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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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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Pre-op radiograph of #14

It’s Vital…with No Fillings…but it Hurts!

September 19, 2014

Radiographs can be so deceiving! This radiograph of the first quadrant looks so calm, so unassuming… everything looks normal. What you didn’t see was the patient attached to this radiograph – having extreme, radiating pain. When everything looks fine on the radiograph, and we have a quadrant full of unrestored or minimally restored teeth, my spidey sense tells me to pick up a probe, and also a transilluminating device…

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cracked tooth

Beware of the Cracks!

May 30, 2014

A patient comes in with tooth #2-6 (upper left first maxillary molar) being extremely sensitive to cold (a.k.a. a “hot tooth”). You notice a very old, large amalgam filling on the tooth which had been done over 2o years ago. No recent restorative changes in the area is reported by the patient…

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middlel mesial canal

MM Canal is a Thing Now?

May 17, 2013

The presence of an independent Middle Mesial (MM) canal has been reported for decades in endodontic literature. Owing it to technological advancements, it appears that the incidence rate for these extra canals is on the rise: Skidmore & Bjorndol 1971 (0%), Pineda & Kuttler 1972 (0%), Vertucci 1984 (1%), Fabra-Campos 1989 (2.6%), Goel et al. 1991 (15%)…

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needle irrigation

Irrigation…How Low do you Dare to Go?

May 2, 2013

I graduated from dental school years and years ago with a deeply instilled fear of perforation, a reluctance to tackle calcified teeth, and anxiety whenever I waited for my obturation film to emerge from the processor. Irrigating the root canal was the breeziest part of treatment, to my memory…

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permaflo purple

How do You “Seal” the Deal?

April 19, 2013

After we’ve spent so much time doing great endodontic treatment – with rubber dam isolation, perhaps gingerly applying OraSeal or Kool-Dam to make sure everything is water tight, carefully instrumenting, copiously irrigating, and then obturating with great style – how can we protect our painstaking work?

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Tooth #1-6 after root resection

Micro-surgery Works, Macro-surgery Doesn’t.

January 18, 2013

When endodontic surgery (a.k.a. apico, apicoectomy) is indicated, certain steps must be followed in order to ensure a successful outcome. Skipping any of the steps below, specially steps 4 AND 5, may result in failure…

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broken files

Your Tooth Broke My Instrument!

November 16, 2012

“A dentist who has not separated a tip of a file, reamer, or broach has not done enough root canals.” — Louis Grossman

There are essentially 2 reasons for rotary rotary instrument separation inside a canal…

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cervical resorption classes

The Pink Tooth

September 19, 2012

One of the reasons for a tooth appearing pink is the presence of External Cervical Resorption (ECR) or Invasive Cervical Resorption. This type of resorption has been described and classified by Heithersay.

Some of the predisposing factors for ECR include: trauma, orthodontics, periodontal therapy, surgical procedures, intra-coronal bleaching/restorations, etc…

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