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Root fracture is a situation that may happen and is generally associated to these symptoms: Depending on the conditions, the symptoms referred by the patient may vary and, in some cases, painkillers are not able to help managing the pain.
Surgical treatment of apical periodontitis caused by a lateral canal, highlighting CBCT planning and bioceramic sealing for complete healing
Endodontic Microsurgery is one of the most important ways to save teeth rather than extracting and placing implant. Here we will talk about a tooth that failed multiple trials of endodontic treatment, endo-surgery was made and follow ups shows complete healing.
A smooth workflow in endodontics and restorative starts from the application of a strict protocol
The recovery of severely compromised teeth is a challenge for clinicians. Every day, we face this issue, and it is crucial to choose the correct technique and, above all, the proper sequence of operations to simplify the process, reduce the number of appointments, and meet the patient’s needs as quickly as possible.
Endodontic mishaps can interfere with the healing process of the body and can result in failure of the root canal treatment if not taken care of. Perforation, if present should be handled immediately and adequate materials to be used for better results. Fracture of an instrument results in improper cleaning and shaping of the remaining […]
The restoration of endodontically treated teeth must be planned before initiating root canal treatment. Because Microbial contamination of the root canal system and peri-apical tissues is the most common reason of endodontics failure (Saunders and Saunders, 1994; Torabinejad et al., 1990). Therefore, the root canal system should be sealed both apically and laterally with appropriate […]
The piezoelectric ultrasonics have the potential to become routinely incorporated into almost every component of endodontic treatment, re-treatment, and apical microsurgery. It is already indispensable as a precise tool with which the most challenging clinical situations, such as finding hidden root canals and removing root canal obstructions, can be done with relative ease, predictability, and conservancy. In this article, I will explain some of the uses of ultrasonics in conventional nonsurgical endodontics.
The failure of root canal treatment is a problem encountered by every dentist. A large number of studies have shown that teeth may continue to have previous periapical lesions or even develop new periapical lesions after root canal treatment. The reasons for root canal treatment failure, the site to be debreached, the method to be repaired, and the communication with the patient are all very important factors in retreatment.
One of the most common complications after dental trauma is pulp necrosis, which is often associated with apical periodontitis. The management of these teeth is challenging due to large root canals, open apices, and thin dentinal walls. 1 Long-term irritation leads to periapical lesions and cysts in the apical region. If left untreated, necrotic and infected pulp causes inflammatory lesions in the periapical tissues to grow over time, leading to structural changes in the bone. In some cases, root canal treatment may be required later during follow-up of injuries, due to subsequent pulp necrosis and infection of the root canal system. 2-3
In this article we are going to review how can we deal with the most hated canal in Endodontics from diagnosis to obturation.
Root resorption is a pathological process that may occur after surgical mechanical, chemical or thermal insult. Generally, it can be classified as internal and external root resorption. Depending on the diagnosis, biocompatible material like MTA can be used in management of these cases. General dental practitioners can face difficulties in diagnosis and treatment planning for […]
External cervical resorption (ECR) is an aggressive form of root resorption (RR), which initiates from the external cervical area of the tooth. Its aetiology is mostly unclear. As in this case, the lesion often progresses asymptomatically, until it is discovered incidentally.
Most mandibular second molars are usually found to have two roots (76%) or one root (22%). The incidence of 3 roots anatomy in such teeth is considered a rare finding (less than 2% in some researches). The incidence of 3 rooted lower second molar with 4 separate canals is considered very rare. This is a […]
The second maxillary premolar may have 1 to 3 roots: with one root canal in 75-96% of cases, with two root canals in 4-24% and three root canals in 0-1%. Careful interpretation of preoperative radiographs is essential for providing insight into the number of existing root canals. In maxillary premolars with multiple roots and canals, […]
The aim of the article is not to introduce a new technique, but to combine existing and consolidated ones in order to maximize the ergonomics, quality and predictability of our treatments; the proposed protocol was designed to satisfy the work mantra "the best work, in the shortest time, in the greatest comfort" and therefore entirely focused on reducing chair time and maximum operational facilitation.
Amongst the different stages of endodontic retreatment, filling material removal may be performed by using manual files and rotary instruments. Further, desobturation may be associated with ultrasonic activation and different types of solvents, although they are currently used with less frequency. However, no retreatment technique is reliable enough to clean root canal system completely after reinstrumentation.
The purpose of this article is to explain all the phases to do in a correct way an apical plug. Today on the market there was a lot of material that perform wery well like MTA or Bioceramic material in putty consistency. It’s important to know not only the technique but also when it is […]
Endodontic cases involving broken instruments are among the most challenging and stressful in the field. Even the top experienced endodontists will agree that removing broken tools demands unwavering calm and exceptional self-control. This procedure isn't for everyone, as a rushed decision or improper removal can lead to failure. It's important to remember that any attempt […]
Perforation is an iatrogenic communication that is formed between the tooth and supporting tissues. It is important to manage perforations as soon as they are diagnosed. An ideal peforation repair material is Mineral Trioxide Aggregate.
Middle mesial canal (MMC) is an additional canal found in mandibular first molars. The knowledge of its presence and its detection, negotiation, disinfection and sealing plays paramount importance in the overall endodontic success.
As endodontists we often encounter retreatment cases with procedural errors such as canal blockages, ledges, instrument fractures and perforations. The ledge is defined as an iatrogenic deviation from the original canal path that does not communicate with the periodontal ligament. The presence of a ledge prohibits the files from reaching the canal terminus, resulting in […]
Dentistry is all about combining clinical art & science of diagnosis to improve the quality of patient’s life. Here we will talk about a patient with a molar needed to be retreated and instead she was misdiagnosed with trigeminal neuralgia.
The maxillary first molar typically exhibits complex root canal anatomy, commonly presenting with three roots—two buccal and one palatal. However, anatomical variations, such as the presence of a fourth root, can occur and significantly impact endodontic treatment. Recognizing these variations is crucial for successful root canal therapy. This article discusses the endodontic management of four-rooted […]
Many times we hear about rotation and reciprocation as rival movements and feel like we have to choose one or the other. In reality both are very important and helpful to achieve a predictable result. Let’s dive into the main characteristics of each movement Rotation: + Removes easily the debris that are created and are […]
This article showing the method of using non-setting calcium hydroxide in case with large periapical lesion .
A patient recently visited our clinic with a complaint of persistent pain in the upper right lateral incisor. Upon examination, we discovered a granuloma at the root of the affected tooth. After careful evaluation, we proposed endodontic surgery as the most conservative solution to address the issue. This approach aims to preserve the natural tooth […]
In retreatment cases , the clinician has to deal with many mishaps such as underfilled, missed and obstructed canals as also with iatrogenic damages as separated instruments and perforations. Underfilled and missed canals are the main reasons for endodontic failures (>30%).Especially underfilling can be a real challenge since it can strongly reduces the success rate […]
There are four options for managing a tooth with posttreatment disease: do nothing, extraction, nonsurgical retreatment, or surgical treatment. Avoiding treatment may result in the progression of disease and continued destruction of supporting tissues, as well as possible acute exacerbation of systemic side effects, such as cellulitis and/or lymphadenopathy. In most cases, these options are […]
Coronal fractures of the anterior teeth are a common form of dental trauma that mainly affects children and adolescents. One of the options for managing coronal tooth fractures when the tooth fragment is available is the reattachment of the dental fragment. This article reports on coronal tooth fracture case that was successfully treated using tooth fragment reattachment.
The clinician must be aware of the possible anatomical variations of these teeth and their relationship to adjacent anatomical structures when planning and performing endodontic procedures.
The position and anatomy of upper molars can make root canal treatment challenging, and instrument separation is common. In the presented case, tooth 1.6 had an abscess, and an attempt at root canal treatment was made. Unfortunately, the previous dentist encountered difficulties and broke a paste carrier approximately 4 mm beyond the apex. In the […]
Root perforations were the second greatest cause of failure accounting for 9.62% of all unsuccessful cases. Seltzer et al. also attributed 3.52% of all endodontic failures to perforation. This perforation if left untreated leads to act as a pathway for microorganisms either from periodontal tissues or perforation site, results in secondary periodontal infection, suppuration, fistula […]
Narrow canal is a great challenge to Endodontist, When combined with calcified entrance the difficulty doubled. Preoperative assessment to the periapical radiograph would help in avoiding many errors that could happen if case is underestimated. CBCT has a great role in assessment and planning for management of canal calcification and blockage and it’s considered of […]
The final objective of endodontic treatment as described by Schilder in 1967 is ‘‘the total obturation of the root canal space’’ and since then many materials and techniques have been developed for obturating the radicular system (1). In the last decade, the development of bioceramic or calcium silicate-based (CSB) sealers has led to the re-introduction […]
Modern endodontic treatment is based on optimal cleaning,disinfection and high-quiality obturation of the root canal system.Anatomy is considered as a key factor in the healing process.That is why a clinician have to be aware of all normal,possible and abnormal variations in the teeth anatomy for achieving a maximum clinical success.In the article presents clinical example that demonstrate the complexity of endodontic retreatment of the maxillary left premolar
A 23 years old, female patient, was referred to my practice for an endodontic treatment on tooth 11. Patient complained of pain above the root and was concerned of the discoloration. Patient reported previous trauma (15 years ago) and an attempted endodontic treatment (5 years ago).
Perforation repair with MTA
Premolars are the most versatile teeth in regards of anatomy. One of the most challenging anatomical variations we have to face is dilaceration. Abrupt curvatures complicate the RCT especially when we have more than one.
As modern dentistry continually strives for excellence, we frequently face the challenge of dealing with complications from older endodontic treatments, which often present unexpected difficulties. Calcifications, perforations, and stubborn obturation materials that are difficult to remove pose significant challenges in treatment. To effectively manage these cases, careful and thorough planning is essential. This involves a […]
The Zoning Technique is an innovative approach in endodontics that aims to optimize root canal treatment by dividing the root canal system into distinct zones and applying specific instruments and techniques tailored to each zone's unique characteristics. This technique enhances procedural efficiency, increases treatment precision, and improves the overall success rates of endodontic therapy. In this article, […]
The C-shaped root canal configuration is an anatomical variation which is caused by the fusion of the mesial and distal roots either on the buccal or lingual root surface (1). The term ‘‘C-shaped canal’’ was firstly used by Cooke and Cox in 1979 (2). Numerous studies have reported that the incidence of C-shaped canals is […]
The goal of an endodontic treatment is to disinfect the root canal system. This will facilitate the resolution of inflammation and the alleviation of symptoms. Failure to achieve this goal means that parts of the root canal system will not be thoroughly cleaned and will carry on containing a significant population of bacteria. This fact […]
A 32-year-old man with a symptomatic maxillary right central incisor came to the private clinic. The patient reported that the incisor had been traumatized previously. The medical history was nonsignificant, and extraoral evaluation revealed normal soft-tissue structures with no apparent pathosis. Upon oral examination, no mobility or probing defect was observed. The tooth was sensitive […]
Pre-endo build-up is an essential part of the endodontic procedure. It has 4 main purposes. First of all, it confirms that the tooth is restorable by means of isolating the healthy dental tissue. It ensures that there is no microbial leakage in the endodontic space. It allows the correct use of electronic apex locator, preventing […]
This article demonstrates the protocols followed on two teeth with unique anatomical features in a conservative, feasible, teachable and repeatable way.
With increasing number of reports and studies of unusual root canal morphology, It is of utmost importance that the clinician must have detailed knowledge of the pulp canal anatomy to achieve effectively proper cleaning and shaping of the root canal system. Failure to recognize the aberrant root canal anatomy will lead to an unsuccessful treatment and thus failure of the endodontic therapy. This case report describes a very rare scenario of a mandibular right first molar with five root canals (three in distal root and two in mesial root) and a maxillary left second molar with also five root canals (three in the mesial buccal root, one in the distobuccal root, and one palatal) in the same patient.
This article is about showing the way of bypassing SI from both inner and outer wall, and which is correct in order to obtain satisfying outcome away from any unnecessary complications.
Sinus tract tracing, proper diagnosis, and patient education are all the big players involved in this tooth story! It is no surprise that I find all of advanced diagnostic techniques, i.e.; cone beam scans for example, extremely useful to figure out the source of pain plaguing my patients, it’s worth investing my time and energy into the latest technology. But keeping things old-school has its value too. Therefore, I would like to show you a case where a classic diagnostic method—sinus tract tracing—proved invaluable in my endodontic diagnosis.
In this article we are going to share how to manage an upper first molar in a predictable way for a long-term successful re-treatment.
Variations in the root canal configurations are a great challenge for the endodontist during endodontic procedures. This necessitates the understanding of canal morphology before initiating the treatment.
Teeth with previous apical resection and persistent apical periodontitis are usually re-treated surgically or with a combination of non-surgical and surgical re-treatment. Alternatively, nonsurgical orthograde treatment of failed apicoectomy can be performed using the apical barrier technique used for apical closure of nonvital teeth with apical resorption or immature nonvital teeth. Mineral trioxide aggregate (MTA) […]
One of the most important prerequisites for successful endodontic treatment is the adequate knowledge and understanding of root canal anatomy. The mandibular first molar (MFM) seems to be the tooth that most often requires root canal treatment and over the years numerous in vitro and in vivo studies have investigated its root canal morphology (1-3). […]
Fractured endodontic instruments visualized on the initial radiograph of a case that calls for retreatment may pose a great challenge to the clinician who is being asked to undertake an already complicated task. Conventional conservative management of separated instruments includes attempts to remove or bypass the fragment, or prepare and fill the root canal system […]
Within the intricate landscape of dental health, the phenomenon of cracked teeth poses a challenging conundrum for both patients and dental professionals. Cracked teeth, an umbrella term encompassing various fissures and fractures within tooth structures, present a complex array of symptoms and diagnostic intricacies, often defying conventional diagnostic methodologies. This exclusive article aims to delve into the multifaceted nature of cracked teeth, exploring their diverse manifestations, diagnostic challenges, and tailored approaches to comprehensive management.
In this article, I will discuss the retrieval of Silver Point Cones using the grasping technique
The main purpose of an endodontic treatment is to render the root canal system free of bacteria. This will facilitate the resolution of inflammation and the alleviation of symptoms. But most of the time, the clinician faces obstacles that must be overcome to properly disinfect the root canals. Failure to remove these interferences means that […]
Nowadays, it is a common thing to have patients with extensive dental tissue loss because of caries. However, high magnification and the use of new technology and techniques help us to save teeth that not long ago would be considered for extraction. A patient, with clear medical history, was referred for evaluation of restorability and […]
In field of endodontic retreatment, the traditional dichotomy between non-selective nonsurgical methods and selective surgical interventions has been redefined by advances in CBCT imaging. This technological leap has facilitated the development of a contemporary method that amalgamates the conservative nature of nonsurgical techniques with the precision of surgical selectivity. This novel, minimally invasive approach allows […]
Case report of the endodontic treatment of a mandibular first molar with radix entomolaris and middle mesial canal
This article clarifies how to to bend gutta-percha cone and preserve this bending even if the temperature of the body can straighten the master cone in deep apical splitting of the canals.
Separation of nickel-titanium instrument during root canal treatment can cause serious complications that may lead to treatment failure. It prevents complete cleaning and filling of the entire root canal space. Therefore, retrieval of the instrument should be tried to achieve better outcome for the therapy. There are two ways to manage this problem:
During a root canal treatment, sometimes we need to remove liquids from the canals, for example during the irrigation procedure, in cases with abundant drainage o before to dry the canals with paper points. The use of a microcanula connected to the equipment could help us to aspirate inside the canals. This can be useful even to remove materials from root canal.
Calcium silicate based cements have many positive features, however they can be difficult to remove if a retreatment is necessary.
The major problem with sub-gingival fracture is absence of adequate coronal ferrule and a compromised biological width. This usually complicates the application of the rubber dam during endodontic treatment. The primary objective of tooth extrusion or forced eruption is to provide both a sound tissue margin for ultimate restoration and to create a periodontal environment […]
Mandibular first premolar usually have a one root and one root canal but it shows a wide variety of abnormal root canal anatomy. The occurrence of three canaled mandibular first premolar with deep apical split is very rare, but it does occur. The incidence of a three-canaled mandibular first premolar is approximately 0.2%, making such teeth most difficult to manage endodontically.
MTA (Mineral Trioxide Aggregate) apical plug is a technique used in endodontic treatment to create a barrier at the apex of the tooth. This innovative solution has revolutionized endodontics by providing excellent sealing ability and biocompatibility. When combined with internal tooth bleaching, the MTA apical plug technique offers an aesthetically pleasing and predictable outcome for […]
As the complex anatomy of maxillary first molars is one of the major challenges in endodontic therapy, knowledge of the complicated root canal anatomy and configuration is crucial to ensure the success of endodontic treatment and prognosis. This article presents an endodontically managed maxillary first molar with special anatomy.
In this article we are going to share management of a pulp stone associated with c-shaped canals in a lower second molar.
The main canals in the mesial root of lower molars are the mesiobuccal and mesiolingual canals. A middle mesial canal (MMC) sometimes is present in the developmental groove between the other mesial canals. The presence of middle mesial canal in the range of 4-28 % is recorded and divided into three types: INDEPENDENT, CONFLUENT, AND […]
Trauma or caries in young children or adolescents can cause pulp necrosis, which may arrest root development in permanent teeth. This in turn results in thin dentinal walls, wide-open apices or sometimes divergent configuration or reverse anatomy, and inadequate crown-root ratio. Treatment of necrosed permanent teeth with immature apices mainly revolves around Apexification and Regenerative […]
To obtain good results in endodontic treatment it is important to remove all microorganisms from root canal system, three dimensionally sealing and the placement of a good coronal seal to prevent communications between oral cavity and the periradicular tissues. Preoperative radiograph identification, root canal access opening, intraoperative identification, location, instrumentation, debridement, disinfection, obturation are improtant […]
The purpose of root canal treatment is to clear pathogenic microbes and infected pulp in the root canal, prevent it from producing toxic products, and protect the periapical tissue. The presence of root canal variation increases the difficulty of this treatment. It has been reported that 42% of retreatment cases are due to missing […]
Bacterial infection of the dental pulp may lead to periapical lesions. They are generally diagnosed either during routine dental radiographic examination or following acute pain in a tooth. Most periapical lesions (>90%) can be classified as dental granulomas, radicular cysts or abscesses. The incidence of cysts within periapical lesions varies between 6 and 55%. The […]
The use of solvents helps removing the filling material form the canals, however it may as well slow down the retreatment process. A case report
The role of endodontics is to save as many teeth as possibile. Today thanks to technology (Microscope, CBCT, New instruments) we are able to manage very difficult cases. It’s very important manage different situation because sometimes first endodontics treatments and also retreatments fails. Today thanks micro-endodontic surgery we are able to give a “new life”to […]
The in-depth knowledge of root anatomy and its possible variations is absolutely fundamental for the long-term success of our therapies. Sometimes, despite the aid of strong surgical magnification and despite good anatomical knowledge, one may come across particular anatomies in an unpredictable way. A correct operating protocol can protect us from errors, giving us the way to correct them without consequences.
In this article, I will discuss the method of diagnosing and analyzing multiplanar curvature, along with the treatment planning using the novel treatment approach.
After conducting a lot of studies of the internal anatomy of the first mandibular molar, it was found that there is a lot of diversity in the internal anatomy of the tooth, and taking advantage of the studies that were conducted, it was found that the main reason of the failure of endodontic treatment occurs due to missing canal of the first molar. Therefore, one must understand and bear in mind the difference in the internal anatomy of the teeth when you need to do endodontic treatments.
Third molars, or, more popularly, wisdom teeth usually erupt in most patients after the age of 17. Abnormal eruption patterns make them more susceptible to dental decay, as well as gingival and periodontal diseases. If there is insufficient anatomic space to accommodate normal eruption, extraction of third molars is the preferred option, to prevent acute […]
Anatomical variation of canals is well documented in the literature and C-shaped canal anatomy was first reported in literature by Cooke and Cox in 1979. This anatomical variation mostly found in mandibular second molars with prevalence between 2.7–52% in different populations. C-shaped canals have rarely been found in other teeth, maxillary first molars, mandibular first […]
The management of cracked teeth represents a difficulty because their diagnosis is complex and there is no consensus concerning their treatment
Every patient wants a functional, healthy, and esthetically appealing smile. This article describes a patient with discolored and fractured composite resin restorations with improper endodontic treatment on the anterior teeth in whom substitution was indicated. This treatment improves the endodontic and restorative aspects.
The surgery of lower incisors should be performed carefully, assessing the possible presence of lingual canals, and avoiding the mistake of underpreparation by not adequately evaluating the clinical situation
Dens invaginatus is malformation of teeth probably resulting from an infolding of the dental papilla during tooth development. Affected teeth show a deep infolding of enamel and dentine starting from the foramen coecum or even the tip of the cusps, and which may extend deep into the root. Teeth most affected are maxillary lateral incisors and bilateral occurrence is not uncommon. The malformation shows a broad spectrum of morphologic variations and frequently results in early pulp necrosis. Root canal therapy may present severe problems because of the complex anatomy of the teeth.
A case presentation of maxillary second molar with 3 mesio buccal (MB) canals.
Internal resorption is a complex case that requires multiple tools and knowledge to treat it properly. Internal resorption is a condition in vital cases where is the loss of dentin in the canal space, and is caused by multi-nucleated giant cells called dentinoclasts. This case was referred to me by a dear colleague after opening […]
The increased life expectancy has led to the increase in numbers of elderly patients seeking dental treatments, and more precisely root canal treatments. According to a survey of diplomates of the American Board of Endodontics, patients over 65 years of age represent 26% of all endodontically treated patients. (1) Maintaining natural and functional teeth plays […]
It is very important to identify obstacles and plan any strategies from the beginning to avoid problems that could cost us the success of the treatment Preoperative radiograph identification, root canal access opening, intraoperative identification, location, instrumentation, debridement, disinfection, obturation are improtant for successful endodontic therapy. The use of the microscope was essential to […]
In this article we are going to share management of a lower first molar with a non-surgical re-treatment (NSRT) approach.
Retreatments in endodontics are always a challenge. Nowadays above all for Endodontist retreatments are a daily routine. Each case is different and it’s important have the right tools and the right strategy to be able to face them. In this article I am describing all the phases step by step to retreat a difficult case […]
As we know, the presence of a second canal in the mesiobuccal root is very common in upper molars. This second canal is usually more difficult to treat, due to its location and anatomy. In the article, we will describe how we can locate it, and how to properly manage the entrance of the canal, in order to carry out adequate instrumentation of it.
Dental anomaly is a condition in which one or more teeth deviate from the normal in form, function, or position. And it includes abnormalities in teeth number, size, shape and structure
A thorough knowledge of the root canal anatomy and its variation is required for achieving success in root canal therapy, along with diagnosis, treatment planning and clinical expertise. Outcome of endodontic therapy depends on the complete disinfection of the entire root canal system followed by a three-dimensional obturation. One of such variation of the root […]
Among all the difficulties we encounter during the reconstruction of an incongruous root canal therapy, a very difficult challenge is always represented by overcoming false paths and ledges mistakenly created during the primary treatment(1). A 26-year-old patient comes to my attention due to a fracture at element 4.7. The patient reports recurrent episodes of pain […]
Adhesive procedures have changed the way of restoring endodontically treated teeth. Postless approaches have been proposed to improve and restore teeth. The preservation of the dental structure of endodontically treated teeth is essential for this. Before performing any endodontic procedure, one must know how the final restoration of that tooth will be handled and whether […]
One of the causes of endodontic treatment failure is calcification in the canal pathway, which prevents complete access to proper working length. In some cases, the dentist is unable to open the calcified canal and an extraction might be suggested then. Therefore, once calcified canals are identified, the clinician should keep in mind the following […]
Retreatment is considered a difficult manipulation that requires the knowledge, experience and technical equipment from the doctor. Resorcinol-formaldehyde therapy is no longer used as a medical material, but since the 1960s it was widely used in different countries, which increases the chance of such a patient getting into your daily practice. The article discusses the clinical scenarios developed because of the use of the mentioned material and ways to deal with it.
Before performing any root canal treatments you should have knowledge on how to face any problems you face during treatment. In this case we switched treatment plan in the middle of the case due to uncontrolled inflammation in this tooth. Diagnosis is the very first step of any endodontic treatment. To diagnose the degree of […]
Dens evaginatus (DE) is a relatively rare developmental anomaly that occurs more often in people of Asian descent than European descent. DE appears as a cusplike elevation of enamel, referred to as a tubercle, and is located in the central groove or on the buccal or lingual cusps of premolars or molars and the palatal […]
Ergonomics in dentist refers to designing tools, equipment, and workspaces to reduce health risks for operators and patients while improving posture and movement and optimizing the results for the patients.an ergonomic way. Choosing the optimal restoration for a root filled tooth requires consideration of a number of interrelated factors. When deciding on the most appropriate […]
One of the most common causes of failure in endodontics is missing canals. The middle canal in lower molars is not an exception and has been studied by numerous authors in the literature. Its prevalence ranges from 0,28% to 53,8% and it’s specially presents in the mesial root. Using different X-ray angulations or with the help of CBCT we can confirm its existence. Understanding the anatomy of the teeth is a key factor for the success of our treatment. In this case we are treating a previously treated lower molar with some hidden anatomy.
MTA has several desirable properties that makes it an excellent choice for apical plug formation . Firstly , biocompatibility to the surrounding tissues . This is crucial for achieving successful healing . Secondly , MTA has sealing capability when properly placed and condensed , it creates a tight seal , prevent the ingress of bacteria […]
Endodontic treatment is the most common procedures that performed in daily clinic routine the aim of endodontic therapy is to treat the infectious situation caused by bacteria from carious lesion which reached to the pulp chamber causing necrosis and lesion formation. Since pulp is the most important part of the tooth, in this article we […]
In this article, we are going to explain the Braiding Technique, a predictable way to remove materials from inside root canals. For this technique, we will use Hedstroem files, and is especially indicated to remove plastic carriers during retreatments. We will see the technical procedure and some clinical cases with video, picture and X-ray. As […]
Proper seal of the root canal system is a key factor for long term success of the endodontic treatment. In the majority of cases, the root anatomy and the apical constriction offer a reliable way to control the correct apical obturation, allowing the compaction of the obturation material and tridimensional seal. However, incomplete root formation, […]
Perforation (often of the floor) is one of the problem to solve that can happen when we start to do a retreatment. There is a lot of confusion and question when we spoke about the management and the phases to solve this type of problem. In this article I am describing all the phases step […]
A thorough knowledge of the root canal anatomy and its variations is required for achieving success in root canal therapy, along with diagnosis, treatment planning and clinical expertise, One such variation of the root canal system is the C-shaped canal configuration. It is termed so because of the C-shaped cross-sectional anatomical configuration of the root […]
The presence of 3 rooted premolars called, little molars, is pretty infrequent. Found in only 1-4% of cases with regional variation. The two morphological types involve either two buccal and one palatal root or two palatal and one buccal root. Managing these cases is demanding due to the rarity and challenges in diagnosis, access, instrumentation, […]
A thorough knowledge of root canal anatomy is essential for predictable and successful outcomes of endodontic therapy. Mandibular premolars are rightly called “endodontist’s enigma” by Slowey, as they are known to exhibit a high degree of variability in their root canal morphology, as compared to other teeth in the oral cavity. These anatomical variations could […]
The presence or absence of periradicular disease is determined according to clinical and radiographic findings. This article will discuss the non surgical endodontic retreatment of a mandibular first molar with mid-mesial canal. Endodontic retreatment is a procedure performed on a tooth that have a previous attempt of definitive treatment resulting in a condition that […]
Speaking of ANATOMIC VARIATIONS The clinician should be aware of root canal anatomy and morphology, not to mention the protocol of debridement, disinfection and obturation. Vertucci5 reported the incidence of one canal at the apex in them at 75%, and two canals at apex at 24%. In the same study, Vertucci5 found maxillary second premolars […]
Root perforation is a challenging situation when the root canal has a pathological communication with periradicular area. Perforations can occur as an iatrogenic accident during a root canal instrumentation and is the second cause of failed endodontic treatment. In some cases complications may lead even to an extraction. Thus, successful treatment of a root perforation […]
Anatomy is one of the biggest challenges in the root canal treatment. During the step of shaping lots of errors may happen like zipping, ledges, transportation, straightening the anatomy and file separation: that’s why in this article we are going to share safe and predictable techniques for instrumenting the root canal system in several types of […]
There have been many recent technical advances in modern endodontics that have the potential to affect treatment outcomes. The purpose of this article is to determine the success of nonsurgical root canal retreatment in molars using contemporary endodontic techniques.
Straight simple root canals are rare in the human dentition; the majority present with complexities and curvatures in different planes, making the endodontic treatment a complex task that requires adaptation according to each specific case (1). One of these special anatomies is the S-shaped root canal. The purpose of this paper is to present 2 […]
Apical periodontitis serves an essential protective function aimed at confining bacteria discharged from the root canal space and preventing them from spreading into adjacent bone marrow spaces and other remote sites. The process is unique in the sense that it cannot eradicate the source of infection. The reason is that once a pulp has become […]
A major problem associated with treating traumatized teeth with necrotic pulps and open apices, is achieving an acceptable seal in the apical area. Apexification has traditionally formed an integral part of the treatment of teeth with necrotic pulps with open apices. Apexification is defined as “a method to induce a calcific barrier across an open apex of an immature, pulplesstooth”. […]
Endodontic management of a tooth is an interesting and challenging procedure that is partly blinded, and its success depends on individual clinical expertise and skill, as well as the procedural techniques applied. Tooth anatomy is the map on which every clinician relies upon prior to initiating root canal treatment. The vast data on tooth anatomy […]
The curved and dilacerated roots in the posterior teeth often present the major challenge to the clinicians during the endodontic treatments. Failure to secure a safe glide path in order to achieve an optimum biomechanical preparation may lead to complications which will jeopardize the final outcome of the treatment due to : Planning should start […]
In retreatments, one of real endodontic challenges comes when disassembly is complete and what remains is a root canal system that has been perforated. What is the critical thinking required to solve such impediment to success? In this article, I am describing the management of a root perforation using absorbable collagen membrane as an internal […]
EIAE (Endodontic interappointment emergencies) is a complication commences a few hours or days after root canal procedures and it is characterized by the development of pain and/or swelling. Despite the advances in the endodontic field, the inter-appointment flare up remains a true nightmare that encounters every dentist. This article will report a case of inter-appointment […]
One of the main objectives in endodontic treatment is the disinfection of the root canal system. However, most of the time we face severely destroyed teeth, which means a challenge for clinicians from the absolute isolation, the selection of the clamp, the isolation technique, etc. Therefore, we must know or resolve these situations with the […]
Endodontic treatment entails thorough chemo-mechanical debridement and disinfection of the pulp spaces, followed by placement of an inert biocompatible material to allow hermetic sealing of the root canal system. Inability to meet either of these objectives can inadvertently lead to endodontic failure. Concomitantly, an awareness of normal and aberrant root canal morphology is a key […]
Understanding the anatomical variations of the root canal system is a must to achieve the main goals of our treatment. The radix entomolaris is the most common variation in mandibular molars. With the help of CBCT we can measure and see the original shape of the additional root, thus creating a predictable strategy for cleaning, […]
As Endodontists our daily work is an adrenaline fuel because we face new challenges on a daily basis and each case requires a strategy to fix it. Strategy before any retreatment consists of reading very carefully the preoperative X-Ray, in order to explain to the patient what is the problem, prognosis ,number of visits, possibility […]
Failure to locate and disinfect all the root canals may be a major reason for endodontic failure. The first Step to reach the success of root canal therapy is to have a good knowledge of the root canal morphology in order to get a successful Root Canal Treatment Slowey has suggested that mandibular first premolars , often […]
An endodontic access cavity is an important first step in successful endodontic treatment. Lately, strongly constricted endodontic access cavities have become quite popular, the idea of which serves to save tissue and thereby increase the tooth's resistance to fracture. Although there is insufficient data to fully support this hypothesis (1), many different modalities have an […]
A case presentation of hemisectioning of the distal root of a LR6 due to fracture, and 6-year review. The clinical aspects and considerations are discussed. Occasionally, during our practice, we are required to offer patients a less common treatment modality. Knowing all the possible treatment options available to us, we can provide our patients with […]
The ledge, which is a deviation from the original canal curvature without communication with the periodontal ligament, is created when the working length can no longer be negotiated, and the original pathway of the canal has been lost. Ledge formation might lead to incomplete instrumentation and shaping, inadequate disinfection, and inadequate three-dimensional obturation of the root canal […]
The discoloration of a dental element can create a strong aesthetic discomfort and can often be the first clinical sign of an ongoing pulp disease. The causes of dyschromias are many and, as always, a correct diagnosis is the cornerstone of solving the problem. The causes that can lead to a chromatic variation of a […]
This article clarifies how to deal with extra root canal system anatomy of premolars clinically and how you can manage and shape the buccal tinny and curved canals of molarized premolar with simple technique by using an handpiece with manual files in reciprocation motion. Endodontic treatment success is dependent on thorough debridement and full obturation […]
The root canal treatment of immature permanent teeth poses many challenges, one of which is the obturation technique. These teeth come with wide apices and sometimes even a divergent configuration (or reverse anatomy) in the apical third. The difficulty in such cases is to avoid overextending the filling material into the periapical tissues. (1,2) In […]
The danger zone is an area of the root canal where the primary thickness of dentin before preparation is under 1 mm. In general, the danger zone is located 4 to 6 mm below the canal chamber orifice. A danger zone can appear in the buccal root of maxillary premolars and molars and in the […]
Ergonomics in endodontics refers to designing tools, equipment, and workspaces to reduce health risks for operators and patients while improving posture and movement. Ergonomics in endodontics is extremely important to ensure effective and safe execution of the treatment. It refers to the design of tools, equipment and workspaces in order to minimize risks to the […]
