ENDOMONTREAL

Dr Pizem Advanced Endodontics Procedures

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Preserving a Natural Tooth with a Root Canal Revision Procedure

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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

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Pain relief through conservative root canal treatmentA very narrow Ninja Access cavity preparation Ninja Access, Alleviating the pain through drainage access cavity  Ninja Access completed drainage through root canal treatment Preserving patient's smile

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

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endomontreal dental clinic case study by Dr Pierre Pizem. Pre-Treatment Root Canal      Root canal filling and Nayyar Core build up

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.

High level of difficulty root canal treatment to perform in a C shape canal, a root canal anatomy variation. Image from: "The Root Canal anatomy project"

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.

High level of difficulty root canal treatment to perform in a C shape canal, a root canal anatomy variation. Image from: "The Root Canal anatomy project"

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.