Life's Context » Surgery

An Example of Imperfection.

Periapex — Tue, 09 Sep 2008 21:44:40 +0000

Everyone likes to show off their best work, but when can you remember being at a continuing education presentation and the presenter shows off work that they have produced that is less than ideal?

Here is a case that was fraught with issues from the beginning:

The patient will be on a recall schedule with me for the next year or two while I keep tabs on healing within the jaw bone. Hopefully the problem of chronic infection from this tooth is solved. Options are very limited now if the infection persists.

Deconstruction of an Apicoectomy.

Periapex — Fri, 04 Apr 2008 11:47:04 +0000

I usually retreat cases like this (access the crown, remove the post, redo the root canal work), but the patient was sure the crown would come off without the post in the tooth, so fine, we decided to do the surgery instead. For those who understand what I’m talking about so far, if the crown is at risk of falling off without the post (during the temporization period), the crown is likely not fitting the tooth as well as it should and is probably leaking. Surgery in situations like that ends up being a short-term solution.

The surgery went fairly smoothly, and I got a decent shot of the root end after I’d resected and filled it. The largest amount of granulation tissue was on the buccal root surface near the apical/middle third junction. The culprit turned out to be a lateral canal. I filled the lateral canal and two main canals with white MTA. The apical bevel looks much sharper in the photo than it really is.

All the bright red is blood-covered jawbone. Here’s the key to the numbers in the picture:

Crown of tooth
Lateral canal
Buccal canal
Isthmus between canals
Palatal canal

There is also a sinus perforation that doesn’t show well on the clinical photo.

Crack of the Week.

Ameloblast — Tue, 02 Oct 2007 19:59:00 +0000

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…

Crack of the Week.

Periapex — Tue, 28 Nov 2006 20:17:00 +0000

Just finished closing this case up. It was a lower left first molar with a persistent abscess (I retreated it a month or two ago). I decided to flap it to see what was going on and to do an apical resection if necessary. I didn’t get past this part once I saw the split mesial root.

Confirmation of a Vertical Root Fracture.

Periapex — Wed, 13 Sep 2006 13:43:00 +0000

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.

Recall of the Week.

Ameloblast — Wed, 30 Aug 2006 17:23:00 +0000

Not that I do one every week…

Here’s a case that was finished last year. Previous endo, post and crown. The tooth was symptomatic and demonstrated either apical external resorption, or more likely, some sort of apical surgery (the patient didn’t recall any surgery but that doesn’t always mean it was not done).

Anyway, the retreatment was started, the canal was medicated, the patient forgot to come back for a few months, xray then showed washout of the calcium hydroxide, but some degree of apical healing. Endo was finished; some apical sealer puffs can be seen.

The recall today shows progressive apical healing and resorption of the extra sealer.

Cracked Roots.

Ameloblast — Wed, 22 Feb 2006 16:59:00 +0000

Speaking of pulling things out from the back of the desk drawer, I had a case today that we aborted the root canal on because of a crack that I found that ran through the floor of the pulp chamber.

I dug the picture above and the two below of cracked teeth out from my archives.