Endodontics&Microsurgery
What a pleasure surprise came yesterday to my clinic. Tooth #36 with apical perf healed completely 3 years after treatment. Just GP + AH plus and disinfection definitely. Preoperative film and pre-endo build-up There wasn't possible to get to apical…
Red Russian cement was very popular in former USSR countries and unfortunately still in use in some cases. The main reason to apply it in the past was canal curvature not possible to pass through. If one been retreated cement…
Missed anatomy is the most frequent cause of apical development. In first upper molars definitely MB2 is mostly missed canal. Both approaches surgical and non surgical can be applied to solve this kind of problem. But what to do if…
To tell you the truth my therapeutic nature opposes an idea to do surgery in case of unfounded and untouched root. But in case of crown and two leg cast post surgery is the only option. Initial X-ray, missed MB…
According to the laws of genre this tooth would be extracted a year before. It's really looked awful - open margin crown, broken file, ledging, perforation, overfilling, apical periodontitis. I was quite pessimistic while starting that treatment. But this tooth…
This patient has been referred 2 at June 2013 for retreatment of 2.7 before ortho tx. Huge PAL in buccal roots projection but there were not any symptoms. Old restoration removed and new build up set. Ready for canal work…
CAP of #35 (13). Cast post and double crown deny coronal access. Surgery is the correct way to try to save the tooth. Retrofilling with MTA I know what some people think - mental nerve, too much risk, open margins,…
Prev endo was done aprox 3-4 years before. Obturation looks quite decent but symptoms appears. Percussion and palp both painful. RD was so kind to remove an old rest and bond a new one. Preoperative images Canals were filled with…
How many canals in first upper premolar could be? One - sometimes, two - usually, three - rare. Four? Are you serious? Preoperative X-ray. It's obviously that something is missing. At least DB. Tree canal anatomy, okay. Happens ones a…
Ideal case for apico surgery and not for retreatment. Localized infection (MB root with probably missed anatomy), rest canals are decent obturation. Tooth was retreated aprox 5 years before and MB2 was found. CAP was still there. Preoperative X-ray -…
Endo surgery can be always considered as an option in case of good prosthesis that patient satisfied with. This is the case is exactly showing that. Cantilever bridge of #21 and pontic of #11 survived for 9 years and I…
The beginning of this story was at April 2013. Patient couldn't bite on her tooth for a month since endo was done at another clinic (initial diagnosis pulp necrosis and SAP). Percussion indeed was painful. I adviced her to wait…
Patient is suffering of sinus tract open and close last year. Tooth had come through two NsReTx resulted with heavy overfilling into sinus. Preoperative X-rays and CBCT scans. Treatment plan was SRetx and overfilling material removal Sinus tract First root resection…
This tooth is kind of routine work which you're not always can be satisfied with result. Looks too much for one tooth: lack of hard tissue, distal deep pocket, PARL on all three roots, and Red Russian discoloration that usually…
Some teeth are needed to be retreated in case of new restoration comes. Everything looks inadequate (rest and obturation quality) but result. There are no symptoms and no apical rarefaction. Do we need to retreat in this case? Yes you do!…
Missed MB2 cases are come sort of routine work for endodontist. I am always admire to see upper molars with all shitty filled canals but PALR usually appears only on MB root Obvious missed MB2 canal, huge PAL on MB…
Русская версия Absolutely asymptomatic tooth and patient. Just wonder how orthodontist could start treatment with such obvious endodontic problem? Typical Resorcinol Formaldehyde mixture tooth discoloration. Extensive periapical lesions on both roots and external apical root resorption. Is it possible to…
Русская версия One more puzzle case which treatment plan better in this case. Surgical or non surgical? Preoperative imagesTooth was attempted to retreat within last month. Any canal in MB root couldn't be negotiated. Via falsa and small perf in…
There is a very popular concept of minimal invasive dentistry, means trying to save what can be saved. My question is why we need to reatreat canals with no lesion and good done endo treatment? In this case I decided…
Patient appeared with pain and swelling in area of #41 (25). Prosthesis was done a couple of years before. Deep probing on MB aspect of #41 (25). Percussion and palpation was painful as well. Preoperative X-ray and image Deep probing…
Do we expect large cyst-like lesion after non surgical RCT? Yes, sure! Caliscan showed that almost 74% of these sort of lesions could disappeared if follow up was longer than usual. Patient appeared with symptoms of SAP in November 2009.…
There is a strong correlation btw success rate of endodontic treatment and obturation level. Longer - worst! This is true if we know that GP cone is extruded out of root. How about sealer extrusion? It's difficult to say in…
Русская версия Patient came to get a second opinion about treatment plan of first mandibular molar. He had consulted with 2 dental surgeons (!) and was suggested apicoectomy or GUESS? Right - extraction and implant! The cause of inflammation looked…
This tooth was treated in 2005 with diagnosis SAP but 9 years later the PAL om mesial root is still there. Surgical decision was suggested and applied Preoperative images. Parl om mesial root secondary mental nerve was exposed during flap…
First endo 11 years ago due to caries. 4 years before patient complained of discoloration then bleaching with H2O2 was done. Actually the bleaching technique is not exactly known, it was walking method for sure Patient presented with sinus tract…
Русская версия Again surgical non surgical dilemma Two previous apicos were done 20 and 8 years ago. Sinus tract appeared 4 months before. Referred dentist has decided to go for non surgical retreatment but 4 visits later sinus tract was…
Just everyday routine work, not to say "easy work" but that what we deal with Preoperative imagesBoth endo and restoration leaves much to be desired Removal all old restoration and new walls building is the first step Missed MB2 orifice…
You can be a very experienced clinician you read tons of literature and use relevant protocols but never have 100% success treating apical periodontitis. This case was NSRTx retreatment of first upper molar after Resorcinol Formaldehyde technique with CAP on…
It started at Nov 2009 with irreversible pulpitis, one visit endo. Two distals and three mesials and I was very proud by final X-ray picture irreversible pulpitis treatment No recall visit was done. Four years later patient appeared with pain…
History of pain for more than 6 months. Tooth #2.4 with CAP was treated by dentist who found only on canal. During 2 months retreatment was attempted, last time with microscope, additional merged canal was found. Patient still had pain…
Endodontic treatment was looking good but PARL showed that something wrong was in root canal IMO options of surgical and nonsurgical retreatment were available. Patient was confident with non surgical way. Preoperative images Access was done through the crown, screw…
Endo done 7-8 years before. Symptomatic more than 2 years. Restoration is Ceramic overlay CBCT of mesial root lesion Lesion is pretty close to external cortical bone The root angulation will demand to cut more in order to get lingual…
History of pain in Jan 2013 second molar was extracted and pain was released No complaints since there. Accidental finding on X-ray Preoperative X-ray GP tracing Sinus tract No lesion on mesial root Lesion and sinus tract on distal root…
That periapical lesion was an accidental finding Patient came after consultation of implatologist with conclusion there was no possible to put an implant. Means full of motivation to save the tooth. Preoperative x-ray and CBCT. Inflammatory apical resorption as a…
Using any NiTi rotary systems with one length philosophy you have to create glide path up to #20 before rotary. It decrease breakage of files. Sounds logically. But in practice this stage can take you 15-20 minutes for molar and also increase chance to…
This patient had no any complains but aesthetics. Restoration was replaced 3 times during 5 years. A year before dentist noticed a pink spot on palatal side. X-ray and CBCT confirmed diagnosis of external resorption Preop X-ray and CBCT show huge…
This patient was sent to my clinic because his dentist has noticed a sinus tract against a lower incisor. Patient himself never felt any discomfort in that area. Clinically teeth looked with no signs of damage. PA film showed huge…
See no worth for non surgical treatment in cases like that. Endo was done twice. The first time 3 canals were founв and obturated. The second time endo specialist tried to fix the problem. Four canals were instrumented and obturated.…
Sometimes during a routine work you suddenly face a challenging anatomy like this tooth C-shaped second mandibular molar with irreversible pulpitis Nothing special that catches your eye on diagnostic X-ray Working length verification 3 orifices in mesial root and 2…
Symptomatic lesion of central mandibular incisor The patient desired to save her crowns.
This patient had no complaints but needed new crown and prosthetic dentist asked me to evaluate an endodontic status Tooth was treated endodontically at least twice. The first attempt was done more than 20 years before, tooth underwent treatment with…
Referred case with internal resorption of central lower incisor. The tooth was not vital and sinus tract appeared. The treatment was already started by referred dentist to relieve suffering of patient. Complete instrumentation of apical portion was done with SAF…
The patient was absolutely asymptomatic, PARL on MB root of #1.6 has pointed to missed anatomy and poor disinfection protocol Should we retreat all canals in this case or only MB root? Preoperative images, tooth discoloration can give a clue…
Poor integrity of distal margin of PFM put in doubt that tooth could restored one more. Diagnostic removal of all old restorations in this case should be done before decision of endo retreatment Preoperative view of periapical and in a…
#47 (31) developed apical periodontitis with sinus truct 2 years after the crowning. Preoperative images At first appointment canals were cleaned and filled with calcium hydroxide paste. Sinus tract didn't exist at the second visit Obturation' steps and pulp chumber…
Nothing special, just routine re-endo before crowning. In orthograde beam preop looks decent but eccentric (off-centered) view shows non obturated space of MB canal. Preoperativу film Cone fit at second visit after all instrumentation was completed Final X-rays Pulp chamber…
Русская версия No symptoms before the treatment and no symptoms after 6 months. Preoperative post operative and 6 month follow up X-rays
Русская версия Here is a typical case of Red Russian cement retreatment. The first endotreatment was done more than 5 years before. Patient said he had some pain in region. Actually symptoms could come from second molar with…
Русская версия A relatively new philosophy of root canal cleaning and shaping called Self Adjusting File (SAF) shows great ability to clean long oval canals. The problem still remains in apical third when SAF has a limitation to clean properly.…
What is the periapical lesion size depended on? Probably it has a correlation with number of intracanal microorganism's taxons and number of microbiota itself. Does the periapical lesion size has an influence on a decision making process? Most of my…
Lateral incisor underwent endodontic treatment more than 5 years before. The only complains was a weak pain when a patient pressed under her nose. She was sent to evaluate surgical or non surgical RCT of lateral incisor. Patient was waiting…
I have no idea why this tooth was endodontically treated, patient didn't remember why when and where it was done. Patient had no complains but fracture of composite restoration. RD has planned to get a new restoration for this tooth…
This patient was sent for retreatment due to symptoms of chronic abscess and sinus tract. Guttapercha tracing film showed that incomplete RCT in first upper molar caused the inflammation. Broken fragment of lentulo in DB canal and sinus tract leads…
Русская версия The endo of premolar and cast post were done about a year before. Provisional crowns joined two premolars and an implant. Patient complained of intermittent pain in region. Preoperative view shows overfill on both roots and PAL of…
Just a regular case of irregular pulpitis of #17 (2). Interesting anatomy - very long buccal roots (23mm) and relatively short palatal one (17mm) Preoperative view Wire film and pulp chamber view Final X-rays and pulpchamber view …
I was asked to make an attempt of non surgical re-Tx of lateral man incisor Two broken fragments are seen in the apical third, root canal is over-enlarged probabaly because of previous attempts to remove the fragments. Preoperative X-ray all fragments were…
Patient was sent to retreatment of second molar as a possible cause of odontogenic sinusitis Preoperative X-ray shows poor integrity of distal margin and probably furca problems After all restorations have been removed pocket depth was estimated. For my big…
RCT of the only premolar was done because of pulp necrosis approximately 7 months before but still had tenderness to percussion and patient couldn't bite on it sometimes. Preoperative X-ray. Premolar has a decent obturation but PDL slightly wideVisible black…
Routine retreatment of first mandibular molar, previous endo done more than 5 years before, PARL on mesial root, normal peridontal probing. Preoperative X-ray Two visit with calcium hydroxide temporary dressing Final view of pulp chamber Obturation view, mesial root was…
The initial endo treatment of the central incisor was done more 20 years before and cystectomy two years later. Patient felt discomfort in the area and sinus tract appeared from time to time. She has been suggested to change crown…
The tooth had no symptoms for long 8 years under the bridge but started to bother a month before the appointment. The bridge was removed шт one piece. Non surgical retreatment procedure was done in two visits. Preoperative X-rays "magic" cotton…
Sinus tract appeared two years after the crown placement. Tracing with GP cone leaded to middle third area, that could get a clue of big lateral canal. It was found and cleaned with ultrasonic agitation of NaOCl. After initial shaping and Ca(OH)2…
Referrative patient was sent for RCT of second right molar. During caries and old restoration removing pulp was exposed Preoperative images Apical patency has been received in all canals and WL were determined by apexlocator. Palatal canal looked underfilled…
Patient referred for RCT of second upper right premolar with ledge in middle third and piece of file. Preoperative images The first step was distal wall re-building and taking the fragment out Then apical ramification and two apical entrances were…
Nothing special, just a routine work. Non-symptomatic second lower molar was sent to retreatment I enjoy the shaping, don't you? Preoperative X-ray WL and obruration step X-rays Final X-rays 6 months
The term "central-lateral dilemma" was borrowed from the lecture of one of the most brilliant speakers in a field of Periodontics Dr Maurice Salama. Missing of two incisors - central and lateral creates huge difficulty for both perio and prosthodontist to make good aesthetic…
Tooth #26 (14) - accidental finding on X-ray. The patient's cheaf complaint was bleeding while flossing between first and second molar. The crown was done 2 years before. According to what patient was talking the RCT was done more than 5 years…
This patient was referred to our practice deu to impossibility to get patency in all canals Tooth was previously treated and partially filled with hard whitish paste. There were no radiographic signs or symptoms that patient pointed at, but RD has…
There is a typical clinical situation: bad spontaneous pain, pain provoked by cold agent, deep distal caries Preoperative view wire and obturation films Mesial and distal view Final X-rays
This patient was referred to my office due to lingering pain in first upper molar and not succeeded treatment attempt Tooth was open for several days CBCT images show broken file penetrate the maxillary sinus and inflammation process probably of endodontic origin…
No symptoms, incidental finding on X-ray before orthodontic treatment Preoperative X-ray All old restorations and root canal filling were taken out, MB2 was found and Ca(OH)2 placed for two weeks Final calibers Pre-obturation images Obturation steps and final radiograph …
The beginning of the case is here 6 month recall
Русская версия The initial situation was that: RD has started non surgical re-endo of 36 which had been treated by resorcinol formaldehyde technique in the past. The dentist could negotiate all the canals but not the MB one because…
Русская версия The patient came with acute toothache and periapical abcess caused by #46. The percussion was very painful and tooth had a high mobility Preoperative view. Huge bone lysis in between mesial and distal root Only old restoration removal…
Русская версия Patient came to our clinic about 18 months before with complains on cold sensitive on his right left jaw. On an X-ray made in parallel technique secondary caries was detected under a filling of #25. Recommendation to remove decay…
Русская версия Incidental finding on CBCT #26 has been treated a year before and in spite of were no symptoms LEO on every root and the bigest one in the palatal root Preoperative image and X-ray Pulp chamber view - too…
Check the whole case here Preoperative and postopertive X-rays 2 year recall Check the whole case here
Русская версия In most cases but not always separated instrument is possible to be retrieved. In case like this retrieving could bring about terrible hard tissue lost and jeopardize the outcome. IMHO the best management strategy is bypassing and embedding fragments into RC…
Русская версия It was incidental finding on CBCT made before implant placement instead of missed 45. #46 and 47 underwent endodontic treatment several years ago, LEO on every root and huge LEO inclided distal root of #46 and mesial root of…
Русская версия Here is a very typical necrotic case. The patient suffers from spontaneous pain, pain caused by hot drinks, pain during mastication No response for cold test, very sensitive to percussion.
Русская версия The patient was sent to re-endo of several teeth before a new prosthetic reconstruction
Русская версия This patient was referred to our clinic for evaluation of RCT #37 (18) The initial therapy was carried out 5 years before that moment. A year before symptoms appeared: swelling, pain, sinus tract. The NSTCT was attempted (patient…
Русская версия Patient was referred for apical surgery of #12 due to acute apical periodontitis and sinus tract. Elective endo treatment was done 3 years before just before PFM placement. After consult we made a decision of orthograde revision first…
Русская версия This patient was referred from dental surgeon that refused to carry out apicoectomy and advised patient to try NSRCT first.
Русская версия I’d like to share with you the second case of perforating internal resorption This patient came to our practice with no referring, just found our homepage on the Internet and came to consult Tooth #12 (#7) was opened…
Русская версия Had to stop my day off and open the office for the patient with emergency The patient just returned from the vacation and had to leave next day on business The pain has began couple of months before for cold water,…
Patient suffered from swelling and vestibular sinus tract, buccal-lingual mobility. Probable trauma in childhood and/or internal inflammatory resorption. Previous endo was done 3 years ago. After the first visit everything was going right: tooth became asyptomatic, sinus tract tended to…
Русская версия Patient have had a toothache and after he was examinated by his dentist got recommendation to make RCT of tooth #36. By some reason he had held the decision making over until the severe pain come and that…
Русская версия Two molars retreatment. The patient came from referral with two ruined molars, pain and swelling in region #36-37 (19-18). It looked like # 36 had caused the problems, but 37’s percussion was much more painful. So the #18…
Русская версия This patient has been referred after RD opened "hot" tooth and was confused by its anatomy. I was told the only distal canal has been identified but pulp chamber all the time filled out by blood come from…
Русская версия Acute pulp inflammation of #38 (17), disto-lingual wall fracture, old fillings, secondary decay - no chance for conservative treatment even there was no communication with pulp chamber #10 K-file no apical patency PreRace 35.08 Profile 25.06 #10 K-file…
Русская версия Patient with pain and swelling in area of #47 (31) sent to retreatment.
Русская версия Primary caries of #27 (15), chief complaint was sensitivity for sweet. After referral dentist has performed vitality test with Endofrost patient felt continuous pain for several seconds (I was told about 10 sec). So patient was referred to…
Patient suffered from swelling and sinus tract in area of frontal anterior teeth. It was about trauma of #11 (8) that happened approximately 8-9 months before the visit. Percussion and palpation was painful. X-ray showed internal resorption with perforation of…
Русская версия This patient was sent to evaluation of re-treatment after buccal wall fracture of #36 (19) After the old filling has been removed the fracture line was revealed, in order to confirm the diagnosis I had to cut the marginal…
Русская версия The begining of the case
Русская версия This patient suffered for several months from swelling and sinus tract in are of 44-45
Русская версия The previous treatment was done many years ago (appr 17-20). Deep mesial decay, PARL on both roos
The begining of the case Русская версия
Русская версия Huge periapical lesion under an old bridge. Just curious but it never hurt.