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45 minute 1 visit case.

Just kidding.

This was a rewarding case for a wonderful patient who was told to take her tooth out (by her sister, who is a dentist) but REALLY didn’t want to lose it.

☑️ huge lesion
☑️15mm+ probing depth
☑️ deep fiber post

She recently moved here from over seas and thankfully her local dentist has confidence in me - and endo - for even the most difficult cases. He knows that I always give my best effort. In this case, I spent so many visits that her English had improved dramatically by the time we obturated. 😁

#maximumeffort #endodontics #saveteeth #rootcanalretreatment @usendopartners ...

Not a failure... a three visit case 😀

I initially treated this case a year ago. It was a straight forward case, treated in a single visit, using Gentlewave (APM). About one year later, the patient returned with symptoms and a new lateral radiolucency. He explained that the tooth never felt quite right. #CBCT was used to estimate the location of the offending #lateralcanal , which was then cleaned with pre-bent k-files. I used calcium hydroxide this time and confirmed complete resolution of symptoms prior to obturation.

#endodontics #rootcanaltreatment #endovac #rootcanalretreatment ...

POE: 2 👉🏼5 💥

#imnotsurprised #endodonticanatomy #endodonticretreatment #endodontics #rootcanal #apicalanatomy #rootcanaltherapy #saveteeth #dentistry ...

This 80 year old wasn’t sure if she wanted to try to save #19 due to the questionable preoperative prognosis. So, I treated it in multiple visits, and obturated today, after healing of the periodontium was confirmed and the prognosis was good.
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#endodontics #rootcanal #endodontist #worthsaving #jshapedlesion #endoperio #endoperiolesion ...

I tried #ceraseal bioceramic sealer today, on the recommendation of @sharonludds , and loved it. The flowability and consistency worked well to obturate the conservative root shapes. It flows through a #navitip without modification. It flows well with warm / cold vertical compaction. Thanks for the tip Sharon!

#endodontics #rootcanal #obturation #thrillofthefill #dentistry ...

I am so grateful for the dentists that don’t give up on teeth, and so are our patients.

#6 was treated by this patient’s general dentist and by all measures it looks like it was done well. The tooth continued to bother the patient and developed an isolated deep probing to the apex along with a j-shaped radiolucency. The general dentist suspected a vertical root fracture but referred for a second opinion rather than extracting.

For predictability, I treated this case in two visits, with #calciumhydroxide and #endovac irrigation. I also confirmed healing of the #periodontal defect prior to obturation. The lesion is healed at the 9 month #endodonticrecall. Another tooth saved by #endodontics.

#rootcanal #rootcanalretreatment #jshapedlesion #endodontist #verticalrootfracture #dentalimplant ...

It’s been a couple years and you still amaze me every day @sonendoinc #gentlewaveprocedure
#rootcanal #rootcanalanatomy #thrillofthefill #endodontics #ucla ...

A palatal canal with #internalresorption and an #apicalbifurcation . Technology in the form of #CBCT and #gentlewave aided in diagnosis and execution of treatment.
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#endodontics #dentistry #rootcanal ...

Endodontic retreatment with management of apical transportation.
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Apical transportation is avoidable by understanding that apical impediments are almost always an abrupt apical curve and almost never apical calcification. Never use apical pressure to try to achieve length. I never use EDTA or C-files as these just encourage creating false canal paths.
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Management includes recovering and treating the actual canal. This is much more difficult to fix during retreatment than to get right the first time. I pre-bend small k-files at the tip using an endo bender to negotiate the apex. It is important to work the file long (1mm, pulled back from the radiograph) so that the canal isn’t lost and new ledges aren’t created.
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This case was obturated with BC sealer and gutta percha using warm vertical compaction.
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Note how the only radiolucencies are at the apex of the MB root and lateral root surface of the P. After removing the gutta percha from the DB and P the canals were not patent. Just like the MB, there is no benefit in apically perforating to get the white line closer to the apex, so no attempt was made and further iatrogenic damage was avoided.
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#endodontics #dentistry #rootcanal #rootcanalretreatment #apicaldilaceration #endobender #uclasod #apicaltransportation #endodonticcomplications #apicalperforation #workinglength ...

This patient came in for #endodonticretreatment of #14 (through the existing access), where the #MB2 and #MB3 were initially missed.
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While she was here we obtained a 15-month #endodonticrecall on tooth #30. In this case, a #separatedinstrument was present in the mesial root and this tooth had been uncomfortable since the day it was treated. My experience is that the file can be removed if it can be seen through the scope. In this case, I decided to abort the effort to minimize dentin removal because we could always come back and get it if necessary, but we can’t replace missing tooth structure. So far so good, her symptoms have completely resolved and healing is looking good.
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#dentistry #endodontics #rootcanal #endodontist #dentalmicroscope #dentalimplant #worthsaving #gentlewave ...

You know those cases that feel better after RCT is completed, but just continue to feel “not normal”? Gentlewave has virtually eliminated that phenomenon from my practice. I almost never get calls anymore with patients asking “is it normal to still feel something?” ...except for this case.
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I completed RCT #18 ten months ago, and it never felt quite right. Unusual; this is my only #gentlewave case from 2019 to do this that I’m aware of. (This tooth was treated short of the radiographic apex due to proximity to the IAN). I took a #cbct and a new furcal radiolucency appeared.
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Selective retreatment was completed in two visits. I located a mid mesial canal with a separate POE leading to the lesion. I was able to negotiate it with pre-bent k-files, shaped, cleaned and placed #calciumhydroxide. She was back today symptom free, so I filled it.
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Gentlewave is a panacea, but we’re not losing our jobs to automation quite yet.
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#endodontics #midmesialcanal #endodonticanatomy #rootcanalspecialist #dentistry ...

Another tooth saved and another patient extremely happy to keep her natural tooth. For some reason, a lot of clinicians extract teeth with deep probings and J-shaped radiolucencies. This probing healed to two mm in the furcation and the one year #endodonticrecall shows excellent healing. I used a dual cure composite tube technique to remove the old style metal #thermafill carriers.
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#endodontics #rootcanal #rootcanalretreatment #endoperiolesion #periodontics #dentalhygiene #abscess ...

Lower molar with 6 canals. 2:3 in the mesial with a mid-mesial with a furcal POE and apical anastomosis. 3:1 distal root. #rootcanal #rootcanaltherapy #rootcanalanatomy #endodontics #dentistry #midmesial #calcified ...

Here is a #TBT to pre-covid Indonesia. When I was young, surfing took me to a lot of places around the world and gave me the opportunity to experience a lot of cultures that have shaped who I am. Dentistry has given me the opportunity to give back to these places. This particular dental mission trip in 2007 was to Sumba, which is three islands east of Bali. We ran our portable handpieces off of scuba tanks. We communicated with the patients by using those two sheets posted on the wall with a few translated worlds like “tooth” and “hurt”. Patients walked for miles and lined up, with swords and all, and we worked until the generators gave up. Then we got to surf! 🤙🏽 #dentistry ...

Ending the day with a fun emergency late patient! 7 POEs from 5 canals including the DB2 mid-root split and an apical bifurcation on the MB1 and P canals. 💥
#endodontics #endodontist #rootcanal #rootcanalanatomy #dentistry #hessanatomy #apicalbifurcation ...