endomontreal

Pre operative film shows a large bony defect reminding us the alleged pathognomonic "J" type lesion. Canals are not visible in mesial root. An impressive soft tissues swelling of adjacent vestibular area was also noted. Endo treatment finished on the 16th of march 2009 with surgical operative microscope (three appointments were needed). Post operative control X ray film (16th of october 2009) shows a nice healing of surrounding hard tissues.

A good diagnosis (you try to probe and there is no probing, you put icy cold water on the tooth and the patient still likes you), a root canal treatment and look at what mother nature can do. This will definitly keep the implant away. Last scan shows a seven years post operative control X ray dental film. The four units fixed bridge has been cemented shortly after complete regeneration of periradicular tissues

A 5 years follow up X ray of lower left molars and second premolar

Two years follow up X ray film (Third to the right) shows nice periradicular tissues healing. A five years control X ray film (Last to the right) shows a perfectly healed PDL and a complete elimination of sealer excess. Sealer excess is not a problem if it is a ZOE based material. Unfortunately, in the name of "good prognosis", retreatment  progressively became an alternative to implant supported crown.

This is a case where, based on the X ray image of a "J" type lesion, and on a deep narrow periodontal probing, one could easily think of a cracked tooth. The microscope showed us otherwise. No crack could be found under microscope observation. As shown on those VRFs, slow but complete periradicular tissues regeneration followed root canal retreatment (which implied a few calcium hydroxyde dressings replacements). This J shaped radiolucency was in fact a narrow desmodontal sinus tract. 

Endodontic retreatment and tooth sectioning procedure performed in 2004. Case study 336

Root canal retreatment in distal root, machined post (Flexipost^TM) cemented with RelyX and an amalgam core build up and tooth sectioning. A complete regeneration of periradicular tissues occured one year later. 

Tooth had a crown in 2008 and is still functional in August 2011

Root canal procedure, case study number 1

First premolar was having an under fill in its distovestibular root canal. Meaning that one small diameter gutta percha point was floating in a canal with a much wider diameter. This available space allowed for a wonderful bacteria colonization which made the patient experiencing an A.A.A. Second premolar was having a root canal filling half way down the canal creating another A.A.A. First molar had a necrotic pulp allowing for another A.A.A. Second molar was having a filled root perforation. This was a rather explosive situation. Fiberglass reinforced composite posts had to be removed in order to allow for endodontic retreatment, calcium hydroxide dressing in root canals helped to stop abundant exudation. An apical ledge was also present in first premolar distovestibular root canal and had to be bypassed. Root canals were filled with condensed gutta percha and Pulp Canal Sealer as a root canal sealer. Casted post were chosen to replace fiberglass reinforced composite posts. 

6 months post operative control X ray film showed good bony repair. Teeth were completely asymptomatic.

Pre operative x ray dental film shows a maxillary upper left canine with no visible root canal. Immediate post operative x ray dental film shows completed case. Canal entry has been localised with a microscope. (magnification 25X) 1 year post operative x ray dental film shows perfect healing of apical bone radiolucency.

Legend #1 is an MTA Apical plug + Gutta Percha obturation performed seven years ago. Last image to the right is a 5 years follow up X ray dental film. Today the tooth is still asymptomatic. So far so good! This MTA material is amazing!

Symptomatic apical lesion on mesio vestibular root of first upper left molar. Pre operative X ray film shows a tough post to remove and a pre-existing root canal treatment performed 20 years ago. First appointment: Crown and casted post removal: MB1,P, DB retreatment and MB2 locating cleaning and shaping. Complete canal system is then filled with Ca(OH)2 and a provisionnal post and crown cemented with Temp Bond insure a good seal for the next ten days.  Second appointment : Final obturation with Pulp Canal sealer lateral and vertical packing of gutta percha One year post-op X Ray shows nice bone healing It's worth it to note that in this case, MB and MB2 apex anastomosis did not prevent this patient from getting an AAA. In first upper molars, an MB2 is present in 93% of the cases. Thus, to always strive to find, clean and shape MB2 should be the standard of care.