Sharing Passion for Fixing Teeth With Endo
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.
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.
The chamber had a narrow tall platform which lends itself to a small yield access. At 1 year there is healing evident in 2D.
A little over a year shows radiographic healing. We found 4 portals of negotiation.
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?
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.
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.
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.
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.
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