Victor Endodontics, PLLC

X-rays offer invaluable information to us in the diagnostic process, but they can also be misleading when not interpreted along with clinical findings. This pre-op x-ray certainly makes it look like separate periapical radiolucencies around #20 and 21. Tooth #21 responded normally to cold testing as well as to EPT, so we recommended treatment of only tooth #20. The 6 month recall x-ray shows complete regeneration of the bone around #21 and hopefully by the 1 year recall we will have complete healing around #20 as well.

Minimally invasive endodontics begins with a plan to prioritize what dentin should be removed and where it can be preserved. Restorative material can always be replaced but dentin cannot. Here is a case from yesterday afternoon where an MO filling was done and the tooth developed an irreversible pulpitis. We removed the restorative material and leveraged the access from there to have easy access into all canals without having to remove large amounts of dentin.

External Resorption is by far the most common type of root resorption that occurs. Internal resorption is exceedingly rare. The cause of external resorptions remain unknown. Trauma and orthodontic movement have been two factors associated with ECIR, but do not explain all cases. This patient's lower central incisor shows a moderately advanced case. This lesion was coming in from the lingual and, given the extension to almost mid-root, the prognosis for treatment is poor t...o hopeless. In many situations, the progression of the lesion can stall and remain stable (even for mayn years). Other times it can progress quickly. Thankfully, the odontoclastic cells that cause the resorption do not attach the unmineralized pre-dentin that srrounds the pulp - so the pulp often remains vital and asymptomatic even when the lesion appear to surround it. Here we have opted to monitor the tooth with annual x-rays unless symptoms develop before then.

HAPPY NEW YEAR!! We are looking forward to another great year serving the Greater Rochester Area. We ended 2016 with this second molar. Fun curves on all the buccal roots including a non-merging MB2. #endo #endoisfun

This patient had an old failing root canal that was starting to cause him severe pain. The lingual side of a bifurcation was missed - which is the branch most commonly missed on lower premolars because it often has a very curved angle of entry. We recommended retreatment. Pre-curved handfiles were able to detect and negotiate the missed branch. 16 month recall from this morning shows the bone healing back around the root after retreatment.

Internal bleaching offers a minimally invasive way to whiten a discolored endodontically treated tooth. After years of hating the appearance of her front teeth, this patient was thrilled with the color change we achieved.

It's been a while since I posted any cases on here. I'll try and put some up more frequently. This 1 year recall from this morning shows how well the body can heal. We were not sure if #25 would require treatment or if the entire lesion was from #24. The recall shows that just with treatment of #24 we were able to get the bone to all fill back in and establish a normal PDL around both incisors.

We closed early due to the snow. Hope you all stayed safe and warm!

Some Friday morning fun finishing this pre-molar with a thin and curved root

Restoring an access after a root canal done through a Porcelain Fused to Metal (PFM) crown can create esthetic challenges. Masking the metal coping with a flowable dentin opaquer dramatically improved the results. Here are some quick pictures from one I just completed this morning (not the best pictures, but they help to show the process).

Even the 'simple' cases can have far more complex anatomy than we imagine. Check out the lateral canals on this lower canine.

Lower first pre-molars have two canals approximately 25% of the time. When a lower first molar presents for re-treatment, the vast majority of the time it is because the second canal was not initially located.

"Fast Break" is a term used in endodontics to describe the situation when you see a canal on a pre-operative x-ray that suddenly seems to disappear partway down the root. A fast break is more-often-than-not an indication that the canal is splitting at that location into two or more canals. This lower pre-molar from last week is a classic example. You can see a wide canal on #21 in the coronal 1/2 that suddenly becomes unclear mid-root. This radiographic finding should heighten your attention to scout that area of the root for additional canals.