Receptionchick says that my desk is way too messy so she bought an in/out tray for me to hide stuff. This seems to have helped a little and so I’m going through my desk drawers again to clean them up.

Here’s a cool case I completed in 2002–a 5 canal lower molar.

This patient reported a history of endodontic treatment in the Far East, then retreatment a few years ago. He ended up in my office because of a persistent parulis buccal to the tooth. I decided to retreat again, but had no real success in resolving the infection. It’s a rare two-rooted lower premolar.

We decided to do some exploratory/apical surgery. After mucosal reflection, I was able to confirm a vertical root fracture that started apically. This is probably partially because weakening of the roots from the amount of intracanal instrumentation this tooth has gone through over the years.

I was not able to apically resect the root to eliminate the fracture because of the complete loss of buccal bone and the short root that would have remained. The prognosis for this tooth is hopeless.

Here’s a case we just finished. Because of the curve and length of canal (26mm), I had to instrument the canal by hand files rather than rotary files. I haven’t done that for a case in years. This case was sent to me after the GP had already been in the canal and found that he couldn’t get to the apex.

Here’s an extremely rare tooth. If this were a first premolar, this type of lower premolar with three seperate canals and foramina exists 0.5% of the time¹.

Lower second premolars would occur like this less than that. As far as I know, there hasn’t been a large enough population of these teeth to determine a precise prevalence.

1. Vertucci FJ: Root Canal Morphology of Mandibular Premolars, J Am Dent Assoc 97:47, 1978. [↩]

This is a case from this week. It was a fairly straight forward non-vital premolar. The patient’s dentist had started the root canal treatment but was not able to find the canals. Using BUC2 and BUC1 ultrasonic tips from Spartan-Obtura I was able to get into the canals. Working lengths were confirmed electronically so that canal that looks like it’s filled a little short probably isn’t (there’s a hint of sealer shooting laterally). If you’re still not convinced, check here.

Our receptionist suggested that I blog this because she liked the final look of the case.