the endospot

Palatal Root Resection to Manage Perio-Endo Lesion

Pat Caldwell — Wed, 25 Nov 2020 04:08:36 +0000

This was an interesting case that initially caused us some confusion. The pre-op PA gave the appearance of a molar with fused roots. There was a deep pocket on the mesiopalatal aspect. The shape of the roots and the deep pocket was concerning. There was no obvious sign of a fracture progressing from the crown apically in this area. Once we accessed the tooth, we were unable to get a reproducable reading with the apex locator, despite optimal conditions.

Pre-Op PA

The lack of a decent apex locator reading and the pocketing was enough for us to warrant investigation with a cone beam CT and once again, we were presented with a situation where the CBCT reveals much more useful information than the PA radiograph.

Apical Resorption

Perio-Endo Bone Loss to the Apex

The initial dressing with calcium hydroxide has failed to resolve the pocketing so we discussed further options. The tooth was dressed again and the pocket again failed to resolve. The tooth remained uncomfortable to function.

Deep Mesiopalatal Pocket

A decision was made to resect the palatal root in order to attempt to save the bridge. The patient has a good understanding that the reduced support may lead to fracture long term, but was keen to go ahead with the treatment. The palatal canal was filled with GIC and the palatal root resected. At six month review, the tooth is now comfortable and the pocket has resolved. We continue to monitor this case.

Initial Cut Prior to Root Removal

Root Removed

Healing at Two Weeks After Suture Removal

Six Month Review PA

Surgical Extrusion of a Fractured Lateral Incisor

Pat Caldwell — Mon, 09 Nov 2020 21:03:14 +0000

This patient presented after trauma to the lateral incisor. The fracture extended around 3mm subgingivally on the palatal. The tooth was judged unrestorable on presentation. We discussed the options of extraction, orthodontic extrusion or surgical extrusion and the patient elected to proceed with the surgical option. This option carries some risk but has the benefit of being fast and less expensive. The tooth was root filled and then extracted and repositioned so that the palatal margin was supragingival. The tooth was temporarily bonded to the adjacent incisor to stabilise it while the repair of the socket occurred.

CBCT showing the extent of the subgingival fracture

Prior to treatment – notice the relationship of the apices of the 21 and 22

After 3-4 months of healing the PA indicates some surface resorption.

After a healing period. the tooth was restored by the patient’s dentist with a post and direct composite restoration. At two year review the resorption appears stable. There is normal periodontal probing. The tooth has a higher percussive tone indicating some ankylosis. We will continue to monitor the tooth for further resorption. At this stage there are no plans for a crown.

Composite restoration

Slide to compare the pre-op and two year review CBCT.

A tooth with a Vital Pulp and Apical Lucencies!

Pat Caldwell — Wed, 04 Nov 2020 22:36:18 +0000

Notice the apical radioluencies in this tooth with a vital pulp.

This patient presented with occasional symptoms. There was a large recurrent carious lesion present and radiographically an apical finding on the mesial root. Once caries was removed, the pulp was exposed. It is interesting that the pulp was vital and inflamed. Often, having an apical radiolucency and a vital pulp is confusing, but basic biology explains this phonomenon.

Once the pulp of the tooth starts to become inflamed, for example due to caries, changes start to occur in the apical tissues. This includes the processes that leads to demineralisation of bone. As this process develops, the demineralised bone will become apparent as an apical lucency. The apical bone doesn’t want to wait for bacteria to reach the apical foramen before it starts to remove bone and form inflammatory tissue. It wants to do this well before the bacteria reach bone. Bone has a relatively poor blood supply and doesn’t handle infection well.

Video showing the vital pulp exposure in this case.

In this case, the endodontic treatment was completed over a single visit as the patient travelled a number of hours for treatment. A gingivectomy was required distally and an amalgam core placed. The contact was left open so the patient can scrub the interproximal area with interproximal brushes prior to crown preparatio.n. A full gold crown has been recommended.

Distal Canal

Mesial Canals

Amalgam Core

Emergency Endo in the COVID-19 Era

Pat Caldwell — Thu, 09 Apr 2020 01:13:42 +0000

Podcast Episode 11 – Bill Kahler on the Magic of Regenerative Endodontics

Pat Caldwell — Tue, 27 Dec 2016 08:36:10 +0000

Bill Kahler is an Endodontist practicing in Brisbane, Australia.

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Bill Kahler is an Endodontist practicing in Brisbane, Australia.

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Bill Kahler, world leader in regenerative endodontics.

Bill Kahler is an Endodontist practicing in Brisbane, Australia. I’ve been keen to do a podcast examining the world of regenerative endodontics for a long time, and as it turns out I’m fortunate to have a world-class expert practicing in my home town. This episode is very technical and we get into the details of how and when regenerative endo can benefit our patients, as well as the areas that still need to be properly explored. I really do think you’re going to enjoy this episode.

Listen and subscribe to the endospot podcast on iTunes. And don’t forget to leave a positive rating and review.

Stream the podcast

Download the podcast as an MP3 by right clicking and selecting “save link as”

Show Notes and Links

Bill’s review article on Regenerative Endodontics

Bill’s JOE article on Regenerative Endodontics in Traumatised Teeth

Find Bill on Facebook

Bill’s Practice website.

Podcast Episode 10 – Imran Cassim and Mile Churlinov on the Importance of Being Multi-Talented

Pat Caldwell — Sun, 25 Sep 2016 03:49:42 +0000

Dr Mile Churlinov and Dr Imran Cassim

Imran Cassim is an Endodontist working in Durban, South Africa. Mile Churlinov is a Macedonian Endodontist, working in Sofia, Bulgaria. They are well known for both their endodontic and restorative skills, and their commitment to sharing and improving endodontic treatment around the world. I took the opportunity to chat to Mile and Imran about why it is so important to be multi-talented.

Listen and subscribe to the endospot podcast on iTunes. And don’t forget to leave a positive rating and review.

Stream the podcast

Download the podcast as an MP3 by right clicking and selecting “save link as”

Show Notes and Links

Find Imran on Facebook

Find Mile and the Endorestodontics page on Facebook

Podcast Episode 9 – Freddy Belliard on Educating the World’s Dentists

Pat Caldwell — Wed, 06 Apr 2016 20:49:23 +0000

Freddy Belliard is an endodontist based in Guadalajara, Spain and in Athens, Greece. Freddy has a passion for raising the standard of endodontics world-wide and is an administrator of two of the largest endodontic forums in the world, Roots and Endolatinos. He’s an all-round nice guy and commits a extraordinary amount of his time to travelling around the world to teach endodontics.

Listen and subscribe to the endospot podcast on iTunes. And don’t forget to leave a positive rating and review.

Stream the podcast

Download the podcast as an MP3 by right clicking and selecting “save link as”

Show Notes and Links

Find Freddy on Facebook

Roots on Facebook

Endolatinos on Facebook

Podcast Episode 8 – Carlos Aznar Portoles on Perfecting Apical Surgery

Pat Caldwell — Tue, 19 Jan 2016 09:56:31 +0000

Carlos Aznar Portoles is an endodontist in Amsterdam, the Netherlands. He is certified to practice endodontics in three different languages. Apart from being an outstanding endodontist, Carlos is known for his drive to achieve excellence in endodontic surgery. In this podcast we explore all facets of this exciting aspect of our specialty.

Listen and subscribe to the endospot podcast on iTunes. And don’t forget to leave a positive rating and review.

Stream the podcast

Download the podcast as an MP3 by right clicking and selecting “save link as”

Show Notes and Links

Find Carlos on Facebook

Podcast Episode 7 – Roberto Cristescu on the Determination to Learn

Pat Caldwell — Thu, 10 Dec 2015 20:41:43 +0000

Roberto Cristescu is an Endodontist in Amsterdam, The Netherlands. His story is one of determination and drive to achieve. I’ve never met anyone who has had such a strong vision of where they want to be and so single-mindedly set about taking the exact steps required to achieve their goals. He also just so happens to be one of the most gifted Endodontists on the planet.

Listen and subscribe to the endospot podcast on iTunes. And don’t forget to leave a positive rating and review.

Stream the podcast

Download the podcast as an MP3 by right clicking and selecting “save link as”

Show Notes and Links

Find Roberto on Facebook

Podcast Episode 6 – David Figdor on Producing Research That Matters Part 2

Pat Caldwell — Wed, 25 Nov 2015 02:09:44 +0000

David Figdor is an Endodontist in Melbourne, Australia. He has been involved in landmark endodontic research over the last 25 years. In part 2 of the interview, we get a bit more technical and drill down into some of the questions that we’d like to answer when it comes to the microbiology of endodontic failure.

Listen and subscribe to the endospot podcast on iTunes. And don’t forget to leave a positive rating and review.

Stream the podcast

Download the podcast as an MP3 by right clicking and selecting “save link as”

Show Notes and Links

Find David’s practice in Melbourne, Australia

A selection of David’s landmark papers:

Preservation of Bacterial DNA by Human Dentine

A big role for the very small–understanding the endodontic microbial flora.

Mechanisms involved in the resistance of Enterococcus faecalis to calcium hydroxide.

Persistent periapical radiolucencies of root-filled human teeth, failed endodontic treatments, and periapical scars.

Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis.

Microbiologic analysis of teeth with failed endodontic treatment and the outcome of conservative re-treatment.