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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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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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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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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tooth malrotation

When Lingual is Occupied

August 19, 2014

Sometimes when the conventional endodontic access is not possible, the unconventional approach can save the day. A clinician should always aim at establishing a straight line access (SLA) in order to properly instrument, irrigate and obturate the canal system…

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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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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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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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