Boyd4Endo: December 2015

Tuesday, December 8, 2015

Case 57 Mesial Buccal Root Amputation

Pre Op # 14

Fractured mesial buccal root. Patient had option to extract with implant or mesial buccal root amputation.

Final Film #14

Mesial buccal root removed. Solid bone around distal buccal and palatal roots.

Post Op 7 Months #14

Healing has occurred with bone fill in in the area of the mesial buccal root. Probing is within normal limits.

Post Op 13 Months #14

13 Months with crown. Pt extremely happy. No periodontal problems.

Comment: Some patients just do not want teeth removed. If within reason there are alternative treatments for fractured teeth, for instance, if a fractured root can be removed with no undue periodontal problems and the patient understands the home care situation, then amputation is a viable option. The patient must understand that a new crown has to be placed.

Case 60 MVA

Pre Op #22,23,24

22,23,24 are symptomatic to pressure, no response to cold.

Final Film #22,23,24

Asymptomatic

Post Op 8 Months #22,23,24

Asymptomatic, almost complete healing.

Comment: Oral trauma can devitalize teeth and one must test all teeth in a quadrant or a specific area to make sure a tooth that is necrotic is not overlooked.

Case 59 What Would You Do?

Xray #8,9

Horizontal fracture apical third.

Comment: Patient traumatized tooth #8 as a child years ago. Has been referred for possible root canal although there are no symptoms. Tooth responds slightly to an ice pencil but not near as does #9. The tooth is yellower in color than 9. My recommendation is no treatment, what is yours?

Case 58 The Perfect Root Canal?

Pre Op #30

Symptomatic #30.

Final Film #30

Ideal.

Comment:I wish they would all turn out like that.

Case 56 Locate ALL Canals

Pre Op #30

Symptomatic tooth, #30 that had been referred where all the canals had not been found. In particular, the mesial buccal canal had never been negotiated.

Pre Op #30

Additional Pre Op film

Final Film #30

Mesial buccal found and there were two canals in the distal.

Final Film #30

Additional final film.

Comment: When dealing with lower molars remember there are usually at least three canals. Two canals maybe found occasionally in second and third molars.

Monday, December 7, 2015

Case 55 Bone Loss in Furcation Usually Indicates Fracture, USUALLY

Pre Op #30

Root canal with furcation bone loss but not probeable.

Final Film #30

Retreatment completed, no fractures noted in access opening.

Post Op 6 Years #30

Bone completely fills furcation.

Comment: A dirty canal system in a tooth with a root canal is not recognizable on an x-ray. Cleaning the canal system is the only way to ensure that the canals are clean and sterlie. An access opening also can reveal the presence of a fracture many times.

Case 54 Retreatment Very Common, Mesial Root Not Cleaned

Pre Op #19

Symptomatic with swelling over mesial buccal root.

Final Film #19

At First appointment mesial canals cleaned thoroughly, at second appointment all canals were obturated down to radio graphic apex.

Post Op 21 Months #19

Symptoms gone and apex area of mesial root completely filled in with bone.

Comment: Mesial canals of lower molars are very commonly not cleaned well enough to the radio graphic apex. When retreatment done the canals in the mesial root are cleaned thoroughly down to the radio graphic apex.

Case 53 Third Molars Are Tough

Pre Op #32

Symptomatic #32 with Periapical lesion.

Final Film #32

Final Film

Post Op 13 Months #32

Periapical lesion gone.

Comment: Third molars can be tricky besides being hard to get to with a rubber dam. Don't be surprised if you tackle a RCT on a third molar that there may be a variety of canal systems from 1-5.