endomontreal

      An endodontist case report. Microendodontics case study number: 505026

Twenty five years old patient presenting with an abscessed maxillary molar. Diagnosis: Persisting disease after root canal treatment. Etiology: untreated second mesio vestibular root canal (MB2).

Two appointments were required to preserve that tooth:

First appointment: Crown and post removals plus root canal filling retrieval, MB2 location and calcium hydroxide insertion as a medicament. 

Second appointment: Calcium hydroxide removal, irrigation, drying, final canal obturation gutta percha and Pulp Canal Sealer. Provisional filling material: Cavit.

Abutment is now symptom free and it is now all set for a casted post and permanent crown replacement.

A 6 months follow up dental Xray film shows an impressive  regeneration of periradicular tissues. Compared to its initial size, apical lesion on mesio vestibular root shrunk up to 80%. Tooth is aymptomatic and functional.

A complex root canal retreatment does not have to mean extraction and replacement by a dental implant. A research study by Farzaneh et al. on treatment outcome in endodontic found an orthograde root canal retreatment success rate of 93% . (Farzaneh M., Abitbol S., Friedman S. Treatment outcome in endodontics: The Toronto Study. Phases I and II: Orthograde retreatment. J Endod 2004; 30(9):627-633)

An endodontist case report. Microendodontics case study number: 511536

Sixty years old patient presenting with an abscessed mandibular molar. Diagnosis: Persisting disease after (25 year old) root canal treatment. A crown and two post removal where necessary in order to gain access to root canal system for retreatment. 

Only two apointments required to save that tooth:

First apointment: Crown and post removals plus root canal filling retrieval and calcium hydroxide insertion as a medicament. 

Second apointment: Calcium hydroxyde removal, irrigation, drying, final canal obturation gutta percha and Pulp Canal Sealer. Provisional filling material: Clip (not radiopaque) from Voco. 

Tooth is now symptom free and it is now ready for a post and a PFM crown.

A complex root canal retreatment does not have to mean extraction and replacement by a dental implant. A research study by Farzaneh et al. on treatment outcome in endodontic found an orthograde root canal retreatment success rate of 93% . (Farzaneh M., Abitbol S., Friedman S. Treatment outcome in endodontics: The Toronto Study. Phases I and II: Orthograde retreatment. J Endod 2004; 30(9):627-633)

case: 430646

Resorption associated with chronic apical periodontitis altered the shape and position of the foramen through osteoclastic activity, in the x ray images, the modified foramen in distal root is positioned farther from the radiographic apex and gutta percha appears in overextension. A large and circumbscribed radiolucency involves both roots as well as the furcation. This indicates an important periradicular tissues destruction. Tooth mobility level 2 goes along with this tissue loss.

This case is definitly a controversial one, meaning that it is possible for different practitionners to prognosticate endodontic success (very few among practioners) or failure with a great amount of disparity. As stated by John I. Ingles, a senior lecturer in endodontics: "The practicing dentist should not be cited for faulty judgment when even the so-called experts tends to disagree on prognosis… All in all, one must ultimately develop confidence in one's own abilities. Being able to practice using a great variety of techniques and not being "married" to a single approach in every case will greatly enhance one's capabilities. And on this is based good prognosis, the result of skill, knowledge, and self confidence."

Endododontic retreatment and MTA root-end fillings have been performed with a Zeiss Pro Ergo Microscope in september 2008. Last displayed X ray film on this post shows a 3 years post operative clinical outcome. Radiographic examination shows a complete regeneration of the periradicular tissues and a resoptive defect healing. 

Should an implant have been put there? maybe, maybe not!

Read more about MTA Precision placement with the microscope (.pdf)

Persistent disease on second mandibular premolar. Tooth decay on abutment. Risks of post removal include: fracture of the tooth, leaving the tooth non restorable, root perforation, post breakage, and inability to remove the post. An additional concern is ultrasonically generated heat damage to the periodontium. Therefore, an apicoectomy and retrofilling or an extraction and replacement with an implant or a fixed prosthesis is a treatment option before initiating the retreatment. Post has been removed in 20 minutes.The use of ultrasonic energy for short periods and water cooling to prevent excessive amount of heat generation proved to be most efficient in this case. A casted post and a new crown are planned.

Crown and post removal on second mandibular premolar,  broken instrument in middle third root canal removed under the high magnification of dental operating microscope(DOM), an acute apical abscess to manage made this tooth rescue a very challenging one.

Pre op. clinical situation:

1  Long roots, root canals calcified in apical thirds on mandibular molar

2  Post to remove and endo to retreat on mandibular premolar

Denticles and an MB2 canal entry to find in this maxillary first molar makes preoperative condition complicated. Post removal, tooth positon in the arch, ledges to bypass and the fact that this is a retreatment case, makes preoperative condition complicated in this maxillary second molar.

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