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Perforating internal resorption case - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are -
From: Terry Pannkuk
Sent: Tuesday, December 29, 2009 6:38 AM
Subject: [roots] Done now?

Here's the surgery on the perforating internal resorption case I 
treated today.  Originally treated in 2006. - Terry

What kind of endodontic filling technic was used in this case? I suppose, that used material is MTA, didn't it? - Deyan Infiltrated with Lido 1/50 Thanks - Terry Wow! Not too easy on a lower second molar. Nicely performed and documented, as usual. How did you control bleeding from the PDL? Thx for sharing - Maarten Actually the access was pretty easy with this guy. He was about 6' 8" with a minimal buccal shelf. Case selection is everything. If there had been poor attached gingiva, poor access, involvement of the furcation/interproximals, I would have extracted the tooth. Knowing what you can and cannot do is more important than actual clinical expertise. You wouldn't believe the number of cases I don't treat simply because I have a "bad feeling" about how it's going to turn out. :) Back in 2006, I remember thinking to myself, "Jeez, this guy is tall with a great big mouth and wonderful anatomy for a potential failure". You wouldn't have seen that delicate little Tedvek suture at the tip of the mesial papilla if I had been fighting a pudgy wide cheek the size of Jaaba the Hut. :):):) - Terry "Knowing what you can and cannot do is more important than actual clinical expertise". Isn't 'knowing what you can and cannot do' exactly the definition of clinical expertise? Before you know what you can and cannot however, you need to try these things. A lot of stuff isn't thaught at dental school or postgraduate programme, and you learn just by doing it. The first time might not result in a satisfactory outcome, the second time will be better, until you reach an acceptable level and are comfortable in offering it to your patients and execute it. Attached is a similar case I treated recently. Haven't done a lot of them. Young lady with a couple of strange carious lesions (all class V lesions) in an otherwise healthy dention. In order to save tooth 46, I started removing the (vital) pulp, then reflected a small flap and restored with Fuji II (resin modified GIC). Calcium hydroxide and a temporary sealing were placed. Two weeks later, the orthograde RCT was finished. Not as perfect as yours, but not as easy as yours, at least from the perspective of the size of the defect... - Maarten

Protaper flaring

6 yr old Empress

Cvek pulpotomy

Middle mesial

Endo misdiagnosis

MTA retrofill

Resin core

BW importance

Bicuspid tooth

Necrotic #8 treatment

Finding MB2 / MB3

Deep in a canal

Broken file retrieval

Molar cases

Pushed over apex

MB2 and palatal canal

Long lower third

Veneer cases

CT Implant surgury

Weird Anatomy

Apical trifurcation

Canal and Ultrasonics

Cotton stuffed chamber

Pulp floor sandblasting

Silver point removal

Difficult acute curve

Marked swelling

5 canaled premolar

Sealer overextension

Complex anatomy

Secondary caries

Zygomatic arch

Confluent mesials

LL 1st molar (#19)

Shaping vs Cleaning

First bicuspid

In Vivo mesial view

Inaccesible canals

Premolar 45

Ortho and implant


Lateral incisor


Churning irrigant

Cold lateral

Tipped to lingual

Acute pulpitis images

Middle distal canal

Silver point

Crown preparation

Epiphany healing

Weird anatomy

Dual Xenon

Looking for MB2

Upper molar resorption

Acute apical abcess

Finding MB2

Gingival inflammation

Irreversible pulpitis

AG BU ortho band

TF Files

using TF files

Broken bur

Warm technique

Restorative prognosis

Tooth # 20 and #30

Apical third

3 canal premolar

Severe curvature

Interesting anatomy

Chamber floor

Zirconia crown

Dycal matrix

Cracked tooth

Tooth structure loss

Multiplanar curves