Isolation technique : LL4 root : 10mm Pocket : Maxillary second molar

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This lady came in on Friday 25.02.05 and needed the LL4 root treated. Duly done in single visit. The preparation was K3 40/06 and lateral condensation of GP with AH plus. The x-rays allowed me to compare my standards of treatment. The LL7 was treated in 1993, the LL6 in 2003,and the premolars Nov 2004, and Feb 2005. I am none too proud of the two molars .The quality of my treatment after joining compared to before bears no comparison...... LL4 ROOT
Chances are this could be a root fracture right? 10mm pocket on straight mesial and 7mm on ml. Patient really motivated to try to save the tooth and knows it might not work. This is one of those situations where 2 visits is a nice approach. No fx seen on access. Cleaned/shaped placed the white stuff. All pain went away after first visit. Finished it today-he said he’s a new man 10mm pocket
I zoom in on the pictures sent to me and let my mind absorb everything
that is to be noticed :
- It is difficult to judge the depth of the final clean cavity contour
without a radiograph, probably crown lengthening was not necessary
- Isolation was adequate and apparently served its purpose
- The interdental dam septum was torn by accident or on purpose,
I can not judge. Maybe this could have been avoided by separating
the two teeth a bit more with a fine diamond prior to installing the dam.
......... Isolation technique
Another maxillary second molar, deep division but no scope...snifff....snifff... 18 years old patient with orthodontic treatment Maxillary second molar

Distal root :Shaping the Canal: Internal bleaching : Molar case

I hadn’t even gotten all of the amalgam out of the chamber when I started smelling that odor if you know what I mean. Shaped the canals and placed the white stuff. We’ll finish this next time and start on the first molar. Shaping the canals

This is just a regular case where RCT was done ( Hybrid tech K3 & LS). I did a internal bleaching and you can see the post op pictures Internal bleaching

5 canals were identified, debrided, disinfected and obturation performed using thermo-softened gutta-percha and resin sealer. The floor of the chamber and orifice interface of dentin and gutta-percha were bonded with a dentinal adhesive and flowable composite to prevent recontamination Distal root

acute apical periodontitis tooth 16. MB1 and MB2 were very close to each other and joined approx. 4 mm form the apex. The reffering dentist had done acute treatment but the pain had continued
... Last molar of the week

Nice case : Hopeless case : Huge resorption : Treatment failure

This patient came to me in pain after 2 other general dentists had been seeing him. The last dentist, a friend of mine, tennis buddy, who has now closed his practice and gone to full time teaching at the local dental school, was treating ( by the patients description )
by draining the cyst and placing medication. The patient experienced several episodes of pain and numbing lip and it would go away when the dentist would treat it
.... Treatment failure
The periodontal loss seems not as much as it was in reality. Guess pictures will speak by themselves. Patient feels good all teeht are tight and in function -
don't know why. god bless the implantology .... Huge resorption
It has been one of those days...
3 vrf cases that could not be treated. 2 I was able to discern clinically before starting treatment. The 3rd, required methylene blew to nail it down and was aborted.
.... hopeless fractures
Couple of simple but nice cases

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Current newsletter : How bleach kills germs : Bleeding pulp : Tip edge and torquing

Dental India newsletter dated 16th November 2008
Mystery solved: How bleach kills germs
Class III - Skeletal change after treatment
14 y male came to the endo clinic with a h/o i was told i needed a root canal by my dentsit. past H/o carious exposure with an IRM pulp cap in 31 a month previous. he was asymptomatic with no response to cold at the time of exam. i didnt perform EPT .....Apexification:Bleeding pulp
The 1st bi has moved into contact with the first molar which has remained stationary (held with a tip back bend; no force applied). The 2nd attachment is a lower 2nd bi extraction case showing Cl .... Tip edge and torquing

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Molar paste:crack:Mixing EDTA & NaOCL experiment

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RCT done in 1999, and afterwards a PFM bridge placed. Same dentist performed the RCT and the bridge. I saw under the bridge in the access cavity the cavit, than the cotton pellet, than only the DB and the P treated (with red russian paste) ...Molar paste retreat
My schedule changed today and I decided to see for myself what happens when you mix EDTA and bleach together.
Of course his is only a simpleton exercise, but in a way answered some of the questions lingering in my mind. Mixing EDTA & NaOCL experimentI wish I had a dime every time a naked eye dentist (NED) said a scope wasn't needed to dx a crack.
Referring dentist sent me this guy for rct on 30. Patient was convinced the problem was 31 Crack...contd

4 canals : 5 year followup; Updates

Updates
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Case studies

Here is one from my practice with the exception that I didn't do anything except splint the teeth with Ribbond and composite (Enamel HFO) for 3 months. The five year follow up shows the teeth unchanged and fully in function "Five year followup...."
she’s been having pain in 8 & 9 and 14; so I say, no problem I can whip these out in an hour and a half. Hope. Need help and advice and no, I still don’t have a scope, but just my 3.5 X magnifiers. more from "four canals"

Four case studies

I examined her today ( she was scheduled for the SRCT tomorrow a.m.) and the sinus was draining purulent material. A periapical radiograph ( straight on) showed a decent endo procedure with a bit of sealer overfill nothing overtly wrong More ...........
I retreated the first bicuspid obturating the entire root canal system with MTA, then bonding up a composite core. Yesterday was 1 ½ years later, the patient had been in a temporary splint for the entire period (not a great situation with his caries index) The second bi has a questionable lateral radiolucency but shows extensive periapical osseous regeneration
More ...........
These teeth both tested relatively wnl to cold. I had the conversation with her about doing endo now
or waiting and only doing if needed. She wanted to do them now, so that’s what we did. Upon excavation of the caries on #2 there was a gross carious exposure of the pulp chamber. These were done as one-steps on 2 separate days More........
Patient presented today with 2+
mobility of crown on previous endo with post and core buildup, opposed in maxilla by full denture. As you can see in the photos, draining sinus tract exiting on buccal. Sinus tract was traced back to radioluscency on mesial aspect of radiograph
More .......
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New additions 11th November 2008

OMFS abstracts

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Retreatment with preservation of crown
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3 canal premolar
2 year follow-up of a endovac case
10 Year follow up
Three metal thermofill carriers
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PERIAPICAL PATHOLOGY + VITAL PULP
Overfill with Epiphany
Calcification and division
most coronar lateral canal
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10mm pocket on straight mesial

Chances are this could be a root fracture right? 10mm pocket on straight mesial and 7mm on ml. Patient really motivated to try to save the tooth and knows it might not work. This is one of those situations where 2 visits is a nice approach. No fx seen on access. Cleaned/shaped placed the white stuff. All pain went away after first visit. more ......
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Pan pathology

this is the PAN for the lesion on the lower left jaw that we looked at today. 56 year old male referred for endo tx #3 from GP. Hx of Thyroid problems and Glaucoma and taking Synthroid, Wellbutrin and Alphagan. More ......
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Lower second molar case

This lower second molar case is a few weeks old but illustrates the point about time. The first clinical is after the case has been completely (or so I thought) prepared. The MB and MM canal "emptied" together when backdrawing on the irrigation syringe, but the ML did not empty. 15 minutes of doing nothing but NaOCl and a little patency, and voila, they all drain together. Think there might have been some crud down there? I took one last look around--and what a moron--I had missed the DB canal and it still had tissue in it. - John A. Khademi More .......
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MTA and Fuji resorpsion repair FAILING

This is an endo done on a cuspid about 12 years ago. I saw her a couple years later and found a large defect from apparent resorbsion. I flapped it, found no soft dentine, placed a glass ionomer ( I did not know about MTA then) and she left for a couple years.
I then a few years later found a pocket hat formed and then placed MTA Gray and Fuji 9 over that. This is a couple years after that (12 years after the endo. The photo is really 'gross' but her smile doesn't show it -thank God-. Advised implant. - Alan Cady More .......
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Coronal leakage

We already had a discussion about the lack of correlation between leakage studies
and the clinical reality, Paul Abbot has a nice paper about it. Here are some cases filled with gutta percha where the filling material was exposed to saliva for at least a year except for the 9 months case. Some remaining Cavity was all softened and there was recurrent decay in all cases. No symptoms and RX healing I all of them. - Jorge More ...........
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Three missing canals

In the preop x-ray it didn't really look like a microperforation and after entering the tooth I was quite sure that it hasn't been one. Instead of microns there had been some mm to close. After irrigation and cleaning the perforations margins with US I placed collagen as a barrier. After that I build my MTA-Dome which was covered by a low flowable composite, followed by Tetric Flow. After that I was able to
locate and negotiate the 3 missed canals. MB1 and MB2 had a quite deep
bifurcation. Contd.........
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methyline blue: Crack

Crack
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Molar case

25 yo female
#14 pulp exposure during decay removal.
Today: pulpal dx: irrev pulpitis, periapical: normal
Upon access you could see the IRM in the pulp chambe
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Oral cancer: Current and future diagnostic techniques

Oral cancer: Current and future diagnostic techniques

Crispian Scully, cbe, phd, md, mds, mrcs, fdsrcps, ffdrcsi, fdsrcs, fdsrcse, frcpath, fmedsci, fhea, fucl, dsc, dchd, DMed(HC),
José V. Bagan, dds, phd, md,
Colin Hopper, md, frcs(ed), fdsrcs &
Joel B. Epstein, dmd, msd, frcd(c), fdsrcse

Abstract: Oral cancer is among the 10 most common cancers worldwide, and is especially seen in disadvantaged elderly males. Early detection and prompt treatment offer the best chance for cure. As patient awareness regarding the danger of oral cancer increases, the demand for “screening” is expected to increase. The signs and symptoms of oral cancer often resemble less serious conditions more commonly found and similarly usually presenting as a lump, red or white patch or ulcer. If any such lesion does not heal within 3 weeks, a malignancy or some other serious disorder must be excluded and a biopsy may be indicated. Dental health care workers have a duty to detect benign and potentially malignant oral lesions such as oral cancer and are generally the best trained health care professionals in this field. Prompt referral to an appropriate specialist allows for the best management but, if this is not feasible, the dental practitioner should take the biopsy which should be sent to an oral/head and neck pathologist for histological evaluation. (Am J Dent 2008;21:199-209).

Clinical significance: Early detection and prompt treatment offer the best hope to the patient with oral cancer, providing the best chance of cure. As patient awareness regarding the danger of oral cancer increases, the demand for “screening” is expected to increase.

*: Prof. Crispian Scully, UCL Eastman Dental Institute, 256 Gray’s Inn Road, University College London, London WC1X 8LD, United Kingdom. E-*: c.scully@eastman.ucl.ac.uk

American Journal of Dentistry
August 2008 Issue
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Implants are here to stay......

Implants are in

Patients are demanding them and manufacturers are improving them. Implants are here to stay, and our latest survey shows that many GPs are embracing them while others aren’t ready to commit.
For the survey results, click here.
By Renee Knight

The concept of a dental implant and what it can do has always made sense to patients. But the dental profession, that’s a different story.

Dr. Carl Misch, founder of the Misch International Implant Institute (misch.com), spent the first 10 years of his now 30-year career trying to get his colleagues to see the benefits implants can bring their patients and their practices. Back then, doctors weren’t convinced that implants were a predictable long-term option.

It’s safe to say those days are gone.

Implant dentistry has exploded in recent years and is widely accepted by patients and dentists. The resistance is gone and patients are more aware that implants are an option that can improve their quality of life for years.

“It is the best alternative the majority of the time,” Dr. Misch said. “It’s better than cutting down adjacent teeth and starting a cascade of destruction.”

The latest DPR Exclusive Implant Survey Report shows that GPs are jumping on the implant bandwagon. Many of those surveyed are involved with some aspect of implant dentistry, with 94% taking part in restoration and 19% placing implants.

Source: September 2008 | Dental Products Report

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Dental India newsletter dated 2nd November 2008

Current and previous newsletters /updates

Dental India newsletter dated 2nd November 2008
Dental India update dated 29th October 2008
Dental India newsletter dated 26th October 2008
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