Pierre Pizem Endodontics
5025 Sherbrooke St W Suite 330A H4A 1S9 Westmount, QC, Canada

CBCT in surgical endodontics - a must-have?! https://voxeltalk.wordpress.com//cbct-in-surgical-endodon/

ROOT CANAL TREATMENT ON A 27MM LONG CALCIFIED FIRST MANDIBULAR MOLAR ALONG WITH A NAYYAR CORE BUILD UP. PROTAPER UNIVERSAL FOR ROOT CANAL SHAPING

Our mission: Saving natural teeth. First emergency appointment for an irreversible pulpitis on a mandibular first molar. Once the root canal procedure has been completed along with an amalgam core build up (occlusal hight has been reduced), patient has been advised to crown his tooth as soon as possible. Unfortunately he came back 6 month later for a second emergency appointment due to same tooth lingual wall fracture. Luckily enough we were able to preserve it with a crown.

Forceps escape for 2 maxillary molars. Root canal treatment and amalgam core build up on both teeth. Cemented the first crown today, the second crown is planned soon for the first maxillary molar

PROTAPER UNIVERSAL NITI file system is efficient in both curvy and dilacerated root canals. Patient first seen a year ago for a root canal treatment on first maxillary molar and today for the second maxillary molar.

CBCT, Dental operative microscope and patience allows a practitioner to give its full effort when it comes to saving natural teeth. Tooth 26 pre operative condition: An omitted MB2 in an unusual location (mesio palatal), an apical perforation in palatal root, an over enlargement of the MB apical foramen. Recurrent contamination due to crown leakage leading to an acute apical abscess.

A challenging short and narrow MB2 Patient presented just days before Christmas with an irreversible pulpitis on tooth 26. Root canal procedure has been completed in a single session end of 2020 without finding an MB2. With the endodontic literature showing that two canals are present in 95.2% of the mesio buccal roots of first maxillary molars, we rescheduled the patient early this year to determine for sure if the canal was not present. And, surely enough, it was. In ord...er to locate the MB2, the mesial access wall has been pushed back because the MB2 canal of an upper first molar is usually found just to the mesial of a straight line between the MB1 and the palatal canal. Unroofing the MB2 orifice by removing dentine until it was clearly visualized under the scope, in this case, has also been necessary. Once opened and negotiable to the apical constriction to the size of a No. 15 H file, the canal could finally be shaped with rotary files instruments, which in my hands are ProTaper Universal. See more

Beginning the year with a root canal on a tooth presenting with an irreversible pulpitis. Failure to access, debride, and disinfect this complex anatomy might have a direct effect on the treatment outcome. The microscope has been very handy in this case to locate the second distal canal. Canals were dry after final irrigation, thus the root canal procedure could be completed in a single session.

Ending the year with this case. Root canal revision procedure on a previous root canal revision failed attempt.

A nice 7 years recall on a challenging root canal revision procedure. The patient had previous root canal with a post-and-crown therapy on the maxillary second molar. As it is the case in most instances it could not be determined if etiology was a persistent or reintroduced microorganisms or if it was a persistent extraradicular infection. Patient has been advised that if the cause was extraradicular infection he might need a further surgical approach. Patient has also been... advised of the presence of a big parallel stainless steel post that would need to be removed to allow for the endodontic procedure to be performed. Post has been exposed by removing adjacent composite material. This process has been facilitated by the use of a dental operative microscope. The post has then been loosened with a Rotopro bur (Ellman International, Inc, Hewlett, NY). A six sided non cutting stainless friction grip bur used around the circumference of the post. Once it has been removed I ensured with high magnification that there was no post cement remains in the apical part of the post space. An MB2 entry has then been located. All 4 canals ve been reshaped and an interim Ca(OH02 has been placed. 2 weeks later the root canal revision has been completed and the patient returned to her referring dentist. See more

Root canal treatment on a long calcified root canal system. In this case the pre operative X ray let us suspect a four canals mandibular first molar. The pulp chamber has been carefully unroofed wit ultrasonic tips under high magnification revealing a square pulp chamber floor rather than a triangular one (a second hint for the presence of a fourth canal). Following the developmental lines, the disto-lingual root canal entry has been located under a mass of dystrophic calcifications. The fourth canal is a very frequently occurring variation in the permanent mandibular first molars (more than 30%) , therefore effort should be made to locate it until proven there are only three canals.

Hello members. Microscope assisted root canal procedure on a tooth presenting with an obliterated pulp chamber. Adherent calcificationshave been removed with a buck one tip. 4 canals have been shaped with ProTaper Universal. Glidepath with Mani K files. WVC and Pulp Canal Sealer

Root canal treatment on a long second mandibular molar presenting with taurodontism. Endodontic treatment through a crown was indicated due to irreversible pulpitis. In such cases, the apical displacement of the pulpal floor makes it really difficult to locate root canal entries. Dental operative microscope with coaxial xenon illumination has ben really helpful in this case. Mani stainless K files for glide path and Protaper Universal for final shaping. Patient's tooth was difficult to get numb and intra osseous anesthesia finally did the trick. (X tip from Dentsply)

Effectiveness of the static-guided (SG) endodontics technique for accessing the root canal through a calcified root canal. Teeth 21, 22 and 23 do need pre prosthetic root canal treatment but complete obliteration of the coronal 2/3 of those root canal systems as well as the fact that those teeth are crowded makes it a very challenging procedure. Risks of massive destruction to sound tooth structure are high as well as tooth perforation . This would most likely result in teeth which would not be restorable. The use of a 3D printed guide greatly facilitates the procedure. Thank you Gergely Benyocs for initiating me to this novel and safe approach.

SOME SNAPSHOTS HERE SHOW THE IMPORTANCE OF WORKING AT HIGH MAGNIFICATION AS WELL AS WITH SOME APPROPRIATE ULTRASONIC DIAMOND COATED TIPS A common entry for two distinct root canals may let one think that this tooth has only a mesial and a distal canal when in fact there is three. Bucc 3 ultrasonic tips from Spartan. Opmi Proergo dental operative microscope. RC Prep and Mani K files for the glide path. ProTaper Universal for the root canals shaping (easy to fracture one in a narrow apical third of a root canal). Obturation technique : warm vertical condensation.

A nice save today. Patient could not afford the elsewhere suggested implant to replace tooth 36 and he was also keen on preserving his own tooth. Root canal re shaping along with interim Ca(OH)2 2 weeks ago and today tooth was asymptomatic and all 4 canals were dry allowing for the final obturation and a Nayyar core build up. Saving a tooth by the mean of a difficult root canal procedure rather than simply extracting it and put an implant takes more knowledge, more technical... skill, more state of the art expensive technology, more patience and it is much more chair side time consuming for the practitioner. Yet, a difficult root canal procedure usually costs less than an implant therapy. Dental insurance plans do not cover for implants therapy but definitely do for root canal treatments. Furthermore, a tooth that underwent for root canal, in most instances, will need a crown to protect it from breaking. Even if dental plans will cover for 50% of a crown bill, wether it is on a natural tooth or an implant, a crown on an implant is on average 50% more expensive than a regular one on a natural tooth. No wonder that informed patients definitely opt for a root canal procedure rather than loosing their natural tooth. See more

Fiber post retrieval, Neo MTA (Avalon Biomed) perforation repair, root canal revision, casted post and a new crown on the way. Patient in pain came in for an emergency appointment, at first sight the peri-apical Xray image would not let suspect a perforation of the buccal cortical plate. This case clearly demonstrates the huge benefit of having CBCT technology as we were also able to explain the situation to the patient and plan for the fiber post removal. Tooth is now asymptomatic and patient is happy to keep his own natural tooth.