swelling | ENDOMONTREAL

Access Through Both a Crown and a Casted Post to Save a Molar

June 6, 2020 By Dr Pierre Pizem Leave a Comment

Planning access cavity through crown as well as a long casted post

Emergency appointment for a recurrent acute pain on top left side. Root canal casted post and crown have been performed on this second maxillary molar one year ago. Patient is 24 years old, cannot eat on that side and he has been prescribed multiple regimen of antibiotics for this issue. No swelling, no mobility, no deep isolated pocket upon probing. Prognosis is good. Decided not to remove the crown because patient wanted to keep it a few more months. Thus, the post has to be drilled of through the crown.

Emergency appointment access to pulp chamber through casted post

An access has been drilled through the crown , through the casted post up to the pulp chamber level. Due to the non precious alloy it was made of, it took 60 minutes with an electric hand piece and quite a few burs to get through this post.

Palatal root canal entry filled with pus and exudate

Blood exudate and pus drained through the palatal root canal entry and patient has ben rescheduled for root canal revision.

Patient came back, tooth was asymptomatic and access through the casted post had to be enlarged in order to locate MB and DB root canal entries

Confirming absence of MB2 with a small field of view CBCT scan

Interim calcium hydroxyde (Metapaste: premixed paste composed of calcium hydroxide with iodoform)

Patient came back after 10 days and Calcium paste has been removed and per operative X Ray confirm a good cone fit check

Asymptomatic tooth, root canal system sealed with Pulp Canal Sealer from Kerr and cold lateral condensation. Nayyar amalgam core build up.. Crown will be replaced in 6 months.

This challenging root canal procedure has been performed by Dr Pierre Pizem , a general practitioner offering endodontic services for the last 28 years. This procedure took him three appointments totalling 4 hours chair side working time in order to save that natural tooth.

Preserving a Natural Tooth with a Root Canal Revision Procedure

May 8, 2017 By Dr Pierre Pizem Leave a Comment

Patient came in one year ago with large swelling on URQ, gave her AB and told her to let me perform an endodontic revision on 14. She vanished and then came back 6 weeks ago with an even bigger swelling, gave her AB and this time, I did not have to insist too much for her to come back and get the treatment done.

Both 2 Posts and root canal filling removal, cleaned and shaped , sodium hypochlorite irrigation, PUI, Interim Ca(OH)2 , tooth got asymptomatic and then patient came back today for final obturation and amalgam post and core build up. She’ll get the crown later…

Alleviating patient’s pain through a conservative root canal therapy first step

September 13, 2015 By Dr Pierre Pizem Leave a Comment

Squeezing a “Ninja” access cavity into a narrow space

Patient has been referred on an emergency basis by referring dentist to treat an acute apical abscess on a lateral incisor. With a pronounced soft tissue swelling, and an excruciating pain, the immediate task is to relieve pressure by establishing drainage through opening up the pulp chamber

Teeth Crowding between 21 and 22 was making it difficult to prepare an access cavity on lingual of 22 without taking the risk of notching tooth 21. Thus, it would have been both easier and safer to preserve the enamel integrity of the central incisor through an incisal or a through buccal access on 22. Still, understandably enough, aesthetic was a concern to the patient who was willing to take this risk.

Using the enamo-cemental junction as a land mark for determining the location of the pulp chamber has been most helpful in the decision process as to where to initiate the access cavity and how to angulate the bur shaft. Luckily enough pulp chamber roof was not deep. In this specific case a very conservative access (Ninja style) cavity preparation as proven to be worthwhile to alleviate patient’s pain while preserving his smile. No more Ibuprofen needed!

Relieving Pain With An Intricate Root Canal Treatment on a C Shape Root Canal

November 1, 2013 By Dr Pierre Pizem Leave a Comment

An intricate endodontic therapy to perform in order to preserve a very painful tooth, patient was taking 3 X 200mg Ibuprofen Pills every 3 hours in order to get through the preceding night. Serous exudate accumulation resulted in mucosa swelling

This type of root canal treatment has a high level of difficulty because debridement of those ribbonlike C shape root canals is extremely painstaking to perform.

These pictures of a “C” shaped second mandibular molar from the rootcanalanatomyprojectblogspot.com have been taken by Dr Marco Versiani. They display the complex anatomy of such a root canal system. Those pictures give a better understanding on how difficult the cleaning and filling tasks of a “C” shape root canal may be.

Calcified root canals entries where located with the help of a Carl Zeiss Microscope. These where embedded in a mass of pulpstones and calcifications which had to be removed with an ultrasonic tip. Calcium Hydroxide Antibacterial gel insertion was mandatory to control infection within the root canal system. This gel has been removed in a subsequent appointment and replaced by a permanent root canal filling. Tooth corono apical build up is an amalgam Nayyar core. A permanent crown is planned.