discussed in a previous post…

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