Sharing Passion for Fixing Teeth With Endo
Seeing as how this case was both apically perf’d and had a large lesion, I would toss it into the problem case type bucket. But we gave it our best, and it looks like that was enough. I’m not sure I ever found the true path. Sometimes it’s worth taking a shot. Looks like things resolved completely in both 2D and 3D.
This patient was in for another tooth so we grabbed a followup of this case we performed 6.5 years ago. Pretty extensive distal caries under the crown. The wide platform lended itself to a truss access. Root-form appropriate instrumentation was completed. We used some bent ultrasonics for chamber cleanup and some bent pluggers to manage the amalgam utilizing a custom resin matrix. We can see the results of deep margin management over time.
Same patient-both teeth probed more than 9mm in the furcation area. In both cases we placed the tooth in medication for a few months during which time the probings decreased to 3mm or less. In both cases, the prognosis is excellent. At two years the first case shows radiographic clearing. Perio of endodontic origin works out well. Primary perio- not so much.
This is the same patient as the prior post but contralateral side. She had extensive decay under the existing crown which didn’t leave much to work with. It was a pretty tough case to band and I couldn’t get it to stay on so I created a custom resin matrix out of Opaldam. Things still look good for this beat up tooth for almost a decade.
Lower canines seem to exhibit a higher degree of prevalence of external resorption than other teeth. Perhaps it’s the higher forces as they guide the occlusion. Perhaps it’s their position as the corner of the arch which. Perhaps its the periodontal treatments that these teeth undergo. Or maybe it’s something else. 3D imaging helps determine the restorability of these teeth. When the resorption passes two line angles most times I’ll throw in the towel. This was the case with the contralateral tooth. By way of clinical classfication this one was external moderate scooping resorption. As is always the case there is osseous in-growth. It’s important to remember that there is hard tissue replacement when reading the scan or the extent of the resorption may be underestimated. It’s important to remove the osseous ingrowth and resect it back until healthy periodontal ligament can be observed under the microscope. As is typical of these cases, the soft tissue looks good at 48 hours during the suture removal appointment.
Kind of an interesting case. Not a lot of tooth to start; we went with a fiber post initially. It broke off at a year. We redid it with a stainless post. Looking good 4 years out. If there’s a failure, I have little doubt that it will be catastrophic- as in the tooth will break.
This is one of those pesky problem case types- the “dreaded disto-palatal” rooted tooth. There is furcal bone loss present, and further, the bone loss proceeds around all the roots and heads distal quite a bit. After six months in calcium hydroxide I thought things were improving and root-filled the tooth. At two years, not much healing could be observed and the swelling returned. We decided surgery was the best option to retain the tooth. Some of these I’ve been doing with resection, retro-preparation, and retro-fillings like this one. Some I’ve just removed the soft tissue. Both approaches seem to be working when I was the one performing the original endodontics.
We used imaging to determine the restorability of this tooth. Based on the resorption classification for clinicians, this is a case of external crestal resorption of the scooping variety. For the deep margin management we chose DME. The patient said she would be happy with 5 years, now we hope for more.
This was a retreatment case where we had to negotiate towards the apical 1/3 before finding the canal. 3D imaging shows resolution of the distal apical finding. In deciding whether to retreat the tooth we followed the retreatment algorithm. The tooth was symptomatic, and while there was some significant tooth removal during the prior treatment and crown, the tooth still has enough tooth structure to meet the patients expectation.
The distal invagination of maxillary molars can create a bit of a challenge when adapting a matrix band. There are lots of matrix options, but if your normal armamentariam is a toffle-meyer and band, then an application of a little Dycal can help out. Just a dab applied with a perio probe to fill the space. Then smooth carbide to clean up the flash. This can be removed an interproximal carver at the time of amalgam carving or later with a scaler. Having this tip in the bag helps one practice Restoratively Driven Endodontics.
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