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.
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 […]
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.
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.
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 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.
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 […]
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.
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 […]
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.
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 […]