Resting In Peace near Hector, by the stream that runs behind our house, surrounded by the very Nature that she loved.

She is survived by 1 cat, 2 dogs, 6 fish, 3 parrots, and 2 humans.

7 Months old on April 10, 2010.

There are certain referring dentists with whom I work well and there are others who have tried me out in the past, but for various reasons send elsewhere now. No hard feelings, no worries.

Just as you can’t please every patient, you can’t be everything to every dentist either. The patient comes first, and if they get more streamlined, effective care via a different generalist-specialist combination, I’m fine with that.

You two or three constant readers of my blog know that I have no problem with patients or dentists looking elsewhere for treatment if they don’t want to abide by my office policies. My treatment philosophies and office policies are what they are for very good reasons and were developed through my years of practice from both scientific evidence and experience.

And yet there are still dentists that try to bully me every now and then. I still have a few things to learn about dealing with them. I react impulsively and aggressively.

Thanks to my co-workers I’ve been able to keep myself under control with this latest episode. They really are the best and I am unfathomably lucky to have them watching over me.

Read the rest of this entry »

Most times when a rotary file breaks in a canal, the fragment is either irretrievable or the risk to remove it is greater than the benefits. This is purely because they mostly break apically, around curves, and the fragment is often no more than 3-4mm in length.

Using ultrasonics to remove a fragment in a situation like that can very easily lead to excessive damage to the apical aspect of the root. Apical surgery is often a more predictable approach if the fragment must be removed. Many times, however, the prognosis of completion of endodontic therapy with the file fragment still lodged in the root (ie. obturation that incorporates the fragment) can lead to a decent prognosis still. It all depends on the presence or absence of preoperative infection within the tooth and the management of the tooth through the whole process.

I have found that when instruments break in canals like this, it often is more a manufacturer’s defect than poor technique.

Here you’ve got a fairly thick file that broke off leaving a long segment in the canal. The canal is fairly straight and the head of the fragment is visible in the coronal aspect of the canal. I was able to trough around the fragment to about 2mm beyond the head of it. The energy from the ultrasonic tip them unscrewed the fragment and it popped loose. Often applying the ultrasonic directly to a fragment will cause the fragment to further fragment, but this piece was thick enough, not around a sharp curve, and visually accessible enough that I was able to retrieve the file and proceed to complete the endo normally.

On the post-op film you can see how close I was to a perforation of the root even though I had good visibility of the fragment through my microscope. Imagine trying to do all of that troughing in the apical third of the root.

Note that this file has radial lands, a larger tip diameter, and a greater than 0.04 taper. It’s probably a GT file.

As all bloggers have experienced over the last 3 years, the concept of sharing our thoughts, frustrations, and joys through short journal entries in a blog has changed. The social media webscape has forced that upon us and this is actually a good thing.

Tumblr, facebook, Twitter, and reams of other organizations provide canvases for us to share, share, and share. To top all of that off, I have gotten myself involved in activities and hobbies that no longer leave me time to blog as I frequently as I once did — and I don’t really need to.

The people that matter most to me are on facebook and see snippets of my life, as I see theirs. My brother and I have a photography business on the side with its own blog and we both spend lots of time on flickr.

I just don’t have the time to write down my thoughts about movies, theatre, and books with the same obsessiveness I once had. I’d like to, but I like too many things.

So what the heck am I going on about?

I’m saying that this blog is still a part of my life, but it’s a much smaller part than it once was because I share my thoughts in lots of other places. This is probably a good thing too because as I become more famous and sought-after for my opinions on movies, theatre, and books, it becomes more dangerous to have my life laid out in a single public forum on the internet.

At this point, I’m thinking that I’ll focus this blog more towards my experiences in dentistry. I’ll probably throw some interesting personal-life stuff in every now and then, but those of you that truly are interested in my personal life (god knows why you’d be) are already my friends on other sites where I expose more of myself anyway.

Refocusing has involved pausing my twitterfeed aggregation and limiting my use of Twitter. Facebook’s changes over the last year, along with a really useful RSS app, allows my brother and me to do things that we could only do in convoluted ways via Twitter in the past.

Times change and technology follows suit. Although the infrequent posts to this blog leave me appearing stifled, I am in fact the complete opposite because of these continuous innovations in the social media landscape.

Just got a phone message from a referring dentist that I was hoping had stopped referring patients my way. The reason for that is a long story in itself and for a post some other day.

The back-story revolves around a patient from this dentist whom I saw for a consultation last week. She’d had root canal treatment done fairly recently and is experiencing persistent, residual symptoms. In my letter back to the dentist I mentioned, among other observations, “poor interproximal restorative margins”.

So this patient’s dentist calls today and says that she doesn’t see poor restorative margins on the PA that she has of the tooth (a recent PA of which I have a copy). She’s not sure where my assumption of poor restorative margins came from and would like a copy of my PA to see what I saw.

Here’s my PA which is not really significantly different from her PA — and this is just what you can see on film. My explorer got stuck under the mesial margin so heavily that I could probably have pulled that whole filling out if I had applied more force.