Here’s a perspective on root canal treatment by someone that just came out from the other end of the drill.

Today is the Boy and Girl’s first anniversary. What a contrast in weather from Mexico last year to Canada now!

This week the snow plows came out for the first time this year. I’ve already started wearing my Muttluks on my walks because of the cold temperature and the snow. I got some frost bite on my paws last year before I got my Muttluk paw protectors.

Here’s a case that came into the office a few years ago.

The patient had been having symptoms and was medicated with antibiotics. They were referred to me for a retreatment. There was no information about when the original root canal was done but the obturation is thin and short and there is apical rarefying osteitis.

It looked at first like a straight forward crown access, post removal, and canal retreatment. On second glance at the film, I became a little worried about coronal leakage under the distal crown margin and the impact this might have on the prognosis of the retreatment.

So we took a vertical bitewing to check the crown margins:

Wow. Here we now have an ill-fitting crown, a much longer than expected post in MB that is heading to a perforation, furcation involvement, a probable perforation into the furcation, and on top of all of that…a crappy root canal.

I ended up recommending extraction of this tooth.

Moral of the story: Take different angled films and don’t forget about the usefulness of vertical bitewings.

Perhaps Love is like a resting place
A shelter from the storm
It exists to give you comfort
It is there to keep you warm
And in those times of trouble
When you are most alone
The memory of love will bring you home

Perhaps love is like a window
Perhaps an open door
It invites you to come closer
It wants to show you more
And even if you lose yourself
And don’t know what to do
The memory of love will see you through

Oh, love to some is like a cloud
To some as strong as steel
For some a way of living
For some a way to feel
And some say love is holding on
And some say letting go
And some say love is everything
And some say they don’t know

Perhaps love is like the ocean
Full of conflict, full of Pain
Like a fire when it’s cold outside
Or thunder when it rains
If I should live forever
And all my dreams come true
My memories of love will be of you

And some say love is holding on
And some say letting go
And some say love is everything
And some say they don’t know

Perhaps love is like the ocean
Full of conflict, full of Pain
Like a fire when it’s cold outside
Or thunder when it rains
If I should live forever
And all my dreams come true
My memories of love will be of you

– John Denver and Placido Domingo.

Here is another recent case. Tooth 12 is a planned extraction. With a mobile crown and chronic infection, the root is likely fractured. Both 12 and 11 were surgerized years ago. An apical resection was done on 12 along with some curettage only around the apex of 11.

This pre-op shot shows a carbon fiber post too deep in the root of 11, with no obturation evident. The tooth had a parulis apical to 11 when I first saw the patient for consultation. A diagnosis of a chronic periapical abscess was established and endodontic retreatment was recommended.

The retreatment was completed over two appointments in order to medicate the canal for a couple of weeks with calcium hydroxide paste. During the first appointment, the post was removed and instrumentation was taken to a #120 file. Working length was established electronically and was found to be consistent over multiple checks.

The PA shows a significantly short obturation with a hint of sealer sneaking laterally towards 12.

What happened here? The most logical explanation is that the root was nicked and perforated during the apical resection of 12.

Should I have obturated to the radiographic apex? I could have, but I had a more reliable length to PDL space with my apex locator. As long as the canal coronal to the perf is disinfected and sealed, I expect the patient’s body to deal with any infection within the apical segment. Generally this happens via replacement resorption of the segment or via flow of blood or plasma through the perf and out the apex or vice versa.

Still, apical surgery is a possible adjunct whether or not obturation had taken place to the radiographic apex so this tooth will need to be monitored for signs and symptoms over the next couple of years.