Sharing Passion for Fixing Teeth With Endo
This patient presented with a previously treated molar with pain and swelling and a large radiographic finding. The tooth was retreated and medicated for a few months. 5 year followup shows complete healing.
Keeping the preparation conservative even in the last 2-3 mm helps in retaining the core. The shape of the access here is a frustum, or pyramid with the tip cut off. This providees a macro-retentive feature for the core. Terminal teeth can be difficult to place a band on so we used a custom resin matrix.
This is one of those cases that doesn’t make any sense. 7 years on a cracked tooth with probing to the apex… probings adjacent to the cracks. We put him in meds for a couple months, the probings resolved. Then we put a core in and let him sit for another 3-4 months. He came back for the other side yesterday, with a necrotic molar with probings. He’s weighing his options, but still, I’m not optimistic.
A case where there was deep interproximal decay. This was an example of deep margin management. The margin was placed on amalgam and the result was a nicely fitting crown. Apically some good healing at over 2 years.
Caries on the mesial and distal made this a dual caries leveraged access. We modified a UT4 to prepare under the truss. An old perio probe and shepard hook explorer was modified to be a plugger to adapt amalgam for the case.
This patient presented with pain associated with failing endo. The endodontic therapy was revised, and the tooth restored with a fiber post and palatal composite. The resorption would be classified as External Crestal Resorption, moderate/scooped. The resorption was removed, and restored with flowable composite. The almost 8 year followup shows healthy gingiva free of recession, and no black triangle formation. There was no bleeding on probing evident.
We ended up retreating both of these molars. Unfortunately there was a lot of tooth spent on the initial treatment the probably affects the long term prognosis. Intermediate term outcome, almost.
We recently finished up this 3 rooted premolar. I considered using amalgam on this one due to the caries rate. Also considered deeper Markley wires. However, since the furcal floor was 3-4 mm below the bone level, I opted for a larger fiber post.
The porcelain crown attempted to correct the spacing caused by a peg lateral and as such the center of the canal was located pretty far distal to the crown. Using the imaging to guide the therapy (Image Guided Therapy or IGT) the access was planned for this particular tooth extending through the incisal edge along the long axis of the tooth. A thin fiber place was placed. The tooth was left in CaOH until there was evidence of radiographic healing.
The patient presented with pain on the distal abutment of the bridge. Clinical examination revealed caries and that the bridge was loose on the mesial abutment. The patient wasn’t interested in implant therapy due to a prior bad experience and chose to have the bridge remade. The premolar was retreated (Thermafill carrier removed with hedstroms) and the molar treated endodontically. Due to the wide short chamber present on the molar we chose to make a dual access leaving a dentin truss for support. The premolar was restored with a fiber post for rehabilitation purposes. We opted to use custom resin matrices for restorative purposes. The 1 year followup shows a good fitting bridge, and a functional asymptomatic restoration.
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