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Roots Digest

From: kendo To: ROOTS Sent: Monday, July 06, 2009 3:32 AM Subject: [roots] Uh oh.........the smell of napalm Part I What I would like is your thoughts. I'm not a scientist, I'm barely an endodontist some of the time................ however, I'd ask you and others who publish to read this over............ it's a collaboration of ROOTS people's contributions, thoughts imagery and the footer will indicate that...... this is the beta submission for approval..............I only wish I could do the science that you do so well, At the end of the day, the greatest contribution in my opinion is to just put it out there.......... Kendo (Kenneth S Serota)

Figs 1a, 1b Previous endodontic therapy on tooth #2.6 (14) had failed; the clinician chose to correct the problem with a microsurgical procedure on the MB root. This procedure failed over time as well (sinus tract). Radiographic and clinical evidence demonstrate the developing apical lesion. The root canal system was re-accessed, the untreated canal identified, the entire system debrided, disinfected and after interim calcium hydroxide therapy, obturated. One year later, the lesion has healed. While the retrograde amalgam remained in the root end, its presumed ability to effectively seal a complex apical terminal configuration was ill-considered. Everything leaks in time; retreatment is always the first choice for resolution of an unsuccessful endodontic procedure where possible.
Fig 1c Listening to both sides of a story will convince you that there is more to a story than both sides [Frank Tyger]. The endodontic implant algorithm ensures that philosophy does not obscure pragmatism and expediency does not denigrate adaptive capacity.

Figs 2a, 2b Tooth #1.5 (4) was determined to be non-salvageable. It was removed, the socket stimulated to regenerate and in four month’s time an ANKYLOS® implant inserted, a sulcus former placed and the tissue closed over the site to allow for osseo-integration to occur

Figs 2c, 2d The choice of a natural tooth versus an orthobiologic replacement will increasingly be a powerful force in dental treatment plans. The temptation to choose one or the other based on expediency versus complexity, on marketing versus science is going to be the sine qua non of the standard of comprehensive care.
Fig 3 The degree of complexity of the root canal system has been understood for most of the past century. The failure to negotiate the labyrinthine ramifications of the root canal system has purportedly been a function of technical limitation rather than comprehension and yet, it took until the mid 70’s to appreciate that thermolabile condensation of an obturating material could demonstrate a greater occlusive degree of the system than any other modality.
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Typical molar

Type II palatal


Deep split

Gold onlays

Cerec Onlay

Multiple access

MB root

Cavernous sinus

Apical in DB

Apical lesion

Resorption lacuna

Upper bicuspid

Pulpitis case

Multiple tooth isolation

Interdental molar bone

Dens invaginatus

Periapical healing

Microscope Zeiss

Calcific metamorphosis

Instrumentation protocol

Perforation case

Double curvature

Buccal sinus tract

Buccal swelling

Lingual version


Tooth # 4

Dumbing down of dentistry

Evidence based dentistry

Upper incisor

MB and ML canal


Furcal floor

Trauma case

Broken file cases

Large lesion

Flex post

MTA obturation