Endodontic Care Center

When I do multi-visit endodontic treatments, I will temporize with a sponge + Cavit + a layer of unbonded flowable composite (SCC). I started this RCT in May of 2016. The patient thought her treatment was finished, so she never returned. When I saw her for another tooth in November 2019, I could not believe that this SCC temporization held up for 3.5 YEARS!!!. The top layer of composite protects the soft Cavit...and apparently IT WORKS very well! I learned this from the great @rickschwartz78. I am sharing this during the pandemic for those of you who are doing endodontic treatment and only temporizing with Cavit. I highly recommend that you reinforce your Cavit because you don't know when it will be permanently restored.

"What does the pulp look like?" I'm sure you all get that question a lot too. I usually tell my pt's that it's like a "blood tinged booger" but that's never been a satisfactory answer. This was a case from a few months ago. I did not have time to work on this vid until recently. It's rare for me to extirpate such an intact pulp chamber and pulp root, all in one piece, so I just had to take a photo. I hope you are all hanging in there. Peace to you all.

During dental school, I witnessed an HIV positive patient remove a bloody gauze from his mouth, then grab the door handle with his soiled fingers. It was eye-opening for me, and I became somewhat of a germaphobe So when I opened my practice 16 yrs ago, I made it a routine to disinfect the common areas in my practice, and not just in the treatment rooms. Each member of my team rotates to do this. Because of this new pandemic, we are doing this more routinely at our office. One silver-lining of this pandemic (if there really is one), is that we are ALL being more aware of fomites and what we touch and are upping our hand washing hygiene. No one is laughing at germaphobes anymore, lol. Be safe peeps!

Personally, I think lower anteriors are the toughest teeth to treat. It requires the most concentration and planning because the room for error is tiny. Using the Pre-op PA, I plan my approach in order to minimize excessive damage. For this case, I entered slightly D to the center. Using the smallest burs and drills, as well as an air-only tip, is crucial (see second picture)...............My intent with posts is NOT to help retain the core which is generally understood... as the function of a post. Instead, my intent is to use the vertical fibers to redistribute the masticatory moments of inertia into the root, where it is surrounded by bone (see green). Without it, all of the masticatory forces would be concentrated at the crown margins (see blue). Because there is so little coronal structure left (see pink), fiber reinforcement and the redistribution of the moment of inertia help to postpone a crown snap-off failure in the future.................I wish I was able to insert the post to where I intended it to go (see yellow). I used a size #1 Peeso (0.70) to get the Brasseler Yellow 04 taper 0.50mm post into the canal. . . . #endodontics #endodontist #endodontists #endodonticspecialist #endodoncia #rootcanaltreatment #rootcanal #rootcanals #rootcanaltherapy #dentistry #dentist #dentists #endoresident #endoresidents #dentalresident #dentalresidents #dentalstudent #dentalstudents #endodontia #endodontie #dentalcases #dentalpics # #brasseler #smallAF #estheticendo @ Berkeley, California See more

Traditional endo access tells us to deroof the pulp chamber, in order to make it easier to see and perform the RCT (RED line). But this doctor-centered convenience comes at a HUGE detriment to the structural integrity of the tooth. The BLUE area is a robust beam of dentin that connects the B and L walls (aka, soffit). Critics say that the pulp horns don’t get treated or filled (YELLOW). Well, it’s definitely evident from this case that this can be done (with lots o...f custom bending of tips). GREEN lines show that I had #straightlineaccess into each canal, so there was no pinning of my files against #pericervicaldentin (PCD). Yes, this took a bit more time to do, but speed is NOT my PRIMARY focus when I treat my patients; I want structural longevity for their teeth! A few extra minutes of my time will, no doubt, lead to much more longevity for the tooth. Don’t you agree? To me, this focus on #dentinconservation is what Contemporary Restorative Endodontics is all about. See more

@nadeau.endo ‘s post inspired me to post this Endo Tip. Even with a bright microscope light, the apical parts of a canal cannot be illuminated well. By placing a layer of calcium hydroxide, the light can be reflected upward to illuminate the canal walls. I call it the "calcium hydroxide mirror." Because I spend my entire clinical time looking through a microscope, this is just a serendipitous observation I made years ago. I'm sure others have observed this too. It sure helped for this case. @ Berkeley, California

Back-to-back conferences. I’m heading off to our annual TDO Users Meeting in San Diego. This will be the first year that it will be held at its new location. But more significantly, this will be the first time it will occur alongside the GentleWave Users conference, ever since TDO was purchased by Sonendo this past year. Immediately afterward, I will be headed to Tacoma, WA for Bioclear's first-ever restorative course for endodontists. @jungendo and I will be proctoring ...this class, led by David Clark. This is an example of the type of restoration that will be taught. It's a direct composite, crown alternative. This patient is the 17 yo daughter of my friend. Instead of removing circumferential tooth structure for a crown, we opted to place a Clark Class II direct composite using the Bioclear Method instead. The prep incorporates compression features to help stabilize the tooth during function. "Compression" is a huge concept that I have incorporated into all of my preps, especially in stabilizing cracks. I STRONGLY feel that this is going to permeate into our profession. I will be tracking her case for as long as possible. She can always graduate to a full-coverage crown later, if needed. But because she is so young, let's just see how long we can retain this tooth with a compressive direct composite restoration. @ Berkeley, California See more

'm heading off to our annual TDO Users Meeting in San Diego. This will be the first year that it will be held at its new location. But more significantly, this will be the first time it will occur alongside the GentleWave Users conference, ever since TDO was purchased by Sonendo this past year. Immediately afterward, I will be headed to Tacoma, WA for Bioclear's first-ever restorative course for endodontists. @jungendo and I will be proctoring this class, led by David Cla...rk. This is an example of the type of restoration that will be taught. It's a direct composite, crown alternative. This patient is the 17 yo daughter of my friend. Instead of removing circumferential tooth structure for a crown, we opted to place a Clark Class II direct composite using the Bioclear Method instead. The prep incorporates compression features to help stabilize the tooth during function. "Compression" is a huge concept that I have incorporated into all of my preps, especially in stabilizing cracks. I STRONGLY feel that this is going to permeate into our profession. I will be tracking her case for as long as possible. She can always graduate to a full-coverage crown later, if needed. But because she is so young, let's just see how long we can retain this tooth with a compressive direct composite restoration. @ Berkeley, California See more

. . . #mb2sday #endodontics #endodontist #endodontists #endodonticspecialist #endodoncia #rootcanaltreatment #rootcanal #rootcanals #rootcanaltherapy #dentistry #dentist #dentists #endoresident #endoresidents #dentalresident #dentalresidents #dentalstudent #dentalstudents #endodontia #endodontie #dentalcases #dentalpics #

Before you all get bombarded with Star Wars posts tomorrow, I thought I would post this early...Star Wars and Dentistry - two of my loves in life. With May the 4th around the corner, I just had to do something for my next animation. Special thanks to @hewittdentistry and @pnwoms for suggesting the idea of using lightsaber sounds from my previous post. This was a lot of fun...But on a sad note, Peter Mayhew (Chewie) passed earlier this week. May he rest in peace. Happy SW Day, everyone. May the Fourth be with you! If this post brought you joy, please feel free to repost or regram. I would appreciate the exposure.

Just messin’ around with sound effects again. It’s been fun. Here’s a case that I did 3 yrs ago. I saw her for another tooth last week, so I took a follow-up rad. Before I did this case, I used to shape bigger. But when I saw some of my cases coming back with vertical root cracks, my shaping took a diet. Some peeps criticize conservative shapes because ya can’t clean the canals sufficiently. Well, here’s an example that healing can still occur. Other peeps criticize... leaving unfilled pulp horns. Well, when was the last time you saw a tooth fail because of a void in the pulp horn? I believe that preserving a beam of coronal dentin (connecting the B and L walls) adds much structural strength to a tooth. Sure, it takes more time to do this, but if it helps a tooth survive long-term, I’m all for it. If I had done a traditional access, I would have removed that robust beam of central dentin. By doing a dual-entry access, I only removed the dentin coronal to the pulp horns. Yes, my entry wasn’t perfect, but I’m loving that beam of dentin. What would you want in your mouth? See more

Here's my latest vid. It sounded odd without any sound (kinda like watching a silent movie), so I searched for some sounds and added them....My research during residency was on digital subtraction radiography, so i had to get rads to line up as best as possible. Ever since then, I've been a stickler for consistent and reproducible acquisition geometry (AG). The better we can reproduce AG, the better we can overlap rads and REALLY compare them. We can then mix in various transitions between Pre- and Post-ops. It's been so much fun exploring the world of animation, using rads. Hope you enjoy this fun one.