Yes, I do work on other teeth besides upper anteriors…We’ve just had a few neat recalls this week.

This a case of a horizontal root fracture. The endo was done 1.5 years after the accident because no vitality had returned to the tooth and a grey caste was developing. Endo for prevention of infection was advised. Teeth with horizontal root fractures are tough teeth to endodontically treat and once infection sets in, the prognosis becomes even more guarded.

Once I started the endo, I got through necrotic tissue coronally, but as I approached the fracture line, I found vital tissue (was able to tell because of hyperemia). In order to try to preserve as much of this tissue as possible (to help with potential reduction and stabilization of the fracture and also for possible biologic closure of the end of the coronal root fragment–ie. apexification) I minimally instrumented to the fracture and then filled the canal to that point with white MTA (mineral trioxide aggregate).

Two years later, osseous healing is complete and the root segments appear to be stabilized. Mobility has reduced. There’s a cosmetic issue now though. Although I used white MTA and the pt’s dentist bleached the tooth prior to placing the final resin, it’s turning more and more grey. Oh well, at least he still has the tooth.

And speaking of horizontal root fractures, here is a case that I did years ago. I wouldn’t necessarily do the same thing today but the post op film looks cool.

Here are some answers to recent questions:

I have a digital camera (Nikon Coolpix 990) attached to my microscope. The scope is off to the left of the following picture. There’s also a video cam hooked up to the scope for my assistant to monitor what I’m doing. I’d rather have an intraoral camera than the Nikon hookup though.

I use my Canon SD500 camera for the other photos that I post.

I don’t have digital radiography in the office so I use an Epson scanner that has a transparency adapter to scan in xrays. I used to take pictures of xrays off the viewbox if I wanted them digitized. This worked decently, but requires a good knowledge of the camera’s exposure settings and some image manipulation on the computer. This was useful when I used to teach and didn’t have a scanner handy when some interesting xray came along.

Not that I do one every week…

Here’s a case that was finished last year. Previous endo, post and crown. The tooth was symptomatic and demonstrated either apical external resorption, or more likely, some sort of apical surgery (the patient didn’t recall any surgery but that doesn’t always mean it was not done).

Anyway, the retreatment was started, the canal was medicated, the patient forgot to come back for a few months, xray then showed washout of the calcium hydroxide, but some degree of apical healing. Endo was finished; some apical sealer puffs can be seen.

The recall today shows progressive apical healing and resorption of the extra sealer.

Thanks to Kelley Alderson of Hilton Realty for inviting us to their Latin Dance party. We had a great time despite the rain (her husband, Chris, had tarped almost the whole yard). Kelley, by the way, helped us to buy the current house that we’re in (she had to beat three offers) and sell the townhouse that we moved from. She sold the townhouse in about six hours after we received two offers.

Here‘s a post about a dental visit that cracked me up.