ProEndo Forum

ProEndo Forum

Welcome to the friendly root canal forum.

This forum is open to discuss day-to-day root treatments. Let's talk about clinical difficulties and how to resolve them.

I like to share my strategies with you so that you can obtain consistent excellent results.

Or write in to discuss or ask any advice on any subject in Endodontics.

I tried over at least a year to promote apexigenesis using calcium hydroxide dressings. Unfortunately the apex did not respond. Conservative and orthograde root treatment did not work due to the large open apex. A surgical approach was decided that would be the best approach and treatment.

fractured central incisor with open apex

 

 

 

 

 

 

 

 

 

 

Here is the Best root canal treatment for 2016 picked out of about 1000.

The roots are measured about 22-24mm.  The root canal shape is curved and tapered to the apex.  A secondary or accessory has been demonstrated deep, near the apex in the distal root.

The shape and flow of the canal is centered and well performed and exhibits a mature and advanced skilled technique.

The prognosis of the tooth is good and well established.

Molar root canal anatomy is complex and often quite challenging to clean and treat with exacting and successful outcomes.  These teeth generally have three roots and multiple root canals with interconnecting systems.  We find that upper first molars have a fourth canal in the mesio-bucal root with about 70-90% regularity, depending uopn which research papers have been studied.  I have found that most second mesio-buccal canals lead directly and "quickly" into the first mesio-buccal canal.  Others may remain singular with their own foramen.  Sometimes upper first molars may have a fourth root, but this is rare.

 Second upper molar teeth also generally have three roots, sometimes the buccal roots fuse and then there are two roots.  Some teeth may even have one fused root.  The tooth may still have three root canals even when the gross anatomy of number of roots may change.  It is rare that upper second molar teeth have four separate roots. 

 

Microsurgical Endodontic Course 2015

 

I am delighted to inform you that another Microsurgical Endodontic course will be held on 11/12th May 2015 at LonDec, London.

Please click on to find out more details.  I have made some practical changes since 2013 (besides the venue) that I hope will improve the clinical practice.  This should be a most informative and clinical-put-into-practice ever course yet.  I am so excited about the venue which boasts a highly professional and complete state-of-the-art equipment and technology.  The instruments for each delegate will be comprehensive and appropiate.  The delegates are invited to bring along their nurses for the second day practical to help assist and become accustomed to the surgery. I look forward to meeting you.  Please fill in the questionaire to register your interest.

PLEASE NOTE THIS COURSE (2015) IS NOW FULLY BOOKED

Dear Gary,

I am so delighted that I decided to get a second dentist’s opinion to try to save my tooth, as if I had taken the first prognosis the tooth would have been extracted.

Prior to meeting you I was so worried as to what the outcome for my tooth would be, but after hearing what you could do to help me and after reading through previous patient’s testimonials, I felt comfortable to put my trust in you and proceed with the surgery.

I am so grateful to you and you team for saving my tooth and making me smile again. The surgical experience was really quite amazing, as I felt so relaxed and safe throughout the apicoectomy which really surprised me, as I was expecting to be petrified. The numbing injections you used on me were incredible, as I didn’t feel anything throughout the whole procedure and they only seemed to numb the area concerned and not the rest of my face.   Great work !

I can’t thank you enough for doing such a magical repair on my rotten tooth and all for a minimal amount of discomfort afterwards. I had a few days of swelling  (my fault I forgot the ice packs) and a small amount of discomfort with the stitches pulling but nothing that a few painkillers didn’t remedy. A week on today since the work was carried out and I have forgotten that I even had it done. There is no pain or swelling and everything is pretty much 100%.

I will be back in December to show you that I’m still smiling.

Best regards,

Dee  ( your number one fan )

 

Pleased to announced I will be presenting the first UK Microsurgical Endodontic course.

Please email This email address is being protected from spambots. You need JavaScript enabled to view it. for information

endodontic microsurgical_course

Root end surgery is necessary when root treatment fails and retreatment has been ruled out.  Retreatments may be ruled out due to obstructions such as posts preventing retreatment, or just patient preference.  Retreatment of the failed root, otherwise, is always the first choice for treatment.

 A patient was referred for assessment for the surgical approach due to the lesions associated with two adjacent teeth.  The patient has suffered recurring abscess which has been previously managed with anti-biotics.  The x-ray below shows reasonable root fillings although the first premolar is slightly overextended and the second premolar is slightly short.  The crowns are supported with posts.  There are lesions associated with both teeth. 

 

apicectomy

Today I reviewed a case I assumed had a periodontal relationship and would not resolve with endodontics alone.  Well a nice surprise awaited when the patient reported that he had no symptoms and was comfortable 

molar endo and perio relationship

X-ray of molar tooth before treatment

Note the wide, vertical bone loss associated especially with the mesial root that extends to the furcation area.   

molar tooth root treament successful

X-ray of molar tooth after 4 months review appointment

The lesion has healed and there has been bone in-fill.  The deep buccal and furcal periodontal pocket has completelyclosed without any periodontal intervention.  The patient has been referred back to his general dental practitioner for a coronal restoration.

Discussion:  A deep periodontal pocket associated with a tooth may be due to endodontic failure, root or tooth crack, and or periodontal disease.  The tooth must be vitality tested.  If the tooth is vital to cold testing and without an endodontic cause, periodontal treatment must be instituted.  The alveolar breakdown must be evaluated for design.  If the breakdown is wider coronally than apically we may assume it has a main perodontal component and treated as such.  In this case above, the lesion appears wider apically and narrows coronally, so it was assumed that the main cause was of an endodontic origin. The periodontal component could not be ruled out due to the open and wide periodontal pocket which was clinically located.  My patient was warned that the tooth may fail due to the added dimension of the periodontal component and the possibility of a crack in the tooth. 

 Summary:  A molar tooth presented with a periodontal component and abscess was treated with endodontic therapy alone.  My patient was explained the endodontic disease process and warned of the possible unfortunate outcomes.  The root canal treatment above resulted in a successful outcome.

 

Anyone will tell you that toothache is one of the worst and most powerful pains we could suffer.  When it hits, there is not much else that you can concentrate on.

Toothache or dental pain is caused from inflammation (swellling) to the pulp or nerve tissue inside a hard shell- the tooth.  The swelling has no where to go and so the quality, intensity and duration of pain may range from a little to extreme.  Below is an x-ray of upper teeth.

toothache unlocalised

 

I have come across a number of lower second molar teeth which exhibit a fused single root.  These teeth may also have a complex arrangement of root canals. The final case depicted in this case demonstrates four canals.  The x-ray below depicts the distal canals with gutta percha filling and a file in the mesial canal to length.

lower second molar

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