I wonder when dentists will start to realize that dentin is not concrete, drywall, wood, or any other construction material; and posts are not really to be used as nails, screws, or rebar (even though they might look similar).

I wonder what that vertical line is towards the apex of the MB root in the 6?

Surprise, surprise — a split root. You can even see the post through the fracture.

The 7 is slated for an orthograde retreatment…

Here’s a case I saw for recall today. The first film is post-op after the endo in the 7 was completed for irreversible pulpitis (the filling on the mesial of the 7 was loose and flopping about back then). The 6 was done about a month afterwards. The second film is from today (38 months later).

Healing is progressing well, there’s still some osseous regeneration to go apical to the 6. And once again, I mentioned the mesial margin of the 7 and the distal margin of the 6 to the patient. I’m tired of mentioning it to the dentist.

Why should they do anything about the margins? Once the endos fail, it’ll be the fault of the endodontist that they didn’t do a proper job…

Someone tried to do a root canal on this tooth many years ago. I guess they decided to stop after they broke a lentulo in the MB canal.

If you’re gonna break an instrument, break one of these because they come out fairly predictably. I used a technique that OfficeMom and I developed a few years ago to retrieve canal objects. It involves bypassing the object with a couple of files, winding them together and pulling. It’s essentially the same thing that the paediatric dentists do to get pulps out.

Sorry about the poor image quality, I took the picture a few years ago.

So the patient was referred to me by their dentist for me to complete the endo. They reported that they had a hard time finding all of the canals because of a lot of pulpal bleeding that was not controllable.

This is what I saw once I got in and cleaned the chamber up. The only accessible canal was the distal right in the middle. The other (red) areas are perforations. To get into the mesial canals I had to go through the perforations on the mesial and angle back into the root (the mesial root had pretty much been severed).

The tooth is toast.

I really hate these kind of referrals:

“The tooth is very complicated and so I’m going to refer you to a root canal specialist that I work with. He’s very good and he’ll finish the root canal for you, then you can come back here and we’ll do the crown.”

How do you think the patient feels when they show up and I tell them that the tooth has to come out? And I’m not making that quote up because although heresay via patients is not usually accurate, you hear it enough (or see it actually written on the referral slip) and you believe.

On the other hand, I have dentists that say this:

“The tooth is very complicated, I’m not sure if it can be saved. I’m going to refer you to a specialist that I work with and we’ll see what he says about the tooth.”

I’m not saying anything more because the picture screams for itself.