Margin Salvation
We got a two year followup on this patient when looking at the premolar. There were three mesio-buccals on this case. The patient requested we keep the crown so we salvaged the mesial margin with amalgam.
Category: Daily Fix
Palatal Split
The chamber had a narrow tall platform which lends itself to a small yield access. At 1 year there is healing evident in 2D.
C Shaped Lone Molar
A little over a year shows radiographic healing. We found 4 portals of negotiation.
Post or No Post?
A pretty common question that comes up when I’ve lectured on restoring endodontically treated teeth is “Do molars need a post?”. I would say, on most initial treatments, the answer is no. Reason being, with a conservative access, the internal access shape is convergent leading to a frustum shaped access which lends considerable retention. In some cases, what your dealt, has already compromised this retentive form. In this root tip endo case, the root filling had been exposed for a long time, and with regard to remaining tooth structure- it already had 3 strikes. The patient knew that this tooth didn’t have a favorable long-term prognosis but wanted to buy some time. So, we pitched a tent with 3 stainless steel posts and placed a bonded amalgam. A little heroic? More or less heroic than Nacho Libre?
C- Shaped Canal System
This patient was in for another tooth so we go this followup image. We had waited for a couple months after starting the case before obturating. Looks like complete healing at a year.
Margin Salvation with Retreatment
It’s always a little disheartening when we access into a bridge abutment to find rampant caries. The patient wanted to get some more time out of the bridge. We we removed all the cariest, retreated the tooth, and flushed up the margin with amalgam. We saved the bridge for at least a year, with no signs of caries so far.
Surgical Treatment of a Lateral Canal
Six year followup of an apical and lateral surgery. The CBCT, even with the significant artifact, suggested lateral bone loss. This could have been attributed to a fractured root. However, in this case it was related to a lateral canal. Both lateral and root end preparations where made, and root filled with grey MTA. Complete healing is evident at the six year mark.
Getting Sideways
Super sideways molar positioned because the premolar never erupted. The area is kind of a food trap, but the patient wanted to keep it. The margin here was so deep the matrix wouldn’t reach. So we packed Cavit and flowed some Dycal over it to finish the matrix. It took me 3 appointments to finish this 28mm monster.
Resolved.
Experience has led some clinicians to the conclusion that large areas of apical bone loss can’t be managed without surgical intervention. And in some instances, that may be the case. However, often, in large areas of apical bone less where the cause is endodontic in nature, nonsurgical endodontics can provide a predictable and favorable outcome. In this case, there was a history of trauma to the maxillary incisor. The apical finding is larger than a centimeter in diameter in both the buccolingual plane and inciso-apical plane (A,B). The tooth was accessed and medicated with Calcium Hydroxide for a few months. When initial signs of healing were observed radiographically, the tooth was obturated and restored. At two years, complete healing can be observed both in 2D and 3D (C,D). Large areas of bone loss can provide treatment planning challenges in the esthetic zone. In addition, many patients are taking medications that put them at risk for bone necrosis of the jaws when subjected to surgical interventions. Often endodontics can help in managing these situations.
Endo Gif
James Ho started doing some endodontic GIF’s; here’s one he made out of a case we finished last year.
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