I’ve just re-added the moon tracker module to the sidebar on the right (it was on the original version of the blog). My front desk staff puts all full moons for the year into the appointment book because of the wackiness that happens around those times. The last full moon and lunar eclipse was an especially crazy time. Don’t know if it’s because of me, or the patients, or a combination of both.

This last week started out on an abjectly depressing note for me. Some major (almost catastrophic) family issues caused me to really withdraw into myself. Things have slowly been resolving and through the support of my wife, my brother and his wife I’m almost back to myself again. Thankfully my patients didn’t suffer too much.

I now know who does and should matter most to me in this short life that we live.

I’ve always maintained that blogging is a therapeutic exercise for me. Although through my comments this week you’ve probably had no inclination of what I was going through, my blog and its readers have been an anchor of sanity for me.

Thank you all.

It’s not usually a good thing when your dentist says “oops” during a procedure. I’m sure that the dentist who did this didn’t say “oops” out loud, but instead thought something much more profane when he saw what he had done.

The patient has been experiencing episodic symptoms for almost a year (since the implant was done). The periodontist who did the implants bounced the patient to an endodontist and an oral surgeon. Nobody really wanted to do anything. A CT scan was ordered by the oral surgeon and, although results were not conclusive, there were findings consistent with the fact that the implant was in contact with the root of the tooth. It was difficult to determine if the canal space had been perforated.

The patient was eventually referred to me for a second endodontic opinion. I recommended exploratory access and a retreatment start. The film above shows the story after I had accessed the crown, cleared gutta-percha from the canal, and then loaded the canal up with Calcium Hydroxide paste. The plan was to leave the tooth in this state for at least 4 weeks to see if symptoms improved.

During instrumentation of the canal, I found a solid, wide blockage in the apical 1/3 of the canal but fairly short of where the root should have ended. Electronic apex locator readings showed an apex at this blockage. These finding are consistent with the blockage being a metallic object that had perforated the root.

Over the past few weeks our patient has not noticed any significant relief from the current treatment. This means that completion of the retreatment will make no difference either. I’m not interested in doing apical surgery around an implant, so back he goes to his periodontist for further direction.