Just because it looks good on the X-ray and you got a “puff💨” don’t mean it’s going to heal! This was a previous root canal performed by his dentist a few years ago. Patient all of a sudden was in extreme pain and swelling. The dx was acute apical abscess. A retreament was in his best interest. The canals were previously filled with Thermofil (I retreat those the most). The Thermofil carriers were removed using heat, chloroform, and headstroms. CaOH2 was placed. Patient returned in 2 weeks and I finished the case with gutta percha using warm vertical condensation and ZOE sealer. The last x-ray was a 6 month recall showing very nice healing. #WorthSaving #Retreatment
Conservative Dentistry • Endodontics + 4 more
Patient 12 years old, occurs with pain and swelling, the patient was already under antibiotic therapy when he came to the office 3 days treated by a colleague who wanted to extract a tooth, the patient responds with a recommendation with the desire to save the tooth. Tooth 16, Pulpal Dg: Previously treated pulp, Ap Dg: Symptomatic apical periodontitis, Th: Retreatment of upper right first molar 16.
Endodontics • Oral Medicine and Radiology + 1 more
Often, teeth needing root canal treatment are fractured, extensively restored, or already crowned. Those teeth that do not fit these descriptions may not need extensive restoration. For example, the darkened virgin tooth, diagnosed nonvital, would not need anything other than a resin restoration to fill the access hole and internal/external bleaching. Figure shows extensive decay from the facial aspect in a 79-year-old man’s tooth. After a root canal was performed, a composite was used to close the minimum access hole, and a Cerec inlay was created to close the defect.
Dental Materials • Endodontics
When considering the replacement of a tooth, we all know that bridges or implants are commonly done. However, it is often possible to save tooth structure by doing inlay-supported bridges where implants are not done. Figure 16 shows an inlay-supported bridge. An inlay-supported bridge can also be done with gold inlay. I have found these bridges to be successful and preserve considerable tooth structure. Full-coverage bridges often fail since decay occurs along the margin(s) of crowns. An inlay offers less opportunity for this, with minimal margin area along the gingival aspect.
Conservative Dentistry • Orthodontics and Dentofacial Orthopaedics + 2 more
Synonyms. Synonyms for supernumerary teeth include hyperdontia, distodens, mesiodens, peridens, parateeth, and supplemental teeth. Disease Mechanism. Supernumerary teeth are teeth that develop in addition to the normal complement as a result of excess dental lamina in the jaws. The tooth or teeth that develop may be morphologically normal or abnormal. When supernumerary teeth have normal morphologic features, the term supplemental is sometimes used. Supernumerary teeth that occur between the maxillary central incisors are termed mesiodens, those that occur in the premolar area are peridens, and those that occur in the molar area are distodens. Clinical Features. Supernumerary teeth are easily identified by counting and identifying all the teeth in the jaws. They occur in 1% to 4% of the population, may have a greater incidence in Asians and Native American and indigenous populations, and occur twice as often in males. Although supernumerary teeth can arise in either the deciduous or the permanent dentitions, they are more common in the permanent dentition and can arise anywhere in either jaw. Single supernumerary teeth are most common in the anterior maxilla, where they are referred to as mesiodens, and in the maxillary molar region , whereas multiple supernumerary teeth occur most frequently in the premolar regions, usually in the mandible and usually positioned in the lingual aspect of the alveolar process. Supernumerary teeth are usually discovered on images because they may interfere with normal tooth eruption. When a supernumerary tooth does erupt, it commonly does so outside the normal arch form because of space restrictions. Imaging Features. The imaging features of supernumerary teeth are variable. They may appear entirely normal in both size and shape, but they may also be smaller in size compared with the adjacent normal dentition or have a conical shape with the appearance of a canine tooth. In extreme cases, the supernumerary teeth may appear grossly deformed. Images may reveal supernumerary teeth in the deciduous dentition after 3 or 4 years of age when the deciduous teeth have formed or in the permanent dentition of children older than 9 to 12 years. In addition to periapical images, occlusal and cone-beam computed tomographic (CBCT) images may aid in determining the location and number of unerupted supernumerary teeth. Care should be taken to review panoramic images for supernumerary teeth because these may be obscured in the anterior maxillae by the image of the cervical spine, or they may appear distorted if they lie outside the focal trough. Differential Diagnosis. Multiple supernumerary teeth have been associated with numerous genetically inherited syndromes, including cleidocranial dysplasia, familial adenomatous polyposis (Gardner’s syndrome) , and pyknodysostosis. Management. The management of supernumerary teeth depends on many factors, including their potential effect on the developing normal dentition, their position and number, and the potential complications that may result from surgical intervention. If supernumerary teeth erupt, they can cause malalignment of the normal dentition. Supernumerary teeth that remain in the jaws may cause root resorption of adjacent teeth and their follicles may develop dentigerous cysts or interfere with the normal eruption sequence. All the preceding factors influence the decision either to remove a supernumerary tooth or to keep it under observation.
As one considers the aforementioned, it becomes apparent that for every treatment, the concept of MID can be applied. Broken teeth, especially at the gum line, need not be extracted but can be super-erupted for a feral effect, then restored . An anterior tooth with loss of a papilla due to a periodontal pocket can have that papilla restored without surgery, and a good result can be obtained by super-erupting the tooth. A less invasive orthodontic procedure (Invisalign) is now available for the patient who has difficulty with periodontal conditions and must floss. Every implant in a dentulous mouth saves 1 or more abutment teeth from preparation. Each onlay may preserve a large amount of tooth structure compared to a crown. The first procedure each dental student does for a patient is a cavity preparation. The G.V. Black model was to remove more of the tooth than the decay dictated in order to obtain resistance form and retention. Modern dentistry has made that model obsolete, and Dr. Black would, in his wisdom, be an advocate of changing his model to meet the new standard of care now possible. With technology leading the way to discovery, a Diagnodent helps find the location(s) of the decay on a tooth surface and quantify it. Is there any reason to prepare a whole central groove of a bicuspid or molar if the caries is only located in a small area of that surface? Marginal ridges of teeth have been shown to provide up to 50% of the support for cusps,7 so why would one want to invade that area if not necessary? When interproximal caries is found on an x-ray, tunnel preps can work well and be restored with a resin-reinforced glass ionomer.
Conservative Dentistry • Dental Materials + 1 more
Transposition Disease Mechanism. Transposition is the condition in which two typically adjacent teeth have exchanged positions in the dental arch. Clinical Features. The most frequently transposed teeth are the permanent canine and the first premolar. Second premolars infrequently lie between the first and second molars. The transposition of central and lateral incisors is rare. Transposition can occur with hypodontia, supernumerary teeth, or the persistence of a deciduous predecessor. Transposition in the primary dentition has not been reported. Images reveal transposition when the teeth are not in their usual sequence in the dental arch image Differential Diagnosis. Transposed teeth are usually easily recognized. Management. Transposed teeth are frequently altered prosthetically for function or esthetics or both.
Oral and Maxillofacial Surgery • Oral and Maxillofacial Surgery
This 9-years old girl fractured her upper central incisors in an accident. The teeth were root-treated and then restored to form and function using the latest technology composite fillings restorations re-enforced with aesthetic fiber posts in a single appointment. The smile of our little patient was back on her face in no time!
Restorative Dentistry • Paedodontics and Preventive Dentistry + 1 more
When 2 molars are missing, how often is a partial denture recommended? Probably, the vast majority of the time. Then, along came implants, offering a tremendous stride forward. However, when adequate bone is not available for an implant, an option can be used to provide a distalized abutment for a bridge. Figure shows missing teeth Nos. 30 and 31. By moving the second bicuspid distally, an abutment was provided for a bridge. (This could also be accomplished using Invisalign.) Once tooth No. 29 was in position and retained for 3 months, a bridge was prepared and seated.
Dental Materials • Endodontics + 1 more