The Endo Fix

Category: Daily Fix

Resolved.

Daily Fix

Suffolk Endodontst

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.

Frustum Retention

Daily Fix

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.

Shaking My Head

Daily Fix

 

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.

Dual Entry Molar

Daily Fix

Hampton Roads Endodontist, www.endovirginia.com

Hampton Roads Endodontist

 

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.

Resorption Retreatment

Daily Fix, Resorption

Chesapeake Endodontst, www.endovirginia.com

 

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.

3 Rooted Premolar

Daily Fix

Chesapeake Endodontist

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.