The Endo Fix

Category: Daily Fix

The Dreaded Disto-Palatal

Daily Fix
Suffolk Endodontist Hampton Roads Endodontist

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.

Deep Negotiation on a Retreatment

Daily Fix

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.

Dycal Help with Matrix

Daily Fix, Tips, Tricks, and Hacks

Suffolk Endodontist

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.

Margin Salvation

Daily Fix

Hampton Roads Endodontsit

 

 

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.

Post or No Post?

Daily Fix
Newport News Endodontist

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?

Margin Salvation with Retreatment

Daily Fix

Hampton Roads Endodontist

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.