I was moving wood last weekend to try to clear the backyard up a bit more before the landscaping started. I had just climbed on top of the pile of wood that I was creating when one of the pieces rolled down and landed on my left hand. It then bounced off and landed on my right index finger tip squishing it so much that it broke skin just under the front of the nail. Blood copiously dripped out.

I was so deeply under the influence of Advil Cold and Sinus pills for my allergies that I hardly felt anything. I did notice that my knuckles were scraped quite nicely on my left hand and did think that my right index finger should be hurting more than it was.

Anyway, being right-handed, and having a sore finger there, it’s a given that this week all of my cases would involve picking my way down calcified canals or around curves. The finger is definitely hurting now.

Here’s a retreatment that I finished today. It was completed by an endodontist late last year and remained bite sensitive. He recommended apical surgery to address the symptoms. The patient came to me for a second opinion.

Because I thought that I could improve on the endo, I recommended a retreatment with consideration for an adjunctive surgery if necessary. Long story short, the post op film shows some decent improvement on the technical quality, but what’s more interesting is the up-bend at the tip of the mesial root. WTF? No wonder my finger is sore today.

At least the patient is comfortable with the tooth now.

I’m almost finished posting all of my interesting archived cases. Just one more to go after this one:

This one is from about 6 years ago, which explains the multiple backfill voids in the obturation. Anyway, I don’t know how many of my peers would attempt a retreat on this tooth. That post which looks like it would tack down drywall appears menacing to remove. It actually came out extremely easily. That was a pleasant surprise. The other surprise was the fifth canal.

That’s one mutant tooth.

The first xray is a duplicate which accounts for the poor quality. The case was referred to me by the patient’s new dentist. When I saw the patient, a parulis existed in the buccal furcation area. Apparently the endo was done in the 80’s and retreated by the previous dentist 1-2 years ago. That was when obturation material was pushed out the apex and the carbon fibre posts were placed and the bridge with the open distal margin was glued on.

I’m posting this case to show that extruded gutta-percha generally doesn’t cause problems.

The canals were cleared and medicated with calcium hydroxide paste for 6 weeks. The parulis disappeared. I obturated the canals.

Carbon fibre posts are a real pain to get out because I have to pretty much drill or ultrasonically destroy them to get them out; unlike metal posts which I can usually get out in one piece.

The extruded material had no impact on healing. The open margin on the distal will have an affect on healing if it isn’t addressed.

I just saw this case for a recall. The first xray is preop from May 2005, the second is a recall film from Jan 2007.

I wasn’t able to get the silver point out in toto from the MB1 canal because it ended up fragmenting on me around the curve. I was able to bypass it though. The tooth was medicated with calcium hydroxide paste for a couple of weeks then obturated.

Looks like healing is progressing well. However I wouldn’t be surprised if, once healing is complete, we see a residual lucent area around the extruded part of the silver point. Chances are a persistent foreign body reaction will go on there.

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.