GreenRoot ENDO

9 year old patient presented with a complicated crown fracture in #9. PA showed open apex. Cvek pulpotomy was completed. 2-3mm of the coronal pulp was removed to expose healthy pulp. This was followed by placement of BC putty, Fuji ix & composite. The fractured segment of the crown was glued back using composite. I year recall shows thick dentinal bridge formation underneath the BC putty. The root formation & maturation seems to be WNL. Pulp tested vital. Patient has remained asymptomatic.

This is a vey special case that presented with multiple issues. I was unsure if I can fix everything with NS-retreat or make it worse. He was advised extraction by several endodontists in his home town due to risks. He trusted us & flew all the way from Alabama for treatment. He was here for another tooth today. 4 year recall exam on #2 shows beautiful healing. Sinuses look clear as well. Patient has remained asymptomatic.

Patient presented with persistent pain after a recent RCT on tooth #2. CBCT was taken for further information. CBCT showed the following findings: 1. Untreated DB & possibly MB2 as well 2. Furcal perforation 3. Guttapercha in periradicular bone possibly mistaken as a DB canal.... 4. Guttapercha /sealer into the maxillary sinus 5. Increased mucosal thickening of the sinus membrane. Patient was informed about my findings & was advised to address these issues with the previous endodontic procedure before proceeding with the crown. Retreatment was initiated. Most of the extruded guttapercha was retrieved non-surgically. A collagen barrier was placed & the perforation was repaired using Bio-ceramic putty. DB & MB2 canals were located. All the canals were cleaned & shaped & obturation was completed with vertical condensation technique. Post treatment CBCT indicated that most of the guttapercha that had extruded into the bone was retrieved non-surgically. There were slight remnants of gutta-percha in the buccal bone. It was decided to leave it alone. Access was restored with composite. Patient was advised to consult with an ENT to see if the guttapercha/sealer in the maxillary sinus has to be retrieved proactively to avoid opportunistic fungal sinusitis especially with IG - A deficiency. Two months follow-up shows healing WNL. Patient is asymptomatic. CT showed a drastic reduction in the mucosal thickening of the maxillary sinus.

5 year recall on a J shaped radiolycency

A 81 year old patient was referred over for us for RCT on #31 due to buccal sinus tract and isolated deep pocket on buccal. CT showed a J shaped radiolucency. The possibility of root fracture was discussed as a possibility with the patient. RCT was completed in 2 visits with CaOH as interim dressing. No fractures were seen during the initial visit under the microscope. Complete healing of buccal sinus tract and pocket was confirmed before completing the treatment. Patient p...resented for a consult on another tooth today. A 5 year recall PA shows complete resolution of PARL. Note: There was a treatment delay between consult and treatment. Hence you see an increased size of PARL in post op PA that was not evident on pre-OP PA.

I had posted a similar case in the past. In this case, the perforation repair was completed within a few days after the initial RCT. Patient was referred over immediately after initial RCT. The referring GP noticed that the gutta percha was not in DB root upon obturation. CBCT & 2-D PA confirmed that the guttapercha was into the furcation and DB root orifice was actually 1.5 mm distal to furcal perforation.... Retreat was initiated. The gutta percha in the furcal bone was removed using braided file technique. The defect was repaired using BC putty. DB canal was located, cleaned & shaped at the initial visit. CaOH was placed as interim dressing in all the canals during the first visit. Complete setting of BC putty was confirmed during the second visit. Obturation was completed. Extrusion of BC putty was seen but that should not affect the overall healing and prognosis.

Mandibular Canine with Two Roots and Two Root Canals This is case report of #22 with 2 separate roots (Buccal & palatal) with canals with separate portals of exit. Literature suggests an overall prevalence of such root canal configuration as 5.7%.

Horizontal root fracture occurs in less than 3% of all Dental trauma. They have a relatively good prognosis especially if the fracture is in the apical third & with minimum dislocation of the fractured segments. In a classic study,Andreasen and Hjorting Hansen noted four types of healing after horizontal root fractures and only one was associated with pathology 1. Hard tissue healing, most commonly ... found in root-fractured teeth in which the coronal fragment is not or slightly dislocated. 2. Connective tissue healing, with bone-like structure between the fragments. 3. Connective tissue healing without bone, often resulting after lateral dislocation, or extrusion of the coronal fragment. 4. Granulation tissue interposition, occurs as a result of infected or necrotic pulpal tissue, causing an inflammatory reaction in the fracture line. This is a case report of hard tissue healing following horizontal root fracture.

Patient presented with a buccal fistula in #19. #19 has a previous RCT. Bitewing indicated inadequate crown with possible recurrent caries on distal. PA showed a PARL around mesial root and a large J shaped radiolucency around distal root. There was an associated 9 mm pocket mid buccal. CBCT revealed an untreated DB root and hints of a possible middle mesial canal (MM) canal considering the wide isthmus. Upon access, MM canal was located very close to MB canal.... Retreat was performed in 2 visits with CaOH as interim dressing. The pocket and the buccal sinus tract healed following first visit. Post op PA shows MM canal with a separate portal of exit.

Patient presented with a large PARL on #2 which is serving as an abutment for a 3 unit bridge. #2 has a buccal sinus tract. RCT was completed in 2 visits with CaOH as interim medication. The sinus tract healed up after the first visit. Post op xray clearly showed the radioopaque gutta percha leaking out into furcation. CT was taken after RCT to evaluate and confirm the resorption defect. CT did confirm internal root resorption in MB root that had perforated into the furcati...on. I did not noticed this finding in the pre-op xray. In retrospect, one of the angled PA did show some unusual finding but it was not as clear as the post op PA or the CBCT. Patient was brought back to retreat MB root and repair the resorptive perforation. The gutta percha in the MB canal was removed apical to the defect. The gutta percha in the bone was left as is as it was not accessible non surgically. The defect was filled with BC putty in the mid & coronal third of the canal. Patient was explained that the MB root is structurally weak & more prone for fractures. She was advised to avoid chewing hard food from right side. General dentist was advised to perform the build up & keep the occlusion light. 8 month recall PA & CBCT shows amazing healing & bone fill. Patient has remained asymptomatic.

This is a 5 year recall of MTA apexogenesis on #14. 5 years ago, i did these procedures in 2 visits. The first visit, i would excise coronal pulp and place MTA on the pulpal floor followed by wet cotton pellet and temporary filling. I would go back again a week later to check on the setting of MTA before i place a permanent restoration. I stopped doing these procedures in 2 visits due to lack of compliance & subsequent coronal leakage resulting in failure. I now place a layer... of Fuji ix on top of MTA followed by composite. This was one such cases where we could not get the patient back for a second visit. This patient came to me for RCT of another tooth recently. He still had the old fuji ix in the access of #14. He has remained asymptomatic. Luckily there was no coronal leakage and the I replaced Fuji with composite. Recall PA shows maturation of the palatal root.

Patient presented for a consult and treatment of #2. CT was taken as the PA showed a possible second palatal root. CT showed that it was an atypical MB2 rather than a second palatal root. MB root further bifurcated into separate MB1 & MB2 at the apical third. The MB2 was located mesial and lingual to the palatal root. The access form was modified to access the MB2. ... While performing a literature search on this particular anatomical aberration, I came across this below mentioned case report. http://www.ijcem.com/files/ijcem0077787.pdf In this patient, the MB2 was located more palatal than the actual palatal root which seemed very interesting & out of the norm.