Case 10 Root canal with curved anatomy

Pre-op xray #18
Very curved mesial root.

Post-op xray #18
Completion of root canal.

Comment:
It is important before endodontic treatment is started that one looks carefully at the anatomy of the tooth. Curved roots present many problems including fracture of instruments and incomplete debridment of the canal system, which can lead to failure. At the very least, cases like this, should be referred for consultation.

Case #9 Fractured or Not?

#19 Pre-op x-ray

#19 File film

Possible diagnosis fractured tooth, however, not probe-able.

#19 Final Film

38 month post op x-ray

No evidence of fracture in access opening.

Comment:
Do not assume fractures.  Always probe carefully around the tooth, fractured roots usually have a significant periodontal pocket. Always check carefully in the access opening for a fracture. There is a dye on the market that can be used if one is unsure.  The consequences of unnecessary extraction can be very costly to a patient especially when the tooth is a bridge abutment.

Note: A root canal had just been completed on tooth #20 by his primary dentist.

Case 8 Consequences of an un-restored tooth - fracture

Pre-op film

Root canal required for tooth number 14.  Tooth was symptomatic to occlusal pressure and was necrotic.

Immediate post op film

Root canal was completed.  Patient was advised to have full coverage as soon as possible.

5 month post treatment x-ray

Patient was symptomatic to pressure and a periodontal defect was developing along the mesial buccal root. 

Photo showing fracture

Fracture noted, tooth non-restorable.

Comment: If at all possible most teeth will require full coverage after root canal therapy. Our office lets the patients know that they should get back to their dentist as soon as possible for a crown. However, if for whatever reason, this is not done in a timely manner, fractures can and do occur, making the tooth non-restorable.  Patients need to be informed when they are referred for root canal therapy that the tooth needs to be restored as soon as possible. The consequences need to be discussed i.e. fractures.