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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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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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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perforated tooth

Not Every Hole is a Canal

October 26, 2013

Perforations or accidental communications need to be repaired as soon as possible in order to achieve the best possible prognosis. The choice of repair material depends on the location and the size of perforation. MTA is still one of the best materials that can be used to seal the pulp floor perforations as long as it is not communicating with the sulcus…

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How can an Apicoectomy Help?

June 4, 2013

There are times when conventional root canal treatment or retreatment cannot heal every periapical lesion out there. Luckily, we have the option of an apicoectomy – which in today’s terms, means microsurgery. During an apicoectomy, the most apical part of the root tip (usually about 3 mm) is removed…

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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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vertical root fracture

It is ‘Game Over’!

October 9, 2012

Vertical root fractures (VRF):

– are associated with endodontically treated teeth.
– are commonly directed bucco-lingually.
– are mostly diagnosed by localized probing defects (+/- sinus tract) that are usually present around the fractured root…

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horizontal root fracture

Is This a Hopeless Case?

June 5, 2012

“In traumatic dental injuries, not only it is important to know when to treat a case (endodontically-speaking); it is equally important to know when not to treat it.” – Martin Trope

Before considering extraction of a tooth with root fracture, no matter how bad it looks on the x-ray, the following treatment approach must be considered…

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vertical root fracture

Oh No, Vertical Root Fracture!

May 29, 2012

We have all come across an endodontically-treated tooth with vertical root fracture (VRF). What gives the VRF away is the pattern of bone loss (more bone loss occlusally than apically) and the clinical attachment loss on the buccal or lingual aspects of a specific root. ..

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