Sharing the Endodontic Knowledge

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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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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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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lost crown

MTA… Saving Open Apices One Tooth at a Time!

June 26, 2013

Providing root canal treatment can be challenging in teeth with incomplete root formation. The apex is large and open, the canals walls are thin and fragile, and this makes disinfection and obturation hard to do. Before the advent of MTA, calcium hydroxide was used in teeth with open apices over a long period of time, anywhere from 6 months to 24 months, to induce a calcified barrier over the open root apex…

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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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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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munce burs

MB2, a Pain in the Neck

April 10, 2013

I was taught that MB2 canals in upper molars are there 60-70% of the time. Newer tools and techniques show us that MB2’s are always there whether or not we can get to it. As a matter of fact I tell our endodontic residents at UBC that “if you haven’t found it, you have missed it”…

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flare up

I’m having a Flare-Up!

March 25, 2013

When our patients experience a “flare-up”, we wish they were experiencing a transcendental jazz trumpet experience, and not the other kind, the endodontic kind! Fortunately, the reported incidence of flare-ups is relatively low, generally somewhere between 1-8%. But when it happens, no one is happy, which is a negative experience for the patient, of course…

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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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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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